Category is... Growth
By Conor Cusack (he/him) University of Queensland
I am a white, gay cis-male. It is extremely important to note that my experiences growing comfortable expressing my sexuality and negotiating society as a gay man are entirely different to others; particularly the experiences of trans people, people with a disability, CALD people and people of colour.
Recently, I was abruptly confronted with a situation, that despite my comparatively significant experience in the gay health space, I’d never come across before. I faltered.
I was with a friend on a ward call shift shadowing a stressed junior doctor when, deciding I couldn’t take much more of staring at someone chart medications, I bailed to grab a hot chocolate. Naturally, as soon as I left, they were called to a code. I downed the drink and rushed to meet them on the ID ward; on the way passing a middle aged couple standing awkwardly in the dimly lit corridor. Walking into the patient’s room, I was immediately struck by how emaciated he was.
Being two med students in a code, my friend and I found a nice, out of the way corner from which we could watch everything unfold and my friend filled me in on what I’d missed. The patient was febrile, younger than us, and had been admitted via ED a couple days prior with FUO and covered head-to-toe in Kaposi’s Sarcomas. He weighed 36kgs. Since his admission he’d been told he was HIV+. The couple in the corridor were his parents. He was terrified that they would find out that he’d contracted HIV and everything that implied with regards to his sexuality.
For over a year, I’ve spent my Saturdays working at a GP clinic with a special interest in LGBT+ sexual health and HIV medicine. I regularly take histories, collect blood, swab throats (amongst other places) and treat STIs. While I’m not great with the vast range of antiretroviral therapies, I feel pretty comfortable performing routine check-ups for people with HIV. Despite my regular exposure to patients with HIV, I’d never seen someone in a florid AIDS crisis and had absolutely no idea how to react.
He started to cry.
Not because of the code, or the influx of people, but because he was scared that this would be the moment his parents found out about his sexuality.
Assuming I was the only other gay guy in the room I felt an obligation to do something. To sit by his bed and hold his hand. To tell him about the dozens upon dozens of patients with HIV from the clinic who live happy, healthy and long lives. To tell him that I’ve seen people coming from similar family situations either eventually be accepted by their own parents, or go on to build loving families of people they choose.
Instead, the best I managed was a pursed-lip smile when he briefly glanced at me. A woefully inadequate attempt at reassurance.
Eventually, we left the code. I went home to a Mum who unconditionally accepts me for who I am. I sought empathy from my friends, many of whom are proudly and openly gay.
As future doctors, it is vitally important that we create a healthcare system that not only accepts LGBTIQ+ patients but welcomes and actively supports them. This experience brought home a couple of things for me;
The importance of understanding intersectionality and the social determinants of health. If you, like me, are a white, gay cis-man who’s struggled with bullying and adversity growing up, you might shy away from recognising the intersectional aspects of our community for fear it lessens your own difficult life experiences. It doesn’t. This is best explained by Roxane Gay, “You don't necessarily have to do anything once you acknowledge your privilege. You don't have to apologize for it. You need to understand the extent of your privilege, the consequences of your privilege, and remain aware that people who are different from you move through and experience the world in ways you might never know anything about.”
Despite what some people think, the fight for LGBTIQ+ equality did not end with marriage equality. In Australia, there is absolutely no valid reason that this patient’s HIV status shouldn’t have been detected and treated early instead of progressing to AIDS. Given his fear, I assume he struggled with significant internalised homophobia fostered by an upbringing of intolerance and hate. This led him to deny the health risks he faced and prevented him from seeking help early when his symptoms manifested. He did the best he could with what he had, but unfortunately it wasn’t enough. Around the world, people are being imprisoned or murdered for their sexuality and gender identities. It’s easy to grow complacent when rarely exposed to the reality of what it still means to be LGBTIQ+ for many people.
