NYAPRS Note: Despite legal gains made by the LGBT community in recent years, they are still marginalized within the realms of physical and mental health care. Rates of suicide, youth homelessness, and substance abuse are higher in the LGBT community, and much more needs to be done to level the playing field, particularly around cultural competence.
NYAPRS recognizes and prioritizes the role of cultural competence in behavioral health. Please join us at our Executive Seminar April 21-22 at the Hilton Albany to hear Lenore Reid-Rose and Carol Tegas present, “The Essential Role of Cultural Competency and Health Literacy within a Performing Provider System.” For more details including the full agenda and registration information, please visit: https://rms.nyaprs.org/wp-content/plugins/files/civicrm/persist/contribute/files/2016%20NYAPRS%20AgendaFinal3.pdf
Equality in LGBT Health Care
By Julie Balter Miami Herald February 22, 2016
2015 was the year we cheered, screamed and cried for the equality strides we made. SCOTUS-sanctioned weddings were celebrated. A certain transgender celebrity transitioned into a mainstream-media hero. Dozens of cities and towns reworked the laws on their books to be more inclusive and better reflect their composition. But after the parties ended and the water cooler conversation tapped out, we all returned to our daily existence, where many of us are still not fully accepted by our immediate families or comfortable being out-and-proud at the workplace. One spot that has consistently remained an area of acute distress — sometimes even dread — is the doctor’s office, where even discussing a routine health matter can become awkward at best.
Whether you’re a card-carrying queer poly or a freshly inked bridegroom, we must beg the question: Can we live happily ever after if we’re still plagued by the physical and mental stresses of discrimination (whether blatant or unconsciously biased) that affect the quality of our health care and wellbeing?
To begin, we need to become aware of where we stand as a community and what obstacles we face. The prevailing prognosis by leading researchers and health studies (such as the Kaiser Family Foundation) confirms the painful reality playing out across the country: LGBT individuals can indeed anticipate a worse health outcome than their non-LGBT counterparts. This is mostly because of discrimination and poor access to quality health care.
You need only look over the Rainbow Health Initiative’s (RHI) summary of data drawn from the U.S. Department of Health and Human Services to realize that cultural, economic and political discriminations have a direct impact on the staggering health care disparities the LGBT community experiences. Here are a few statistics that stand out:
• LGBT youth are two to three times more likely to attempt suicide.
• LGBT youth are more likely to be homeless.
• Lesbians are less likely to get preventative services for cancer.
• Gay men are at higher risk of HIV and other STIs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STIs, victimization, mental health issues and suicide, and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to care because of isolation, as well as a dearth of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol and other substance abuse.
Despite South Florida’s progressive environment, many within the community are still susceptible to the biological and sociological barriers that incur these disproportionate rates of disease. To wit: Cancer-linked agents, such as e-cigarettes are aggressively marketed to South Florida LGBT youth; in fact, Vapor Shark was one of the title sponsors of Miami Gay Pride, and walking through Wilton Manors you could amass a heady count of vapor retailers.
More directly, a National Center for Biotechnology Information (NCBI) report identified several major cancer types that disproportionately affect the LGBT population. Consider, for instance, that lesbians are generally less likely to experience pregnancy and are therefore at a higher risk of being diagnosed with endometrial, ovarian and breast cancers. Transgender patients rarely receive biologically applicable health screenings — making early detection difficult. They are also at higher risk for various forms of cancer associated with increased exposure to hormones. Antiquated insurance policies reflect a lack of education, and culturally competent health care providers who understand the nuances of caring for LGBT individuals are scarce.
While such factors underscore the importance of early and frequent cancer screenings, the problem is compounded by a lack of communication between individuals and health care providers. Preventive care and treatment are often avoided — because of embarrassment or traumatizing past experiences — or inaccessible. The vicious cycle of discrimination, low income and/or lack of insurance coverage exacerbate the problem. This is a community that experiences a greater propensity for a number of serious illnesses and faces more obstacles to the most basic preventive services.
A Spoonful of Sugar
Fortunately, when it comes to the three C’s of optimal health care — critical services, cultural competency and community support — local advocates are raising the standards.
