Transcript 同志友善醫療研討會
同志友善醫療研討會 Gay-friendly Healthcare Webinar By: Sabrina Chan & Norman Kwan, AIDS Concern What makes us want to promote LGBT-friendly healthcare? Behavioral change (safer sex) HIV testing Support for people living with HIV 個案一 我曾經去過社會衛生科做性病檢查。 當時醫生聽到我說要做檢查時問我是不是同性戀，我 就坦白說我曾經與男人發生性行為。之後他神色凝重， 做了一些審犯式的「輔導」，說了一些「好玩唔玩玩 呢D?」﹑「有無『咩咩』呀?」之類的話。 我好後悔透露自己的性傾向。希望醫護人員知道，性 傾向不是「想玩的野」，而是天生的。 個案二 我到全科門診接受性傳染疾病的檢查。在我透 露了性傾向後，醫生表現震驚，並建議我到新 造的人協會接受輔導，改變性傾向，並拒絕提 供性病測試服務。 我感到十分冒犯。我的性傾向不是一種病，但 他的診斷手法卻令我感到如此。 個案三 我因為肚瀉而向全科門診求醫，對醫生透露了性 傾向。醫生一臉錯愕，開始談起聖經，說上帝不 會容許同性戀行為。他沒有做任何檢查，直接給 我開抗生素。 我感到很不受尊重，希望醫生不會因他們對同性 戀的意見而疏忽診症，也不會在診症時宣揚自己 的宗教意識。 Have you ever avoided talking about your sexuality when seeking sexual-health related services? 45% Yes 55% No Why did you hide your sexuality? 65 55 26 Feel embarrassed Fear of being stigmatized or discriminated Afraid that the doctor will disclose my sexuality 27 Irrelevant to my health condition Have you avoided seeking medical services below for fear of disclosing your sexual identity? 20% Yes No 80% Have you been discriminated or unfriendly treated by healthcare professionals? 9% Yes 91% No Promote gay-friendly healthcare • • • • Familiarize with the healthcare needs and culture of the gay patients Increase your sensitivity to diverse sexual identities in consultation Make your patients feel safe to disclose their sexual orientation or gender identity Give support to staff to maintain a culturally safe environment for gay patients Common MSM Jargon Terms Top/1仔 Btm/0仔 Vers/10仔 Sissy Open relationship BB Wild fun Chill fun Grindr/Jackd Meanings Common MSM Jargon Terms Meanings Top/1仔 Insertive in anal sex Btm/0仔 Receptive in anal sex Vers/10仔 Can be both insertive and receptive Sissy Open relationship BB Wild fun Chill fun Grindr/Jackd Common MSM Jargon Terms Meanings Top/1仔 Insertive in anal sex Btm/0仔 Receptive in anal sex Vers/10仔 Can be both insertive and receptive Sissy Effeminate Open relationship BB Wild fun Chill fun Grindr/Jackd Common MSM Jargon Terms Meanings Top/1仔 Insertive in anal sex Btm/0仔 Receptive in anal sex Vers/10仔 Can be both insertive and receptive Sissy Effeminate Open relationship A relationship that can seek other sex partner BB Wild fun Chill fun Grindr/Jackd Common MSM Jargon Terms Meanings Top/1仔 Insertive in anal sex Btm/0仔 Receptive in anal sex Vers/10仔 Can be both insertive and receptive Sissy Effeminate Open relationship A relationship that can seek other sex partner BB Bareback, anal sex without condom Wild fun Anal sex without condom (drug may be involved) Chill fun Sex with drug Grindr/Jackd Common MSM Jargon Terms Meanings Top/1仔 Insertive in anal sex Btm/0仔 Receptive in anal sex Vers/10仔 Can be both insertive and receptive Sissy Effeminate Open relationship A relationship that can seek other sex partner BB Bareback, anal sex without condom Wild fun Anal sex without condom (drug may be involved) Chill fun Sex with drug Grindr/Jackd Social dating app in gay community Common lesbians slang Terms Meanings TB A TB(Tomboy) is usually a lesbian who exhibits male behavior or dresses like a man. TBG TBG is a lesbian who is attracted to TB and exhibits comparatively feminine behavior. Pure Lesbians who are feminine, and are attracted to feminine lesbians. No label Bi Lesbian who does not consider herself to fall into the above categories. The abbreviation of ‘bisexuality’ Dispelling LGBT myths LGBT Myths 1. Gay = HIV positive? – Although gay community has higher HIV prevalence than general public, unsafe sex is the key factor of HIV infection 2. Gay = anal sex? – – Anal sex is one of the major sexual behaviors in gay community, but only 64.5% of them perform it They have different types of sexual behavior besides anal sex Gay = effeminate? Lesbians=masculine? LGBT people = promiscuous? Healthcare Concerns of Gay Men HIV/AIDS Situation in HK Local HIV/AIDS situation in second quarter of 2015 HIV/AIDS Situation in HK Local HIV/AIDS situation in second quarter of 2015 PRiSM – HIV Prevention and Risk Behavioral Survey of Men who have Sex with Men in Hong Kong (2006, 2008, 2011) HARiS – HIV and AIDS Response Indicator Survey for Men who