Editorial

2015 was a landmark year in the USA for lesbian, gay, bisexual, transgender, and queer (LGBTQ) civil rights. In June, the US Supreme Court Obergefell vs Hodges decision upheld marriage equality for same-sex couples, suggesting a nationwide move toward the rejection of stigma associated with LGBTQ sexuality. In December, the US Department of Health and Human Services (HHS) released their annual report—Advancing LGBT Health & Well-being—which highlights substantial advances in health initiatives for LGBTQ people and their families, as well as outlining HHS objectives in LGBTQ health care for 2016. The HHS report is both welcome and necessary. Globally, 5–10% of any population is estimated to comprise LGBTQ individuals, and their health needs are unique. Stigma of sexuality can lead to syndemics early in life for some young LGBTQ people, who, without adequate family, societal, and health-care support, can develop depression, turn to substance abuse, or engage in high-risk sexual behaviours that might increase susceptibility to HIV and other sexually transmitted infections. Neglecting the health of LGBTQ people can lead to life-long health disparities, which increases pressure on health-care systems, as a result, for example, of costs of HIV care or treatment for mental health issues. The HHS report notes several measures implemented in 2015, aimed to meet the unique needs of specific populations within the LGBTQ community. Among those initiatives is a programme to deliver comprehensive HIV prevention and care services for gay, bisexual, and other men who have sex with men (MSM) of colour (launched by the CDC), together with more than US$2 million of grant funding for organisations working to meet the needs of young racial and ethnic minority MSM and young minority men with HIV or at high risk for HIV infections. Support for these specific programmes is urgently needed, with more new HIV infections being reported in young black MSM than in any other ethnic age group of MSM. Looking forward to 2016, the report recommends extension of non-discriminatory policies, especially with regard to reduction of health inequalities and implementation of the Affordable Care Act for LGBTQ individuals. Many LGBTQ people might not have had previous health coverage and they might be navigating www.thelancet.com Vol 387 January 9, 2016

insurance and health-care systems for the first time. Encouragingly, the specific needs of transgender people are included in the report, with the recognition that many in this community remain unable to acquire adequate health coverage. Most notably, transitionrelated care is currently excluded from many coverage policies, irrespective of medical necessity. The end of conversion therapy for young LGBTQ people in the USA is also an important advance. On the basis of research from the American Psychological Association and behavioural health experts, from the beginning of 2016 the Substance Abuse and Mental Health Services Administration will communicate to health-care providers that conversion therapy is not an appropriate mental health treatment. Instead, the report emphasises that sexual orientation, gender identity, and gender expression of young LGBTQ people should be affirmed and supported. Details regarding how this support will be provided are eagerly anticipated, but across all aspects of health care it is important that physicians view LGBTQ health as a part of routine care, and that a safe and informed environment is provided for all patients. The unique needs of each patient within the clinic must be understood, as well as recognition of other health challenges LGBTQ people might face, such as trauma care for victims of anti-gay violence, many of whom do not seek help from law enforcement agencies. In the past year, the USA has led the way for LGBTQ civil rights, and affirmed this commitment to equality by actively seeking to address the health needs of LGBTQ people. Some progress has also been made elsewhere—for example, in December, Greece legalised civil partnerships for same-sex marriage, and the Malawi Government upheld a moratorium on prosecutions of homosexual activity. Although these are positive steps that will help to diminish stigma about LGBTQ sexuality globally, for many people civil rights are still vastly inferior. In The Lancet in March 2015, Robert Duvivier and Elizabeth Wiley called on WHO to lead the movement to end health disparities and discrimination of LGBTQ people. And, almost a year later, this call to action remains urgent—and unmet. Health equality, and appropriate and specific care, for the LGBTQ community starts with abolishing discrimination, ending stigma, and addressing disparities. „ The Lancet

Adam Roe/Scholz Press/Corbis

Meeting the unique health-care needs of LGBTQ people

For the HHS report Advancing LGBT Health & Well-being see http://www.hhs.gov/programs/ topic-sites/lgbt/reports/healthobjectives-2015.html For Duvivier and Wiley see Correspondence Lancet 2015; 385: 1070–71

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Meeting the unique health-care needs of LGBTQ people.

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