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© Niyazz via Canva.com Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs.  Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health.  PrEP and PEP  Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months.  Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days.  PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location.   HPV Immunization  All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime.  The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never!  STI Testing  Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year.   Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you.  Prostate Exams  Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old.  These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened.  Pap Tests and Pelvic Exams  Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer.  Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings.  Mammograms and Breast Exams  People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual.  The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project.  Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.

Read More About 6 Healthcare Action Items for the LGBTQIA+ Community

Despite the challenges of a pandemic, the Renown Rehabilitation Hospital continues to help their patients thrive outside of the hospital walls. On July 31, 2021, they hosted the first-ever Renown Alumni Sports Extravaganza, or RASE, a day focused on adaptive sports for all abilities. “Sports and recreation have a unique way of breaking down emotional barriers,” states Jared Worchel, DO, MS. The alumni used their skills on a climbing wall, Frisbee golf, archery, an obstacle course and bag toss. Over 20 people spent the day cruising the first adaptive mountain biking trail in the Tahoe region. “Having old friends meet up and seeing new friendships form had to be the highlight of the weekend,” says Shaun Stewart Certified Therapeutic Recreation Specialist (CTRS) with Renown Rehabilitation Hospital. “RASE was a great way to learn new methods to improve outdoor recreation engagement from both participants and the many programs involved.” Dr. Worchel agrees, “The smiles really make it worth it, and we even saw several touching moments with tears of joy when participants completed a task and finally felt like they were getting past their injury, mentally, after years of being so focused on recovery.” Adaptive Climbing and Camping One touching moment came on the adaptive climbing wall. Cassie Firchau, an occupational therapist at Renown, recalls a rehab alumni who had never been on a climbing wall (pre or post injury) conquering the wall. “Everyone was cheering him on. I was impressed with how he used the ascending pull up bar to get up the wall,” she remembers. Mark Wellman, the founder of No Limits, provided the climbing wall. “I had heard of Mark, but I had no idea that he climbed El Capitan only a few years after his spinal cord injury,” says Cassie. “Having him at the event was a great opportunity to learn how to stay active and enjoy the things you love, no matter the circumstance.” After dark, the event continued with a DJ spinning hits followed by overnight camping. That evening Shaun Stewart had the chance to talk to one of the alumni. “He spoke on how he was nervous about camping and how it would go in a new campground. He said that he was happy for an opportunity to practice with our group prior to going out on his own,” remarks Stewart. “Knowing that this event can help create opportunities even outside our events is great to know.” Adaptive camping activities allow all abilities to not only enjoy nature, but also connect. “We also saw a lot of interaction between the participants themselves, sharing their journeys with each other during the down times which was possible with the extended format,” explains Dr. Worchel. “Overall it was an overwhelming success and we are already looking forward to next year.” Northern Nevada's Adaptive Sports Community Not only did the Renown Rehab alumni come together at RASE, but so did the greater northern Nevada community. Along with the hard work of the Renown Rehabilitation employees, the City of Reno Adaptive and Inclusion Programs, Wasting Arrows, Disable Sports Eastern Sierra, No Limits, and High Fives Foundation, provided support and equipment for the alumni. “It was so great to see multiple groups, volunteers and non-profits collaborating to support alumni participants to live life to the fullest, and to experience outdoor recreation in such a dynamic way,” states Josh Patterson, Supervisor of Rehab Therapy Services at Renown Health. "The City of Reno is so grateful for this sponsorship to bring together new and old Renown alumni to learn and encourage each other. There were many firsts this weekend, and we look forward to future participation in City of Reno Adaptive programs,” says April Wolfe, CTRS, City of Reno Parks and Recreation. For more information on future alumni adaptive events, please email: shaun.stewart@renown.org.

Read More About Renown Hosts Adaptive Sports Day for All Abilities at Sky Tavern RASE Event