Providing Culturally Competent Care

Begin Removing Barriers

PROVIDING CULTURALLY COMPETENT CARE

HEALTH CARE CONCERNS OF LESBIANS AND WPW

At a minimum, lesbians and WPW should receive the same health screenings and preventive care as other women. However, a thorough patient history that includes sexual behavior may indicate the need for additional screenings, harm-reduction counseling or treatment.

Breast Cancer

It has been hypothesized that lesbians may be at 2 to 3 times greater risk for breast cancer compared to heterosexual women due to higher rates of obesity, alcohol consumption, nulliparity (not bearing children), and lower rates of breast cancer screening (Haynes, 1992). Current data demonstrate an underutilization of breast self-examination (BSE), clinical breast examination (CBE) and screening mammography.

Sexually Transmitted Infections (STIs) and HIV/AIDS

The majority of lesbians with HIV acquire the infection through injection drug use. The use of alcohol and crack cocaine, alternative insemination with fresh semen, and unprotected sexual activity with an HIV-positive female or male partner are all additional risk factors. STIs and HIV may be spread from one person to another via contact with objects capable of transferring infected fluids or tissues, such as sex toys.

Resistant or recurrent vaginal infections may signal the presence of HIV. Some lesbians have regular or occasional sex with men and routine standards of care should apply. To know what areas require culturing (anus, throat, vagina) clinicians must determine what sexual activities were engaged in. Anticipatory guidance about “safer sex” can help introduce sensitive topics.

Cervical Cancer

As a group, lesbians experience a unique constellation of risks for cervical cancer including smoking, obesity, and alcohol use. Most lesbians have histories that include heterosexual intercourse. Some have histories of unprotected sexual activity with both male and female partners or STIs. Cervical cancer related to human papilloma virus (HPV) has been reported in lesbian women with no history of heterosexual activity (Bailey et al., 2000). Despite the documented risk for cervical cancer among WPW, many lesbians receive less frequent gynecologic care (e.g., Pap tests) than heterosexual women do.

Tobacco

The use of tobacco, which has clearly been linked to negative health outcomes, is of serious concern. Research on tobacco use among adults consistently shows a higher prevalence among lesbians and gay men than among the general population. Research reports that 38 - 59% of LGBT youth smoke, compared to 28 - 35% of youth in the general population. Adult LGBT smoking rates in some studies are as high as 50%, compared to 28% among the general population of adults (Ryan et al., 2001).

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PROVIDING QUALITY CARE

Applying Solutions for Quality Care

Using the strategies suggested below will help create a climate that allows patients to share their concerns. Acknowledging the importance of these issues and a willingness to address them without judgment, leaves the door open for honest communication.

Be aware of making generalizations or assumptions based on personal filters of cultural, educational, and experiential backgrounds.
Healthcare providers do not have to agree with a person’s behavior or beliefs in order to provide respectful, sensitive, and well-informed care.
Post a written nondiscrimination policy in plain view: “We do not discriminate on the basis of age, race, national origin, gender, language, income, religion, sexual orientation, or disability.”
On intake forms, state: “Anything that you would rather not put in writing may be discussed privately during your visit.”
Use a private location for conducting an interview and avoid interruptions.
Assure confidentiality.
Establish rapport before asking intimate questions.
Listen carefully and be alert to nonverbal cues.
Explain how the information collected is used and that all questions are routinely asked of everyone.
Use gender-neutral language (e.g., “partner” instead of “husband”) until the partner’s identity is established.
Become knowledgeable about the range of human sexual behaviors.
Always ask if there are any other questions or concerns that the patient would like to discuss.

SUMMARY

Lesbian identity and behaviors do not exist separately from the complex and multi-faceted identity of each individual woman. Sexual identity is not an isolated trait. Lesbians and WPW are members of every population seen in the clinical setting and are vulnerable to the same barriers to health care experienced by all women. Additional barriers related to sexual orientation may further inhibit access to care. Cultural competence provides a patient-centered framework from which to approach the totality of each individual. Like any other learned clinical skill, cultural competency requires ongoing practice. The goal of culturally competent care is a system of care provision that is responsive to the needs of all patients.