Campbell Wesley R, Jahan Mojgan, Bavaro Mary F, Carpenter Robert J
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.
Mil Med. 2017 Mar;182(3):e1603-e1611. doi: 10.7205/MILMED-D-16-00255.
With repeal of "Don't Ask, Don't Tell" (DADT) in 2011 and the Supreme Court decision regarding Section 3 of the Defense of Marriage Act (DOMA) in 2013, military providers are now able to openly address unique health needs of lesbian, gay, and bisexual (LGB) service members and their same-sex spouse beneficiaries. These federal laws created health care barriers, either real or perceived, between providers and patients and often limited medical research involving LGB patients in the Military Health System (MHS). Men who have sex with men (MSM), the largest proportion of LGB service members, represent a segment of the population with the highest risks for disparities in primary care with regard to sexual health and mental health disorders. We provide a review of available research about this military population, in addition to a review of specific health care needs of the MSM patient in order to aid the primary care provider with screening, testing, and counseling.
A structured literature search was conducted to identify recent literature pertaining to health needs of U.S. military MSM service members. In addition, a review of applicable clinical guidelines, Department of Defense policies, and expert opinion was used to identify areas of particular relevance.
There is little published to characterize the MSM population and their health needs as beneficiaries of the MHS. Only recently have directed assessments of the active-duty MSM patient population been pursued in the post-DADT, DOMA era. Unique needs of the MSM patient identified center around both sexual and mental health, disparities that are paralleled within the nonmilitary MSM population. Population-specific epidemiology driving risk for sexually transmitted illnesses, substance abuse, and mental health disorders are identified and used to inform preventive medicine recommendations for the MSM patient. In addition, resources on MSM health for the health provider are included.
DISCUSSION/IMPACT/RECOMMENDATION: The MHS at large now openly serves the MSM population and is making progress toward addressing their unique health needs. Despite ongoing challenges to address remaining disparities, MSM patients, beneficiaries, and primary providers are now more able to have frank, open discussions about specific health needs of this minority segment of the U.S. military without fear of reprisal.
随着2011年“不问，不说”（DADT）政策的废除以及2013年最高法院关于《婚姻保护法》（DOMA）第3条的裁决，军队医疗服务提供者现在能够公开应对女同性恋、男同性恋和双性恋（LGB）军人及其同性配偶受益人的独特健康需求。这些联邦法律在医疗服务提供者和患者之间制造了实际的或感知到的医疗保健障碍，并且常常限制了军事卫生系统（MHS）中涉及LGB患者的医学研究。男男性行为者（MSM）是LGB军人中占比最大的群体，在初级保健中，他们在性健康和心理健康障碍方面面临着最高的差异风险。我们综述了关于这一军人群体的现有研究，以及MSM患者的特定医疗保健需求，以帮助初级保健提供者进行筛查、检测和咨询。
进行了结构化文献检索，以识别与美国军队MSM军人健康需求相关的近期文献。此外，还综述了适用的临床指南、国防部政策和专家意见，以确定特别相关的领域。
关于MSM群体及其作为MHS受益人的健康需求，几乎没有公开的描述。直到最近，在DADT、DOMA时代之后，才开始对现役MSM患者群体进行定向评估。MSM患者的独特需求集中在性健康和心理健康方面，这些差异在非军人MSM群体中也存在。确定了特定人群的流行病学情况，这些情况导致了性传播疾病、药物滥用和心理健康障碍的风险，并用于为MSM患者提供预防医学建议。此外，还为医疗服务提供者提供了有关MSM健康的资源。
讨论/影响/建议：整个MHS现在公开为MSM群体提供服务，并在满足他们独特的健康需求方面取得了进展。尽管在解决剩余差异方面仍面临挑战，但MSM患者、受益人及初级医疗服务提供者现在更能够就美国军队中这一少数群体的特定健康需求进行坦诚、公开的讨论，而不必担心遭到报复。
