THRESA GILES
Special Contributor
In the past few decades, there has been greater public acceptance and favorable policy changes for the LGBTQ+ community. According to studies, roughly 61 percent of non-LBGTQ+ adults support the community, and more than 7 in 10 people say they would support a friend or family member if that person were to come out.
Policy advancements such as marriage equality and gender recognition have also led to more acceptance of the LGBTQ+ community.
However, even with strides made in acceptance and policy, there remain glaring health disparities for the community, and those disparities are widening, not improving. These deeply entrenched disparities prevent people in the LGBTQ+ community from accessing equitable healthcare and leave them facing persistent stigmas and competent services that are culturally aware. These factors result in worse physical and mental health outcomes for a population already vulnerable.
In other words, disparities in access to healthcare present one of the greatest challenges the LGBTQ+ community faces today.
An understanding of systemic drivers that lead to disparities is required if these issues are ever to be resolved.
Factors fueling disparity
There are several reasons these disparities exist, expanding the health gap between members of the LGBTQ+ community and their heterosexual and cisgender peers. Bias can still arise in healthcare settings, even with wider acceptance of LGBTQ+ people. Stories range from the provider’s refusal to provide HIV medication to children being denied access to care at a pediatrician’s office because the parents were a same-sex couple.
These reported stories contribute to the ongoing healthcare disparities that are keeping people sick and separated from the healthcare system they rely on for care.
Social determinants can also play a role in healthcare gaps. Factors such as income inequality, lack of stable housing and unemployment can plague the LGBTQ+ community and lead to issues with accessing healthcare services.
LGBTQ+ youth can be particularly vulnerable, as they face high rates of homelessness and mental health challenges. Transgender individuals have come up against many roadblocks in recent years in accessing gender-affirming care and equitable healthcare treatment.
The LGBTQ+ population also brings unique health risks to the table, which can widen health disparities, especially in areas where specialized healthcare may not be as readily available, such as rural areas. A higher prevalence of STIs and HIV in the community can come up against a limited availability of free testing services, leaving those in the LGBTQ+ community vulnerable to worse health outcomes.
Persistent stigma and a lack of comprehensive provider training
Although great strides have been made in society with acceptance, stigma still exists — especially in healthcare. This persistent stigma can keep LGBTQ+ people from receiving quality, equitable care. Many providers may lack the confidence or skill set to address needs specific to this population. What can result from this lack of training is action based on assumption or perceived insensitivity or even hesitation to provide needed care.
Bias against LGBTQ+ people among healthcare providers is not always overt. Sometimes, subtle biases can affect care delivery. Providers may overlook key indicators of illness or risk of illness, avoid important discussions about prevention or sexual health, and fail to offer screenings or testing that could be life-saving.
This lack of preparation or education among healthcare professionals can sow the seeds of distrust in the LGBTQ+ community, leading them to avoid seeking care.
Community organizations bridging the gap
With these disparities persisting, community-based organizations have stepped up to bridge gaps in care. These organizations are often deeply rooted in the community, by members of the very community they serve. Members of vulnerable, marginalized communities can better understand the needs of the community experiencing disparities. They can provide culturally sensitive care, advocate for needed policy changes, and provide healthcare that is designed to fit community realities.
These community organizations can offer free HIV testing, support groups, affordable care, peer-led education and additional resources that can help bridge gaps in care for the community. Providers in these community organizations are more attuned to the needs and vulnerabilities of the LGBTQ+ community, providing a safe space for members of this community to receive necessary care.
These community organizations can address the root causes of healthcare disparities in the LGBTQ+ community with actionable solutions such as provider education, reforms to patient intake and bedside interactions, creating LGBTQ+ affirming environments, expanding access to preventative services and medications, and advocating for widespread policy changes.
Despite the growing awareness of the healthcare-specific needs of the LGBTQ+ community, health disparities persist. Rooted in years of stigma, a lack of training, discrimination and systemic neglect, these disparities have negatively impacted outcomes for the community. Community organizations bring inclusive education and support, equitable and affordable care and testing resources, and affirming environments that can change the face of LGBTQ+ healthcare, leading to better outcomes and a better future for the community overall.
Thresa Giles is CEO of Hope and Health of Central Florida. LGBTQ+ community health care organizations in North Texas include Resource Center and Prism Health Care of North Texas. AIDS Healthcare Foundation and AIDS Outreach Center of Tarrant County also offers services focused on HIV prevention and treatment to the community.