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Staking out a little-known front in the war against the “Don’t Ask, Don’t Tell” policy, a San Diego physician this week warned readers of the nation’s most prestigious medical journal that military regulations threaten the health of gay service members by encouraging secrecy about their personal lives.
“Infections go undiagnosed. Service members and their partners go untreated,” writes Dr. Kenneth Katz in a commentary in The New England Journal of Medicine. And civilians “also pay a price” because they’re at risk of getting infected by service members with sexually transmitted diseases.
In an interview, Katz — who oversees the county’s four STD clinics — said he often treats gay service members who avoid the free medical care offered by the military because they’re afraid of being discharged. “They’re not willing to take that risk, and as a result they come to the municipal clinic,” said Katz, who emphasized that he’s only speaking for himself, not the county.
“We’re seeing the lucky ones, the ones who know about us and can get to us,” he said. “I worry about all of our service men and women who don’t know about places like ours or don’t have access to them.”
The national debate over gays in the military has not focused on health but instead on whether gays have a right to serve and whether their open presence would hurt the country’s defenses. Much of the debate has focused on “unit cohesion.”
“Anything that threatens the nonsexual bonding that lies at the heart of unit cohesion adversely affects morale, disciple and good order,” writes a Marine veteran in the Wall Street Journal. And in an article this week, Slate notes that “units that get along well are happier, less likely to experience desertions, and better at coping with the psychological stresses of military life.”
Katz avoids the unit cohesion issue and instead says health issues are worthy of attention, especially considering the number of gays who serve and must keep their sexual orientation private.
No one knows how many gays serve in the military. However, a 2002 study found that active-duty Navy sailors made up 9 percent of the patients who visited a San Diego gay men’s health clinic over a two-month period.
In the journal commentary, Katz writes that he diagnosed a gay service member with gonorrhea after the man went to a clinic out of fear that a military doctor would threaten his career. The service member wasn’t able to return for a screening appointment because he was heading out on a combat mission to Afghanistan.
As for lesbian service members, they face a lower risk of sexually transmitted diseases than gay men. But they risk their health too when they fail to be open with doctors about their lives, Katz said. (Lesbians face special medical concerns: research shows they tend to be fatter and smoke more than other women, and physicians fear they may be at higher risk of breast cancer.)
The military announced this year that it will not pursue discharges of gay service members based on information that they disclose during medical treatment. But Katz writes that service members and military doctors have told him that they aren’t aware of the policy:
Colleagues of mine who are military clinicians have told me they typically don’t ask about the sex of their patients’ sex partners, even if that information might be relevant clinically, because of “don’t ask, don’t tell.” Many of them have told me that they are not aware of changes to the policy that would allow them to inquire, confidentially, about their patients’ sexual behaviors.
In an interview, a Utah psychologist who studies sexual orientation said service members who aren’t open with their doctors are also at risk of harming more than their sexual health. Physicians often deal with conditions like depression and anxiety, and a lack of openness hurts their ability to determine the best treatment, said David Huebner, an assistant professor of psychology at the University of Utah.
“The doctor doesn’t know whether someone is struggling with the fact that their parents just kicked them out of their house because they’re gay or their partner split up with them,” he said. “Having that information is useful for doctors: Is this something I need to prescribe a strong antidepressant for, that I should send the patient to a therapist about, or that will resolve itself in a couple months?
“There’s just a number of ways which not being able to be open about your relationships and your sex life will compromise a physician’s ability to treat you effectively,” Huebner said.
Please contact Randy Dotinga directly at email@example.com and follow him on Twitter: twitter.com/rdotinga.