It wasn’t long ago that South Florida’s largest public hospital was the focus of a Lambda Legal lawsuit — Langbehn v. Jackson Memorial Hospital. Long-term lesbian partners Janice Langbehn and Lisa Pond (then unable to legally marry) were denied the same hospital rights enjoyed by married partners, including visitation and basic information. Of course, this episode, along with some education, was the catalyst for a series of sweeping reforms. Jackson now boasts special recognition from the Human Rights Campaign (HRC) as a Health Equality Index (HEI) Leader in LGBT Healthcare Equality.
What changed? Jackson implemented HRC’s comprehensive policies, ranging from the collection of sexual orientation and gender identity data (SOGI) to enacting standards of equality for transgender patients.
“We want to create an environment that lowers the barriers to care that have traditionally made it difficult for marginalized groups to access quality health care and preventative care that can result in healthier lives,” says Nicolette Tessler, senior vice president and chief executive officer of the Jackson Behavioral Health Hospital.
Tessler acknowledges that continued education and best practices require ongoing conversations with the community. “We know that much work lies ahead, so we are in discussion with policy leaders … with whom we hope to partner in order to deliver best practice care.”
But Jackson is not the only player locally. While it is certainly the largest institution to adopt community-based health care for individuals who identify as LGBT, options for culturally competent medical services have a long history in South Florida. Care Resource, a renowned center for HIV and AIDS-related services (including PrEP management), is also a full-scale federally qualified health center that offers comprehensive primary care. Approximately 15,000 visitors and more than 11,000 HIV tests are processed annually by this organization alone.
In Fort Lauderdale, the Pride Center provides STI screenings and HIV testing and PrEP services, as well as education, prevention and counseling. SunServe provides high quality, culturally relevant care across the community, with special attention to those in financial need, minorities, youth, seniors, HIV positive persons and those with life-challenging physical or emotional conditions. Many of their services are either free or charged on a sliding scale.
With more than two dozen service locations throughout South Florida, the AIDS Healthcare Foundation (AHF) has provided much-needed medical care and advocacy for those who are HIV positive and/or who already have AIDS for years.
SAGE, a champion for LGBT seniors, is not your grandfather’s shuffleboard club. They host a wide range of educational and support services, and also serve as a primary center for ongoing social activity (never underestimate the restorative powers of same-sex dancing at any age).
Although LGBT communities are increasingly requiring their network of national and local health organizations to implement culturally sensitive policies and services from the top down, the reality is that individual patients are still their own best advocates.
It is essential that patients make informed choices about the services they seek. Resources like the South Florida LBT Health Directory — a comprehensive list of LBT-friendly physicians made possible by a grant from the Aqua Foundation for Women — simplify access to information.
Most recently, mytranshealth.com, a comprehensive medical directory for transgender patients, achieved full Kickstarter funding and will soon become available exclusively in Miami and New York City. Both directories include social credentialing, so patients can share feedback and experiences.
As an informed patient, it’s also crucial to know your rights. Download the LGBT Healthcare Bill of Rights at healthcarebillofrights.org. Created by LGBT HealthLink in partnership with leading advocate organizations such as HRC and Lambda Legal, the Bill of Rights summarizes your full legal health care rights relating to gender, visitations, decision-making on your behalf and more.
While it’s important to be informed and embrace your inner self advocate, it’s also important to stay positive. Where once we endured the stigma of a presumptive community-wide death sentence from AIDS-related illnesses, today it seems that some actuaries are willing to bet we’re going to stick around a little longer: Progressive companies such as AEQUALIS and Prudential have even partnered to offer life insurance policies to those living with HIV.
“As medical technology advances, we continuously evaluate and update our underwriting criteria, which has resulted in our ability to offer insurance to people dealing with various medical or chronic conditions,” says Mike McFarland, chief underwriting officer of Prudential Individual Life Insurance.
Also, while you never want to dismiss any serious medical conditions, you should take the restorative powers of a South Florida winter to heart. After all, we have one of the warmest, most committed, socially and politically engaged local LGBT leaderships. Our peer communities are deeply connected and wholly invested in our social welfare. And as individuals we are becoming empowered consumers, collectively working to educate, advocate and act in the interests of qualified equality for all.