I had a very odd experience at my doctor’s appointment a few weeks ago. Odd enough that I’m going to write about it here even though I’m not sure it ties in neatly to bisexuality; the nice thing about having a platform is that I can write about whatever I consider important.
It was a routine appointment, and I told my doctor that I wanted the full run of STD tests as part of my annual check-up. She started asking me about my sexual behavior, and after ascertaining that I still have the same regular partner as last year and still use barriers for all of the behaviors we discussed last year, she turned to me and said “So what are we doing all of this testing for?” I was understandably taken aback, and just stared at her looking flabbergasted while she launched into a spiel about how people having safer sex within the context of a monogamous relationship just don’t need yearly testing. Granted, this doctor seems to have a pretty strict idea of what constitutes safer sex (she asked me quite earnestly when the last time was that I’d had someone else’s fingers in my mouth without a latex glove, and insisted that even boiled silicone toys should have condoms on them – maybe she means monogamous couple who wear hazmat suits with each other?), but still, let’s back up a little. When did doctors start discouraging patients from having yearly STI testing? Seriously? And this is not an isolated incident. I’d already heard a friend or two say that her doctor thought she wasn’t at risk and didn’t need to be tested. And when I went around in a haze of disbelief telling people about this crazy thing my doctor said, many of them told me they’d had the same experience.
I can think of so many problems with this strategy. What happened to the constant push to get tested? I still get that from the ubiquitous ads telling me to know my status, and from my peers in my fairly slutty, sex-positive, very risk-aware subcultures — from pretty much all of the cultural sources I come in contact with. But not, apparently, from my doctor. My doctor at the LGBT health center, no less. This is a place that offers Herpes 1 and 2 testing as part of its basic testing procedure and has fliers on its walls advertising countless support groups for folks who are HIV+. If anyone is going to be on top of encouraging everyone to get tested, I’d expect it to be the doctors here. And it hardly matters that I was able to convince my doctor that I actually needed the tests, or that I probably could have had them by insisting even if I hadn’t convinced her. The important thing is that many people trust their doctors, and go to them as their main source of not only medical care but also medical information and advice. If advising people not to get tested is a general trend in medicine right now, there are probably a lot of people out there listening and not getting tested.
What I really don’t get is who this advice benefits. What’s to lose in getting tested, and how can it possibly compare to the risks involved with *not* being certain of your status? A few dollars of lab work, versus the damage an undetected and untreated STI can cause; we all know about HIV, syphillis involves stark raving madness before it kills you, and even the easily-cured gonorrhea can lead to infertility if left alone. Even for money-grubbing insurance companies, it should be clear that prevention and early detection are significantly cheaper than late-stage treatment. And I’m having trouble thinking of rationales for this other than insurance companies leaning on doctors to order fewer expensive tests. (Also, they’re not expensive. I just paid for my own, and if I hadn’t tested for Herpes 1, all the rest would have come to $60.)
‘Cause it’s just not true that people in monogamous couples don’t need yearly testing. I haven’t been keeping track of the men, but nearly all of the women I know who’ve contracted STIs have done so while in what they believed to be monogamous relationships. I’m all for trusting your partner, but I’m also all for taking care of yourself — you’re not with your partner all the time, you don’t know what ze does or doesn’t do when you’re not there (or what protection ze does or doesn’t use while doing it). I don’t think this should keep people from trusting others enough to have relationships — or even enough to be fluid bonded, though that’s a harder one for me — but it should certainly mean getting tested. Because you can be a lot more sure of your test results than you can be of what’s happening when you’re not around. I’m utterly confused as to why doctors wouldn’t take that into account when advising on testing.