Knowing this, what can we do as good allies and future doctors to improve the health of the diverse LGBTIQ+ community? Here are some suggestions that might be good places to start,
Realise that merely watching Drag Race, listening to Troye Sivan and going to a gay bar once a year are not enough to qualify as a ‘good’ ally or even an ally at all. As my friend and prominent advocate, Paige Wilcox says in her open letter,
“... we’ve gone beyond the point of needing allies purely for visibility and social media likes. If you’d like to be an active ally and really make a difference, there are options.”
You are not alone in this, I have had to acknowledge that to the diverse groups that make up the majority of my community, I am an ally and that this comes with responsibilities. One of which is taking a back seat and giving other members of the LGBTIQ+ community a platform when the opportunity arises.
The T in LGBTIQ+. It would be inappropriate and inaccurate for me to attempt to provide information about trans or gender diverse communities and their experiences. There are many resources and personal experiences online from which you can learn; you can start at the convenient link above. What I do think is appropriate to say, as someone who works with more trans and gender-diverse people than most medical students, is that despite a weird and persistent belief among medical students and doctors, you do not have some innate ability to divine when it’s necessary to ask people about their preferred pronouns. You might think you do but you don’t, and carrying on with that attitude will eventually cause someone harm and it won’t be you. The trans and gender diverse communities face many barriers in health care; things like ‘Trans broken arm syndrome’, being treated disrespectfully, the pressure to out themselves, discriminatory administrative forms and more. Postponing healthcare due to fear of all of these things can mean that conditions are more severe on presentation. Creating genuinely accepting and safe spaces for trans and gender diverse people enables them to access healthcare just the same as any other patient.
If the curriculum your medical school uses to teach about LGBTIQ+ issues is outdated, discriminatory or unacceptable - challenge it. As an ally you can approach issues in a way that LGBTIQ+ people inherently cannot. LGBTIQ+ people are automatically forced into a position of vulnerability when asking others to tolerate them. Hearing incorrect or misleading information as an LGBTIQ+ medical student puts you in the position of either allowing that misinformation to persist, potentially tainting the clinical interactions of peers with your community, or out yourself and adopt the role of an advocate to provide the correct information. No member of the LGBTIQ+ community is under any obligation to be an advocate for their community or a source of information by virtue of their sexuality or gender identity. Additionally, recognise that many of the people involved in biomedical research and medical education have their own biases, conscious and unconscious, that influence how they portray issues. Be critical of what you hear and read, and draw your own conclusions.
Finally, learn about sexual health, pre- and post- exposure prophylaxis, and U=U. Contrary to what medical education suggests, the LGBTIQ+ community is about vastly more than just sex and sexual health, however this is an area consistently handled remarkably poorly by doctors leading to poor patient experiences with future implications for how they access healthcare. You should be able to take a sexual history as easily and fluidly as you would take any other aspects of a history. You should be fully aware that the standard blood screen and a urine NAAT for chlamydia and gonorrhoea is rarely sufficient for an STI check for any patient; that PrEP is a safe and effective way of preventing HIV in people at risk; and that people with HIV and an undetectable viral load on treatment cannot transmit the disease to their sexual partners.
Pride month is an amazing time of year where the colour and vibrancy of our community is on full display and I strongly encourage all LGBTIQ+ people and allies to get amongst it, particularly if you’re newly out of the closet. Listening to wealth of knowledge our LGBTIQ+ elders have to share about the adversity they faced and recognising their role in moving us forward is vital to our collective story. For allies, we welcome you to appreciate the art and culture of our community whilst remembering that this is a relatively new experience for many LGBTIQ+ people. However, it’s fundamental to remember - if you want to dance with us when we celebrate, you need to stand with us when we face adversity.
There are none. It’s 2019 and you’re a medical student. Look it up yourself.
Conor Cusack is a final year medical student at UQ, the Co-Chair of the Queensland Medical Students’ Council, and a weekend medical assistant at Gladstone Road Medical Centre, a leading practice in the Qld LGBT+ healthcare space. He’s a proud member of UQ’s Rainbow Med and QAMSA, AMSA’s Queer Network, and readily approachable by any LGBTIQ+ medical students seeking support and guidance on what it means to be LGBTIQ+ in medicine.
Published: 20 Jun 2019