Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients

Published:January 27, 2020DOI:


      • Inadequate training and education are prominent barriers preventing the delivery of adequate care to lesbian, gay, bisexual, transgender, and queer/questioning patients.
      • Sexual health history begins with a candid discussion of sexual behaviors, desire, physical function, and overall satisfaction.
      • Providers must identify those at highest risk for HIV. Current Centers for Disease Control and Prevention guidelines are not sensitive or specific enough. The HIV Incidence Risk Index for Men Who Have Sex With Men is an evidence-based risk assessment tool with increased sensitivity.
      • An interprofessional, collaborative approach will best optimize the health and well-being of transgender transitioning patients. Therapy is managed by properly trained providers.


      The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is a vulnerable populace that accounts for 4.5% of the United States population. Unfortunately, this group of individuals faces discrimination. They need access to quality, prejudice-free health care. This article initiates the discussion of how nurse practitioners, primary care, and family practice providers can provide inclusive, unbiased, quality care to this community that is evidence based. Information is provided about common barriers preventing this population from receiving equitable care. Evidence-based methods are outlined for screening this population for common health conditions, paying particular attention to an established HIV risk assessment and its application in clinical settings to identify candidates for pre-exposure prophylaxis. Finally, pharmacologic information about preexposure prophylaxis and transgender hormone therapy is presented. The information presented prepares nurse practitioners to begin caring for this population.


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      Adam Joseph Aisner, MSN, FNP-C is a family nurse practitioner in Los Angeles, California, and can be contacted at [email protected]


      Michelle Zappas, DNP, FNP-BC is a clinical associate professor, University of Southern California, Los Angeles.


      Adrienne Marks, MSN, FNP-C is a clinical nurse II at Stanford Health Care, Palo Alto, California.