The other thing I would expect them to take into account is the fact that people don’t tell their doctors everything. When my doctor asked why we were doing all of this testing and I said because it had been a year and that’s what you do, that could easily have been the last thing I said. I didn’t have to tell her that I’m in a nonmonogamous relationship and prone to casual sex — hell, I had to interrupt her spiel on the safety of monogamous relationships to do so. And what if I was in a nominally monogamous relationship but I was cheating? While I might not feel the need to point that out, it would certainly affect my level of risk. What if I shared needles? She might have asked me about that if my answers about drug use indicated the need, but I bet drug use is another thing people routinely lie to their doctors about. As, come to think of it, is sexual orientation; particularly lies of omission. What bits are involved can affect how risky sex is and how likely people are to use barriers, whether it’s men not using condoms with other men because they can’t get knocked up, cis women not using barriers with other cis women because it’s so much less risky than sex with penises, or not being prepared because you’re sneaking out doing something counter than your claimed identity and having protection on hand would mean admitting to yourself that you’re about to do it. My doctor asked my orientation (last year), but how many outside the LGBT health center do? And how may patients outside the LGBT health center hesitate to answer honestly? Not to mention the countless people whose identities don’t give you the whole picture on their behaviors (I know lots of dyke-identified people who have sex with men, and not a few fags who have sex with women – I’d probably know similar straight people, except I don’t know many straight people these days). And the faulty assumption that people sleeping with only women or only men will always encounter the same sets of bits and have the same sorts of sex with them. “Are you having sex with men?” is a totally different question from “Are you having intercourse?,” so if that’s the information doctors want, they may not always be getting it accurately.
And while I’m writing about bisexuality and health (and about withholding information from one’s doctor), there’s something I’m sure ties in to bisexuality quite neatly. Girlfriend, Esq. and my Google alerts both pointed me toward this report on bisexuality and health (read the report itself as a .pdf here). I want to take a moment to object to their statement that “Lesbian/homosexual women were more likely to be obese versus at a ‘normal’ weight compared to straight/heterosexual women” as a statement of health. Evidence that lower weight equals better health are much more uncertain than the medical establishment would have us believe, and it’s been theorized that higher weights among lesbians could have to do with lesbians being more likely than straight men to find a wider range of body types attractive, thus putting less pressure on queer women to hate their bodies and try to lose weight (and you know what’s unhealthy? Self-hatred and yo-yo dieting). But the medical establishment’s fatphobia aside, it’s an interesting report. Apparently gays and lesbians are measurably less healthy than straight people in a number of areas (“self-reported health; disability-related activity limitation; asthma; current and past tobacco smoking; anxious mood; 30-day binge drinking and substance use; and lifetime sexual assault victimazation.”), and bisexuals are even worse off (“access to health insurance, as well as medical and dental providers; heart disease; anxious and depressed moods, 12-month suicidal ideation; current tobacco smoking, and lifetime and 12-month sexual assault victimization. In addition, bisexual women were more likely to report disability-related activity limitation, 30-day illicit drug use, and lifetime intimate partner violence victimization”). I’ve been hearing speculation along those lines for a long time, but maybe having an actual study to point to will catalyze people a little more to figure out what’s going wrong here and fix it. (On the bright side, queers are more likely to have ever been tested for HIV, and gay men are more likely to have gotten colorectal cancer screenings, and to report recent condom use.)
Of course, we could always follow this guy’s advice and simply stop having all of that queer sex. That would clear the problem up for sure. No gays, no measurable health disparity! ‘Cause it’s definitely actual homosexual behaviors that are leading to poor health. It’s not that queers are likely to have lower incomes and less support from their families, and therefore less access to both health insurance and medical care – even though this study itself says that bisexuals have less access to health insurance and are less likely to have a regular healthcare provider, and those two things in and of themselves could explain a lot of health disparities. It’s not that homophobic doctors might be consiously or unconsciously be providing a lower quality of care to queer patients, or that queers are not coming out to their doctors for fear of that and therefore aren’t getting healthcare that’s really targeted for them. It’s not a lack of training and education on how healthcare could be targeted for us. There’s no way that the extra stress and despair of life in the closet or of facing individual and systemic homophobia affect health generally and specifically lead to more self-harming behaviors like drinking, smoking, and drugs. No, none of that. It’s the evil of our ways manifesting in our bodies, for sure. And forcing us back into the closet definitely won’t make the problem worse.
I wonder what “strategies to reduce the number of gays, lesbians and bisexuals” he thinks the Department of Health, Governor, and Legislature have come up with, since everything from McCarthy-era witch hunts to concentration camps to, oh, believing the lifestyle is inherently evil and unhealthy has failed in the past, and those pesky gays, lesbians, and bisexuals still insist on engaging in their unhealthy gay, lesbian, and bisexual behaviors. Here’s a nice rebuttal.