Happy LGBTQ+ Pride Month - celebrating diversity and advocating for Health Equity. Two smiling women running under a colorful rainbow flag. The woman on the left has dark hair and wears a light blue tank top and white knit vest, and the woman on the right has long flowing black dreadlocks and wears a white tank top. They are outdoors with greenery in the background.

Happy LGBTQ+ Pride Month!

As we celebrate our beautiful differences, we should take a moment to remember that there’s still a lot of work to do to bring health equity to the 20 million+ and growing (and likely undercounted) Americans who identify with this group. As with other underserved communities we’ve discussed, resolving these inequities is both a public health concern and a matter of social justice. Every person deserves to receive the best care available to them, regardless of their sexual or gender identity.

Disparities and inequity for the LGBTQ+ community have a long history, in fact, homosexuality was considered a disease in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973. And while our society has become more educated about sexual identity since then, disparities persist today.

LGBTQ+ (lesbian, gay, bisexual, transgender, queer) people are more likely to experience discrimination while seeking healthcare, compared to straight and/or cisgender people (those whose gender identity matches the gender assigned at birth). Nearly 17% of LGBTQ+ adults and 20% of transgender adults avoid health care due to negative prior experiences. This avoidance or delay in seeking treatment of course creates poorer health outcomes.

Transgender men (born female) are less likely than cisgender women to get cervical cancer screenings. Trans women are less likely to get prostate cancer screenings. This could be providers not recommending testing due to confusion or discomfort in raising the matter, or distress for the patient in acknowledging biological vestiges of their former gender identity.

Biologically female lesbian and bisexual women are also less likely to receive regular cervical cancer screenings, and transgender men and women often encounter difficulties accessing hormone therapy and other gender-affirming treatments. These barriers contribute to higher rates of undiagnosed and untreated health conditions and have mental health impacts.

In general, members of the LGBTQ+ community are more likely to suffer from mental health issues such as depression, anxiety, and suicidal thoughts. This increased risk is often compounded by a lack of healthcare providers who understand and respect the unique needs of LGBTQ+ patients.

These mental health issues are further exacerbated for trans people because hormone therapy and other important gender-affirming procedures are often difficult to receive (and are under attack in many states).

Previous bad experiences in healthcare settings can deter LGBTQ+ people from seeking medical care. These incidents can include denial of services, verbal harassment, and insensitivity or ignorance about the specific health needs of LGBTQ+ patients. This avoidance of care can create unresolved health issues and negative outcomes.

While the Supreme Court’s ruling in 2020 protects LGBTQ+ workers from employment discrimination, there are still gaps in federal and state protections. The lack of comprehensive anti-discrimination laws in some states leaves people vulnerable to bias in various aspects of life, including housing, education, financial services, and, of course, healthcare. There are currently more than 750 pieces of LGBTQ+ related legislation being tracked by the watchdog organization the Human Rights Campaign. While some of these bills help us make progress by banning dangerous conversion therapies, many of these bills are attempts to move our social systems backwards by proposing transgender healthcare bans, curriculum censorship, and reversing existing civil rights laws protecting this community.

LGBTQ+ people are more likely to experience poverty and unemployment, limiting their access to healthcare. This economic instability often means that they are less likely to have health insurance, increasing reliance on public health services that may not always be equipped to address their needs.

Financial challenges also mean that other social determinants such as housing instability and access to healthy food can impact the health of the community.

Mandatory cultural competency training on sexual orientation, gender identity, and related healthcare disparities gives providers a better perspective on the unique health needs and challenges faced by LGBTQ+ people. This encourages a more inclusive and respectful healthcare system, mitigating many of the issues described here.

Creating a welcoming environment can encourage LGBTQ+ folks to seek care an disclose relevant health information. This can include non-discrimination policies, inclusive intake forms, and visible signs of support such as gender-neutral bathrooms, inclusive signage, staff training certifications in cultural competency, and so on.

Raising awareness (in both straight/cisgender and LGBTQ+ communities) about LGBTQ+ health issues, and identifying educational resources should be high priorities. Discussion and knowledge foster compassion, reduce stigma, and help encourage patients to seek preventive care and treatment.

Peer support networks and organizations dedicated to LGBTQ+ health advocacy play an important role in addressing healthcare inequity. Providing resources, education, and empathy can ensure that LGBTQ+ individuals receive the care they need, in a welcoming environment, from providers who treat them with respect.

Advocate for policy changes, support LGBTQ+ health organizations, and educate yourself and others about LGBTQ+ issues.

Addressing healthcare inequities faced by this community is a real and complex challenge that requires effort from policymakers, healthcare providers, and the public. By implementing inclusive policies, providing cultural competency training, and supporting advocacy efforts, we can create a healthcare system that works better for everyone. Healthcare equity should be more than just a goal. It’s a fundamental right.

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