Anal cancer is now recognized as a disease disproportionately affecting MSM, particularly MSM who are infected with HIV.[79, 80] Anal cancer is biologically similar to cervical cancer. Both cancers are primarily caused by the sexual transmission of HPV and both are preceded by cellular changes that can be detected.[81]

In the past decade, anal cancer screening and prevention modalities have been developed,  based on the time-proven approaches to cervical cancer screening.

Although data are not available on the impact of these interventions on the prevalence of anal cancer, evidence suggests that these interventions can find and remove anal cancer precursors.[79] Some organizations that publish guidelines for the care of people infected with HIV, most notably New York State’s AIDS Institute, have started to incorporate anal cancer screening into their recommendations.

A recombinant HPV vaccine (GARDASIL1) for use in women has been available since 2006. In late 2009, the Food and Drug Administration approved the use of the vaccine for men and boys, though the CDC declined to recommend its routine use because of the high cost-benefit analysis. Data on the vaccine’s efficacy in preventing anal cancer are not yet available.

SUMMARY
LGBT individuals have specific health needs that require targeted and culturally appropriate interventions, yet they encounter multiple barriers when attempting to access health care services. Eliminating health disparities within this community will only succeed with a multilevel approach that includes input from community members, health care workers, and policy makers. First and foremost there needs to be improved identification of the determinants of health through greater inclusion in population-based research. Behavioral health interventions, such as the DEBIs, are best-practice examples of culturally appropriate and sensitive programs; however, public health interventions still need to be developed that move beyond sexual health topics and address the other critical issues faced by the LGBT community.

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Anita Radix, MD, MPhil, MPH, and Gal Mayer, MD, MS

Anita Radix, MD, MPhil, MPH, Director of Research and Education, Callen-Lorde Community Health Center
Dr. Gal Mayer MD practices internal medicine in New York, New York. Callen Lorde Community Health Center

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REFERENCES

1. The Gay and Lesbian Medical Association. Healthy People 2010 companion document for LGBT Health.
2. Solarz AL,  Institute of Medicine,  eds.  Lesbian Health:  Current Assessment and Directions for the Future. 1st ed. Washington, DC: National Academies Press; 1999.
3. Dean L, Meyer I, Robinson K, Sell R, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101-151.
4. Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sex: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
5. Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City. Men Ann Intern Med. 2006;145:416-425.
6. Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age,  United States,  2002.  Vital Health Stat. 2005;362:21-26.
7. Goodenow C, Szalacha L, Rubin L, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Pub Health. 2008;98(6):1051-1058.

Full References  »