Health Disparities in the LGBTQIA+ Community: A Conversation with allgo

If you’ve ever had a negative experience in the healthcare space, you may know how difficult it can be to feel comfortable returning to a doctor’s office to establish boundaries with your provider.

According to The Report of the 2015 U.S.Transgender Survey, one-third of respondents reported having at least one negative experience with a health care provider, including verbal harassment, refusal of treatment, or having to teach the provider about transgender people to receive appropriate care. Nearly one-quarter (23%) of respondents reported that they avoided seeking the health care they needed in the past year due to fear of being mistreated as a transgender person.

More recently, a 2020 study conducted by the Center for American Progress found that:

  • 30% of LGBTQIA+ Americans faced difficulties accessing medical care due to cost
  • 15% of LGBTQIA+ Americans postponed or avoided medical treatment due to discrimination
  • 33% of transgender Americans had to teach their doctor about transgender individuals in order to receive appropriate care.

Everlywell was founded on the principle that everyone deserves access to affordable and accessible healthcare, and our mission extends to every community. Marginalized groups are disproportionately affected by patterns of discrimination and substandard care within the healthcare system—which is dangerous, as everyone should get access to the care they need when they need it.

Discrimination and limited access to high-quality healthcare disproportionately affect LGBTQIA+ communities of color, who are at a higher risk of contracting and living with an undiagnosed sexually transmitted infection like HIV. Black and Latinx gay or bisexual men account for the highest HIV infection rates in the United States. In 2018, the Center for Disease Control and Prevention reported that African American gay and bisexual men made up 37% of the nearly 40,000 HIV diagnoses among gay and bisexual men. Socioeconomic factors like poverty—which include limited access to high-quality healthcare, housing, and HIV prevention education—are linked to the increased risk for HIV infection among communities of color.

We believe the necessary changes start with listening to the experiences and advocating for the needs of vulnerable groups. To help our community better understand how health care discrimination impacts LGBTQIA+ populations, and for tips on how to navigate conversations with healthcare providers, we reached out to enakshi ganguly, the Health and Wellness Coordinator at allgo to discuss healthcare issues for the LGBTQIA+ community.

allgo is a queer people of color organization that focuses on supporting and advocating for the rights of queer people of color through cultural arts, wellness, and social justice programming.

What are some of the challenges the LGBTQIA+ community faces as far as health and wellness go?

The LGBTQIA+ community faces barriers to accessing necessary medical care, largely because we are not thought of in information forms, bedside manners, or patient-provider rapport. Healthcare providers often assume that the patient is heterosexual and interact with the patient’s care on their assumptions. Moreover, even before a patient can meet their provider, the office staff, office environment, and information forms lack inclusivity and creates enough alienation for patients to not want to come back again.

These barriers are further complicated for queer people of color communities who not only experience homophobia and transphobia by healthcare providers and staff, but also racism and xenophobia. Many of our community members find that medical professionals are not responsive to their culturally relevant healing modalities or generational/personal trauma.

There can also be doubts that the provider is sex-worker positive or if they will work from a HAES (Health at Every Size) perspective that celebrates body diversity without equating a patient’s weight to the state of the patient’s health. This causes many to not feel comfortable disclosing relevant health information, and as a consequence, routine testing or screening may be missed.

What are some examples of common healthcare discrimination for the LGBTQIA+ community?

Often it’s how the patient is treated by healthcare providers or staff, like when they insist on calling their patients by their legal name instead of the name they like to be called. It’s interesting how transphobia works because these providers may as well adjust what they call a cisgender patient who goes by a particular nickname that is not their legal name. But because the patient is transgender, they would not make that adjustment for them.

LGBTQ+ populations had also experienced their boundaries being crossed by being touched by a provider without their consent when they had expressed that they experienced sexual trauma, and have to be asked permission before being touched. Other times, it’s outright refusal to treat LGBTQIA+ patients or denying them the proper tests, medicine, or treatment.

At the hands of their healthcare providers, queer people of color patients often experience a lack of cultural competence, unwillingness to prescribe medication, and a general lack of mindful listening. This all feeds into racism, xenophobia, anti-Blackness plus the heterosexism and transphobia providers carry into the room with them.

What are some tips for LGBTQIA+ people to navigate and advocate for themselves within the healthcare system?

  • Own the information form you are given. If they only have a place for a legal name, write down the name you answer to and your pronouns throughout the form, and wherever you feel like your health is not being captured. If you have the capacity, talk it through with your provider and let them know that you did not feel the information form was comprehensive.
  • You have the right to not step on the weight scale. If the healthcare provider needs your weight, give them an estimate.

When your doctor greets you, make sure to let the provider know your name and pronouns.

  • When meeting a provider for the first time, make time at the beginning of the appointment to ask them any necessary questions, including whether they practice size inclusivity and if they have done research about people of color health.
  • Let your provider know about your past experiences with healthcare providers, both positive and negative.

Remember that your healthcare provider is there to serve you. Interview them and ensure that they hear your concerns and respect your boundaries. If a healthcare provider tries to push your boundaries, restate them and say, “Thank you for respecting my boundaries.” If they continue to push you, consider seeing another provider.

Do you have any self-care recommendations for the LGBTQIA+ community?

Everyone’s capacity of self-care is different. I encourage folks to have their own unique approach to their self-care routine or self-care tools. This can look like taking a bath, watching TV, cooking and eating good food, and so on. One thing I would suggest we all do is to check-in with ourselves throughout the day to ensure that our bodies and mental state are being heard and supported.

How can we as a community (as individuals, as healthcare organizations and telehealth companies) push for change to serve the LGBTQIA+ community and their health?

By educating yourselves and others about the intersections of experiences and how our identities overlap to create unique, joyful experiences but also painful and jarring ones. The health disparity that queer people of color face is one of the worst in this country because it is both exacerbated by racism and heterosexism.

Another way is to vote, if you can, in your local elections, and show up to city hall and open council meetings. There are so many ways we can be politically active in our neighborhoods and cities as a way to support the safety of both queer people, people of color, and queer people of color.

Closing the gap starts with raising awareness, advocating for vulnerable communities, and supporting organizations that provide resources and are enacting change for marginalized communities across the spectrum.

Access to affordable and trusted health care for everyone is at the heart of what we do here at Everlywell. We believe in order to change the statistics; the healthcare system needs to change. We’re committed to listening and creating space for communities to share their stories, advocate for their needs and demand change from the healthcare system at large.

To learn more about how healthcare discrimination impacts vulnerable populations and support the work that ena and the rest of the allgo team are doing in the Texas community, visit their website.

Helpful Resources:

References

1. James SE, Herman JL., Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality. URL. Published 2016. Accessed September 28, 2020.

2. Discrimination Prevents LGBTQ People From Accessing Health Care. Center for American Progress. URL. Accessed September 28, 2020.

3. Meyer IH, Frost DM. Minority stress and the health of sexual minorities. In: Patterson CJ, D’Augelli AR, eds. Handbook of Psychology and Sexual Orientation. New York, NY: Oxford University Press; 2013:252-266.

4. Sharita Gruberg, Lindsay Mahowald. “The State of the LGBTQ Community in 2020.” Center for American Progress, URL. Accessed June 09, 2021.

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