Caring for the Sexual Health Needs of Black Gay and Transgender Men
If you’re a healthcare provider who serves Black men who have sex with other men, you should be offering them specific sexual health and wellness screenings on a regular basis.
Black men who have sex with other men (including Black transgender men) have special sexual health needs and challenges, particularly around their elevated risk of contracting HIV. But whether they are HIV-negative, living with HIV, or don’t know their status, it’s not likely that they are getting the services they need.
Researchers have found that men are 80% less likely than women to use a regular source of health care. Because of stigma and concerns about confidentiality, Black men are less likely than other men to see a healthcare provider on a regular basis. So it’s important to make some extra effort to establish rapport—and to offer a comprehensive set of services that will give them a good perspective on their overall health.
Building Bridges to Wellness
We know that individuals who have a positive relationship with their providers are much more likely to return for follow-up and to remain in care—so building a personal connection with your patient is an important step toward supporting him to take good care of his health.
The best care happens when your patient trusts you and feels comfortable talking to you—especially about very personal things, like his sex life. When you begin your exam, start by asking him if there is anything in particular that he’s concerned about, or that he wants you to address?
Once you respond to any specific concerns, you can explain that you will be asking some detailed questions about his sexual activities and partners and that you ask all your patients these questions. Let him know that his answers will help you to decide which health screenings he may need, and they can also help you to identify particular risks he may be facing and how he might reduce them. Key questions include:
- Are you currently sexually active?
- If so, do you have sex with women, men, or both? Any transgender partners?
- Do you engage in penetrative sex? If so, do you “top,” “bottom,” or both?
- Do you engage in condomless anal, oral, or vaginal sex?
- Do you use drugs/alcohol during sexual activities?
- Do you know your HIV status? When was the last time you were tested for HIV and other sexually transmitted infections (STIs)?
Explain that he is at higher risk for HIV and other STIs if he has multiple partners and/or has receptive anal sex—particularly if he doesn’t use condoms. Using drugs or alcohol during sex can also increase his risk for both STIs and sexual or other violence.
There are many ways to lower his risks, however, including taking PrEP, using condoms consistently and correctly, limiting his number of sexual partners, and abstaining from or limiting his use of drugs/alcohol.
General Health Services
Talking about his sexual health also gives you a chance to emphasize that he should pay attention to his health in all areas and to offer him other services that will keep him healthy for the long term. Those include:
Colonoscopy to test for colon cancer
Anal Pap smear to test for anal cancer
Vaginal Pap smear for cervical cancer (for trans men)
Prostate cancer and breast cancer (Yes, men get breast cancer too!)
Hepatitis C (HCV)
Blood work to screen for:
Testosterone and cholesterol levels
Chlamydia, gonorrhea, syphilis, and herpes
Hepatitis A & B
Tetanus, Diphtheria, Pertussis (Tdap)
If your patient is living with HIV, be sure to offer him these additional services:
Viral load test
Complete blood count (CBC)
Tuberculosis (TB) skin test
For more on recommended immunization schedules, you can check the Centers for Disease Control and Prevention (CDC):