For more than 40 years, I have cared for LGBTQ+ patients and people living with or affected by HIV. Throughout my career, I have seen how much healthcare has changed, from the earliest years of the HIV epidemic to the highly effective prevention and treatment tools available today.
I have also seen what has not changed enough: too many patients still feel that sexual health exists outside of “regular,” or primary, healthcare.
As Chief Medical Officer at Spectrum Medical Care Center in Phoenix, I bring a background rooted in HIV medicine, LGBTQ+ health, and personalized primary care. During my residency, I treated some of the nation’s first AIDS patients before moving into faculty roles at NYU Langone Medical Center and Florida Atlantic University, and most recently serving at the LGBTQ Center of Southern Nevada. Across these roles, I have advocated for harm reduction, community HIV-prevention strategies, and a core philosophy that runs through my work: sexual health is not separate from overall health.
I have seen time and again how integrating sexual health benefits both patient experience and health outcomes. When sexual health is woven into a person’s broader care, it creates opportunities for providers to deepen trust and strengthen prevention plans that support long-term wellbeing.
Support Beyond a Single Appointment
Whether directly or indirectly, many patients have been told that sexual health is distinct from general care, and something to seek out only when there is a problem or underlying concern. A patient may visit a clinic for STI or HIV testing, a PrEP prescription, contraception, or another reproductive-health need, then return to a different system where the rest of their care happens.
This status quo leaves important opportunities on the table, particularly opportunities for proactive prevention, a more complete medical history, and less time and frustration for patients.
Patients do not experience their health in siloed categories. Their primary care needs do not turn off when they come in for STI testing, and their sexual wellbeing is not irrelevant during an annual wellness exam. When services exist in separate appointments, patients often have to complete similar paperwork and retell their personal history. For providers, that creates more chances to miss something important.
An integrated model takes a different approach. When sexual health is part of primary care, it naturally opens conversations about preventive care, medication interactions, stress, substance use, reproductive goals, and healthy relationships. These discussions build trust and allow providers to recommend care that addresses both immediate needs and long-term health.
Integrated Care = More Effective Prevention
One of a primary care provider’s most important responsibilities is emphasizing prevention and recommending regular screenings based on risk, health history, and age. The same is true within sexual healthcare. Integrating sexual-health prevention into primary care can give patients greater access to the care they need to stay well now and protect their health later.
Consider a patient who comes to Spectrum Medical for STI testing. That visit may include an STI panel, an HIV test, and a conversation about prevention options such as PEP, DoxyPEP, or PrEP. Rather than leaving it there, our providers can also discuss vaccination status, current medications, follow-up or screening schedules, and the opportunity to connect with primary care services if the patient has not already done so.
When a patient’s entry point into care offers a wider, coordinated plan, they are more likely to receive the preventive services and ongoing support that fit their needs.
Whether someone is coming in for contraception, gender-affirming care, or STI and HIV prevention, the visit can create an opportunity to discuss recommended vaccinations, including hepatitis and HPV immunizations, or screenings for cervical or prostate cancer if they are due. We also welcome questions about mental health, substance use, future reproductive goals, and sexual safety.
These are not separate conversations competing for limited appointment time. They are interconnected elements of a patient’s wellbeing, and care models should reflect that.
Continuity Builds Trust
Clinical research consistently shows that primary care is most effective when it is not limited to isolated interactions. Continuity allows providers to understand a patient’s history, note changes over time, revisit decisions, and coordinate support as needs evolve. Sexual healthcare fits naturally into this model by helping providers see the fuller picture of a patient’s health.
A patient’s circumstances may change their prevention needs. A relationship may end, a medication side effect may emerge, insurance may change, or a new diagnosis may influence a treatment plan. The ability to see a provider who already knows their history can make those conversations easier and help expedite the care they need.
Continuity also supports honesty, personalized care, and meaningful trust. This is especially important in LGBTQ+ communities, where historical prejudice continues to hinder access to quality, identity-affirming care.
Many people, particularly LGBTQ+ adults, have experienced healthcare where they felt judged, dismissed, or invalidated. As a result, some may edit their story before entering a primary care setting or withhold information about sexual practices, gender identity, or health concerns because they fear stigma or scolding.
This is a barrier that providers can address through inclusive, nonjudgmental sexual healthcare that connects patients to broader primary care services.
For many LGBTQ+ patients, sexual health may be the first setting in which they feel understood by a provider. When clinicians normalize conversations about sexual activity, prevention, and gender identity without shame or assumptions, patients may be more likely to seek other forms of care from someone they trust. They may feel freer to ask questions, discuss treatments, and address ongoing concerns more holistically.
Research continues to show that continuity of primary care can improve healthcare use and lower costs for patients and institutions. Integrated primary care is also increasingly recognized as a foundational strategy for ensuring that care is high-quality and personalized to the individual and communities served.
For patients, continuity means fewer handoffs, less repetition, and a clearer sense that someone is paying attention to the whole picture.
Care That Reflects Real Life
Our team at Spectrum Medical believes that sexual health is routine healthcare, and should be addressed with the same respect and clinical rigor as any other area of health. This way, a patient’s care reflects their real life, and not compartmentalized chunks of it.
Patients come to us with different needs: PrEP, routine testing, HIV care, pharmacy support, inclusive gyno care, gender-affirming care. What can unite all of these services is a primary care provider who listens without judgment and opens access to more personalized care.
It’s important to note that integrated care doesn’t mean that every patient needs every service or every fact during each visit. It simply opens the door to more thorough, more thoughtful primary care that serves a person’s health goals. Healthcare is strongest when we stop treating sexual health as something happening in a silo. It is preventative care, and when we integrate it accordingly, we create a more connected, responsive experience for every patient.
Howard Grossman, MD, is Chief Medical Officer at Spectrum Medical. A nationally recognized internist and leader in LGBTQ+ health and HIV medicine, Dr. Grossman brings more than four decades of experience delivering compassionate, identity-affirming care. He has led major LGBTQ+ and HIV-focused clinics nationwide, founded New Jersey’s first private primary care practice dedicated to LGBTQ+ health, and previously served as Executive Director of the American Academy of HIV Medicine.
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