have Sex with Men (2014) • Initiated by the Department of Health to track the epidemic and inform intervention • HIV Prevalence HARiS 2014 HIV Prevalence 5.85% • Condom use rate for last anal sex HARiS 2014 Regular partner 70% Irregular partner 81% • HIV testing rate in 12 months HARiS 2014 HIV testing 62% Pick up 3 most major factors that make you not to have a HIV test 90 80 45% 70 60 50 40 30 20 10 0 Frequency People may I think I am I don't want I am afraid of think I have I am unsure of The testing unlikely to the others finding out AIDS/promiscu where to get sites are too have exposed know that I am myself is HIV ous if I get tested. far from me. to HIV. gay. positive. tested. 84 62 54 57 47 23 I don’t have time to get tested. I am afraid of needle/blood in test. Others 42 37 11 Reason of not using condom 140 120 100 80 60 40 20 0 Frequency Have Sexual not Have Condom pleasure Partner Not discusse not Not Under Under is not /enjoym not Too infected d with Partner reach conveni influenc influenc effectiv Client ent of infected expensi with partner refusal consens ent to e of e of e in HIV refusal skin-to- with ve HIV/STIs about us with buy alcohol drugs preventi skin HIV/STIs use of partner on feeling condom 117 94 71 41 34 27 20 18 14 10 3 2 Others 24 Drug Issue • • • • • E- Ecstasy V- Viagra P- Popper (Alkyl nitrites) I- ICE (Methamphetamine) K- Ketamine Drug Issue • ~10% respondents used drugs before/ during sex • Poppers (71%), Ecstasy (28%), Viagra(22%), Ketamine (22%), ICE (amphetamine) (17%) • Significant factor of HIV infection (PRiSM 2011) Healthcare Concerns of Lesbians Sexually-transmitted infections (STIs) • Lesbians can also give each other STDs in the following ways… • vaginal-vaginal contact oral sex digital vaginal or anal contact sharing of sex toys Common STDs include herpes, gonorrhea, chlamydia and HPV Cancers • Several factors put lesbian women at higher risk for developing some cancers common for women. – 63% of the lesbians reported to be current smokers and are more likely to develop lung cancer. – Lesbians are more likely to develop breast, endometrial, and ovarian cancers, as they may not experience the full-term pregnancy. – Only 13.8% of the lesbians has ever gone through pap tests to detect cervical cancer, which put them more at risk for cervical cancer. What is the relevance of sexual orientation to consultation? Let’s listen to the patient cases shared by doctors… 「曾經有一位男病人來我門診看病的時候喉嚨 痛，之前在其他醫生處方下服用抗生素，但未見 好轉。經過詳細的詢問後，發現他曾經與男人發 生過口交的行為，而喉嚨痛原來是他感染淋病的 徵兆，而不是普通傷風感冒的症狀。 因此，即使是看似普通的症狀，都需要醫生細心 詢問才能為病人解決生理上的困擾。」 —方陽醫生 「來我門診的病人好多都有情緒方面的困擾。作為一個精神科醫 生，我必須了解一個病人的家庭、感情各方面的生活狀況。對於 一個同志來說，每個生命的階段都可以是一個關卡：出櫃的掙扎、 隱藏身份的憂慮、同志配偶福利的缺乏...... 這些都是一般異性戀 者不會遇到的危機和壓力。 因此，如果不了解病人的性傾向，便很難準確而全面地理解他們 遇到的問題。只有讓病人覺得你是開放的、不帶批判的，他才會 把自己的生活狀況全面地告訴你。」 —馮威才醫生 「只要是性傾向相關的資訊與醫學診斷有關，我都 會細心詢問病人的性傾向。例如如果一位病人皮膚 出紅疹，或者身體上出現了一些性病的徵兆，我便 需要問及他的性傾向和性行為模式。如果他是一個 10仔，與男人發生過肛交的行為，我就可能需要在 他的前列腺及肛門都抽取一些細胞作化驗作全面的 檢查。」 —黃峻峰醫生 「曾經有一位男病人在直腸裡面生了一個大概3cm的腫瘤，來我 門診看病的時候很緊張，因為他之前到過其他診所看診，被初部 診斷為大腸癌，需要立即切除。經過詳細的詢問，才發現這位病 人是0仔，亦曾經與男人發生過肛交的行為，經過一輪檢查後， 証實他直腸中的不是癌症的腫瘤，而是由HPV所造成的直腸疣， 只需進行濕疣清除小手術便可。 事實上，有很多與性健康相關的疾病的與症狀可能與其他疾病相 若，作為醫生如果可以開放而誠懇地問及病人的性傾向及相關資 訊，便可以更準確地作出診斷。」 —方陽醫生 What are the things to pay heed to in consultation? Increase your sensitivity in consultation • Avoid making assumptions about the sexual orientation of the patients • Use gender-neutral language such as ‘partners’ or ‘significant others’ when talking about sexual relationships of the patients Increase your sensitivity in consultation • Appropriate V.S. Curiosity in asking questions Example: • To help assess your health risks related to _______, can you tell me about___________? • Use their language Make patients feel safe to disclose their identity • Ensure the privacy of your patients • Inform your patients that the information about sexual orientation is confidential Thank you! The Dr. Rainbow Scheme is “sponsored by the Equal Opportunities (Sexual Orientation) Funding Scheme”. “Any contents of this material / any activities organized under this project do not represent the position of the Government of the Hong Kong Special Administrative Region”.