For weeks we’ve been hearing words such as “elective” and “essential,” often weighing in our minds whether one thing is as important as another during the coronavirus outbreak. In health care, surgeries have been canceled and some physician offices have had limited or no in-person hours at all. For some LGBTQ patients, whether an adolescent who’s just coming out, or a transgender person who is already receiving gender-affirming hormones, this disruption in regular care can have frightening and unnecessary consequences.
“We see this specifically with youth who may be in different stages of coming out, as LGBTQ,” points out Dane Menkin, a family nurse practitioner and director of LGBTQ services at Main Line Health. “They may be in lockdown with family members who don’t know, or maybe one parent knows but the other doesn’t. It’s a scary time for them.”
Young LGBTQ people may be home from their usual college environments and without the usual supports offered at colleges and community events. Not having regular face-to-face dating encounters can also be particularly isolating. Menkin goes on to explain that transgender people who may have begun gender-affirming hormones or transgender youth who began puberty suppressing medication, have a real need for timely continuation of care.
“Imagine a trans-boy taking puberty suppressing medication, who may never have menstruated or had stopped for a year, now starting to menstruate again,” says Menkin. “You can imagine the impact on his mental health.”
Thanks to telemedicine —rapidly rolled out and widely adopted within weeks of the Pennsylvania statewide COVID-19 stay-at-home order—LGBTQ care is now available right in their own homes. And it is this touchpoint with primary care providers by video that Menkin says is allowing physical check-ins, such as STD consults or demonstration of self-injection of gender-affirming hormones, as well as the mental health support that many LGBTQ patients need but cannot get elsewhere.
LGBTQ mental and physical health risks
Many studies show higher rates of depression among LGBTQ people, a segment of the population that is less inclined to seek medical care in general, partly due to past negative experiences in health care settings. LGBTQ adolescents in particular are at even higher risk for depression and isolation. If you’re the parent or caregiver of a young LGBTQ person who tells you they’re struggling, Menkin says be sure to listen to them and reach out for help if you’re concerned.
LGBTQ individuals are also more likely to use tobacco, more likely to have problems with substance use, and more likely to have risk factors for HIV. A 2018 LGBT health needs assessment for southeastern Pennsylvania indicates poor health behaviors and factors compared to other Pennsylvania adults in several areas:
Without the usual barriers of transportation or concerns about the waiting room, telemedicine makes LGBTQ care more readily available to more people, more quickly and more often—and Menkin hopes to see this favorable trend continue beyond COVID-19. Gaining access to highly competent and compassionate care is seen as a privilege in many places. Telehealth makes care accessible to LGBTQ people everywhere.
Menkin further emphasizes the importance of consulting with a doctor if you’re concerned about having had an encounter and being exposed to HIV or a sexually transmitted disease (STD). “Talk to us on the phone and we’ll assess the risk/benefit of going to the lab and having blood work done.” Labs are still open in spite of COVID-19 but they’re not accepting walk-ins or patients without an appointment, so you’ll need to call your provider first.
“If you are taking PrEP (Pre-exposure Prophylaxis) to prevent HIV transmission and are wondering whether to continue taking your medications during this time when many are less sexually active, be sure to check with your clinician,” Menkin advises. “Keep in mind, although there are some small studies looking at their use for treatment, the medicines used for PrEP do not prevent you from you from getting COVID.”
People living with HIV have not been identified as being at an increased risk for COVID by the Centers for Disease Control. The World Health Organization also states in an extensive FAQ about COVID-19, HIV and antiretrovirals: “At present there is no evidence that the risk of infection or complications of COVID-19 is different among people living with HIV who are clinically and immunologically stable on antiretroviral treatment when compared with the general population.”
Meanwhile, adds Menkin, “Life moves on. The pharmacies are open, patients can get medicines. We want people to know that whether you’re a new or established patient, we’re providing telehealth LGBTQ care and continuation of care to all the vulnerable patients we see.”
Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.