“Epidemiology today is considered to be the core science of public health and is described as a constellation of disciplines with a common mission: optimal health for the whole community” (Stanhope & Lancaster, 2008). Epidemiology continues to play a large role in public health to improve on disease prevention and health promotion in communities across the United States and the World. The Gay, Lesbian, and Bi-sexual and Transgender (GLBT) community at it relates to HIV will be the main focus of this epidemiology paper. This paper will focus on the GBLT population in regards to their vulnerability and susceptibility to HIV, along with the epidemiology and levels of prevention. The following paper will discuss the definition and purpose of epidemiology, methods of epidemiology, the epidemiology triangle, as well as the levels of prevention that relate to HIV ethical and legal considerations, cultural considerations on health status, and how characteristics influence vulnerability in the GBLT community.
According to Ard & Makadon, “Not only are lesbians, gay men, bisexual women and men, and transgender people distinct populations, but each of these groups is itself a diverse population whose members vary widely in age, race and ethnicity, geographic location, social background, religiosity, and other demographic characteristics.” In the past GLBT community was more accepted in San Francisco and New York, and with more people “coming out,” the GLBT population has become more publically recognized across the United States. According to an NIBC article the phrase “lesbian, gay, bisexual, and transgender community refers to a broad coalition of groups that are diverse with respect to gender sexual orientation, race/ethnicity and socioeconomic status.” The GLBT is a different population, but they are very diverse in race, age, location and social backgrounds. Location is one of the biggest differences due to it being easier to express your orientation in a larger city. In rural areas, the GLBT people may feel more uncomfortable coming out due to fewer support services.
With the GLBT population, the most prevalent epidemiology is HIV/AIDS. First we need to know the definition of epidemiology. Merriam-Webster Dictionary defines Epidemiology as “Study of disease distribution in populations. It focuses on groups rather than individuals and often takes a historical perspective. Descriptive epidemiology studies a population to see what segments (e.g., age, sex, ethnic group, occupation) are affected by the disorder, follows changes or variations in its incidence or mortality over time and in different locations, and helps identify syndromes or suggest associations with risk factors. Analytic epidemiology conducts studies to test the conclusions of descriptive surveys or laboratory observations. Epidemiologic data on diseases is used to find those at high risk, identify causes and take preventive measures, and plan new health services.” HIV the most common disease within the GBLT community but it is more prevalent within gay and bisexual men. HIV is a sexually transmitted infection that is transmitted through body fluids and blood.
According to the Mayo Clinic, HIV/AIDS is described as “AIDS (acquired immunodeficiency syndrome) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body’s ability to fight the organisms that cause disease. HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have AIDS. There’s no cure for HIV/AIDS, but there are medications that can dramatically slow disease progression.” HIV is transmitted in five ways: through unprotected sexual intercourse, transmission of contaminated blood, sharing of contaminated needles, mother to child during breastfeeding. Contrary to popular belief, HIV cannot be transmitted through kissing, hugging or shaking hands. In addition, sharing eating utensils or bathroom facilities, does not transmit HIV.
The only absolute sure way not to contract HIV is 100% abstinence but it is not for everyone. The community health nurse role is crucial, they must have a full spectrum of understanding the HIV virus. When a patient comes in for testing, the nurse must understand their fears and offer emotional and psychosocial support. To better understand the disease works we need the Epidemiological Triangle that is “disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements, the agent, host, and an environment, are traditionally referred to as the epidemiologic triangle. This model, originally developed as a way of identifying causative factors, transmission, and risk related to infectious diseases. Changes in one of the parts of the triangle can influence the occurrence of disease by increasing or decreasing a person’s risk for disease. Specific characteristics of agent and host, as well as the interactions between agent and host, are influenced by the environmental context in which they exist, and may in turn influence the environment” Stanhope & Lancaster, (2012).
