Because HIV is often transmitted sexually, it is normal for healthcare workers to ask patients with HIV/AIDS about their sexual orientation and behaviour. Unfortunately, for many years healthcare professionals sought to notify and test previous and current sexual partners to try to understand the epidemiology. When compulsory, such “partner mapping” denies patients’ right to privacy, and in most parts of Europe it is now up to patients whether they inform their sexual partners about any infection discovered.
Surprisingly, much of the discourse in the UK about doctors discussing patients’ sexual orientation is about the embarrassment felt—by doctors and patients alike—when talking about sexuality. But healthcare professionals need to be able to talk about all sorts of sensitive things, such as pee, poo, and phlegm. It should come as no surprise, even to more conservative doctors, that people have sex—and in all sorts of ways.
The discussion shows that morality, as well as health arguments, continues to hold sway in this area. But sexual health is an integral part of general health. Non-heterosexual people are disproportionately affected by specific health problems, and admitting this is the start of constructive consultation about the reasons and solutions. Visibility and honesty can also eventually reduce stigma. HIV/AIDS activists have fought long and hard for evidence based sex education in schools.
Belonging to a sexual minority can be risky—being gay is associated with a higher risk of mental health problems, drug and alcohol misuse, and discrimination—even in societies that do not criminalise homosexuality. Asking about sexual orientation could and should introduce a longer conversation about sexual health. Patients and patients’ organisations should fight to ensure that sexual health related data are kept safe, because all societies discriminate against people on the grounds of their sexuality.
By Tamás Bereczky, HIV activist, and communications adviser