The Epidemiologic Triangle describes the potential imbalance of health. The agent is the HIV virus, and the host is human interaction such as race and education, and the environment represents the risky behavior such as unprotected sex or sex with multiple partners. Quantitative and qualitative is used to evaluate community interventions. The community nurse must have a full spectrum and understanding of HIV. The primary importance of the community health nurse and the Epidemiology Triangle is education thru prevention. According to the Stop HIV website, there is a primary and secondary prevention, “Primary Prevention: Preventing an individual from becoming infected with HIV. Secondary Prevention: Once a person is infected with HIV, assisting the person in staying healthy as long as possible and not developing complications.” In the primary prevention stage, individuals are taught how better to protect themselves against HIV and other sexually transmitted diseases. The use of condoms and monogamy is two of the easiest ways to prevent the spread of HIV among the GBLT populations.
The secondary prevention is actually to use the techniques they learn in the primary prevention. According to the CDC ” Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young gay and bisexual men (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all gay and bisexual men. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were gay and bisexual men, or gay and bisexual men who also inject drugs.” Some characteristics with the population that may affect their vulnerability would include promiscuity among bisexual men, overtly effeminate, and the differences within the population. Bisexual men are more likely to have unprotected and infect their female partner without her knowing.
By being very feminine in public, opens them up to bullying and discrimination. With differences among the population varies from open public affection to still remaining in the closet, and same partner violence among lesbians. “About 17-45% of lesbians report having been the victim of a least one act of physical violence perpetrated by a lesbian partner and sexual abuse by a woman partner has been reported by up to 50% of lesbians” (Suzana Rose, Ph.D.). Health People 2020 reports that “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons have been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.” Insurance is a significant problem with same sex partners because many companies do not recognize them, and they are not able to able to be placed on their partner’s insurance.
Having no medical insurance makes it hard to provide medicines that are needed to help keep HIV from turning into AIDS. There is a need for more LGBT health centers and the expansion of insurance coverage to include domestic partners of the same sex. Doctors must be informed about LGBT health issues due to biases in health care despite the communities growing acceptance of the homosexual population lifestyles. Second, although there are no specific diseases that affect only the LGBT health because of various health disparities. These disparities include a lack of culturally competent health care, legal factors and social discriminations. The LGBT community faces discrimination, biases, and legal issues every day, but the Transgender population feels it more. According to the ACLU “Much of the discrimination transgender people face mirrors that experienced by lesbian, gay, and bisexual people, but is often more severe.
Additionally, transgender people face a range of legal issues the LGB people rarely do. Identity documents are not reflecting ones gender.” Not only do they have a problem with their identification papers but there is the problem of public restrooms. Which restroom would one use if their transition has not been completed? One of the biggest legal issues in most states is same sex marriages and same sex domestic partnerships. Same sex marriages are not recognized and this leaves the one partner’s unable to be the next of kin in order to make medical decisions. One ethical issue would be the development of a vaccine that must be tested on HIV in different stages. And if the vaccine is developed, who would be able to afford the medication. How would third world countries such as Africa where HIV and AIDS are prevalent be able to afford it? With society taking significant steps toward accepting current views on sexuality, we have begun to remove the stigma that have been associated with being gay, lesbian, bisexual or transgender for many years.
Accepting lesbian, gay, transgender and bisexual orientations, behaviors, relationships, lifestyles and same sex marriages may also remove any biases. In conclusion, Epidemiology is everywhere in today’s society. HIV is one disease that is most associated with the GLBT population. Because of this there still the stigma that if you are homosexual that you have HIV/AIDS. With education of the GLBT population as well as other populations on how HIV is spread and can be prevented, we can break the epidemiological triangle at the host point.
The break in the triangle is completed by primary and secondary prevention of education on preventing the spread of the disease itself. We also discussed some legal and ethical issues that the GLBT population face every day. Over the years many psychologists, behavioral scientists, and community health nurses have made great strides in changing the community views of homosexuality, recognize the legitimacy of gay male, lesbian, bisexual, and transgender behaviors, relationships and lifestyles in today’s society. Until biases are removed there with always be some kind of legal and ethical issues dealing with HIV and AIDS among the Gay, Lesbian, Bisexual, and Transgender population.
American Civil Liberties Union: Discrimination against Transgender People Retrieved June 11, 2014 from
Center for Disease Control and Prevention Fact Sheet
Retrieved June 12, 2012 from:
Healthy People 2020
Lesbian Partner Violence Fact Sheet Suzana Rose, Ph.D. National Violence against Women Prevention Research Center University of Missouri at St. Louis Retrieved June 14, 2014 from:
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