Courtesy of Fenway Health—
Gay and bisexual men are at least 44 times more likely than the general population to become infected with HIV. Lesbians are less likely to get preventive services for cancer. Transgender people have higher rates of attempted suicide. And bisexuals have higher rates of tobacco and alcohol use. To call attention to health disparities such as these, and to focus on finding ways to end them, the National Coalition for LGBT Health created LGBT Health Awareness Week in 2003.
This year’s awareness week takes place from March 29 through April 1. To learn more, we spoke with Jennifer Potter, MD, Director of the Women’s Health Program and Women’s Health Research at Fenway Health, and the Advisory Dean and Director of the William B. Castle Society at Harvard Medical School.
Q: Why does there need to be a focus on health for LGBT people? Don’t doctors provide the same care for everyone?
A: There is no “one size fits all” type of care. In order to achieve health equity, one must know how to ask each unique patient about their identities and life experiences, and the strategies they use to cope with adversity. This means one must know how to create a welcoming atmosphere, ask the right questions, respond affirmatively, and handle peoples’ bodies with care. Acquiring knowledge specific to different sexual- and gender-minority populations is also crucial to guide competent care.
Q: Since you have been practicing as a physician, what are the most dramatic/impactful changes you have seen in providing healthcare for LGBT people?
A: More institutions are implementing policies to routinely collect sexual orientation and gender identity data so we can actually learn who we are serving and track health outcomes in these populations. Standard of practice guidelines are beginning to include mention of persons of diverse sexual orientation and gender identity. For example, the American Congress of Obstetricians and Gynecologists has created a resource guide for the care of transgender people which notes that transgender men with a cervix should have regular Pap smears. Last, the Affordable Care Act has dramatically increased access to care for LGBT people and enhanced coverage for transgender health needs.
Q: Is it important for LGBT people to be out to their healthcare providers? If so, why?
A: It depends what you mean by ‘out.’ If you mean being out about one’s sexual orientation identity, then yes, because our identities are often associated with life experiences (in this case, stigma and discrimination), which a provider will want to know about in order to be able to offer holistic, trauma-informed care. It is also important for providers to learn about their patients’ sexual practices, since these practices are closely related to risk for sexually transmitted infections, including HIV.
Q: What would you say to a transgender person who does not want to go back to her doctor because the last time she was there, office staff called her by her legal male name?
A: I would say that I’m sorry this happened, and it shouldn’t have happened. I would ask if the incident was a deal breaker, or if the person thinks it might be workable to give feedback to the doctor and make sure office staff are properly trained to provide competent care at future visits. If the person is interested in providing feedback, I’d then review ways to do that most productively and successfully.
Q: What things need to happen in the healthcare profession to improve health outcomes overall among LGBT people?
A: We need to collect sexual orientation and gender identity data across the board—from primary healthcare settings to cancer registries. This is the only way we are going to get detailed information about all of the gaps in care experienced by LGBT people. This information will also enable us to measure quality improvement for LGBT populations in areas most in need of change. We also need better education for healthcare providers about the unique health needs of LGBT people and how to deliver culturally competent care. Last but perhaps most important, we need greater transparency in the delivery of care, such as Open Notes, which permit patients to read their doctors’ notes and become actively engaged in managing their own care.
Q: What questions do you wish more patients would ask of their doctors?
A: Any questions!
Q: If someone is unsatisfied with their doctor, what is the best way to find a new one?
A: I urge people to give direct feedback to the doctor, and if possible to try to work things out. How else will we get things to change? Other than that, friends are a great resource. Find a provider through word of mouth. Also, organizations like the Gay and Lesbian Medical Association maintain find-a-doctor listings for LGBTQ-friendly providers.
Q: What are the top three words of wisdom you find yourself giving to LGBT patients to improve their health?
A: There are no boilerplate answers. It really depends on each person and their unique needs.
LGBT Health Disparities
It has long been observed that LGBT people experience disparities in health as compared with the general population. In 2011, the Institute of Medicine issued “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding” which formally documented the disparities. The report also called for additional research and institutional change to address these disparities, which range from greater rates of smoking among LGBT people to greater vulnerability to HIV infection.
It’s important to note that these disparities track with higher rates of societal stigma and discrimination, which can lead to bias among health care providers; public and private policies that have historically made it harder for same-sex partners to access health care insurance; and higher rates of poverty and homelessness, all of which can impact health.
Below is a list health disparities experienced by LGBT people, as documented in the report:
- LGBT youth are more likely to attempt suicide and be homeless.
- LGBT populations have higher rates of tobacco, alcohol, and other drug use.
- Transgender people have a higher prevalence of depression and anxiety.
- Transgender people have a high prevalence of attempted suicide and victimization.
- Gay, bisexual and other men who have sex with men are at higher risk for HIV and other sexually-transmitted infections.
- Young men who have sex with men and transgender women, especially those who are Black, are at especially high risk for HIV.
- Lesbians and bisexual women are more likely to be overweight or obese.
- Lesbians are less likely to get preventive screenings for breast and cervical cancer.
- Elderly LGBT individuals face additional barriers to optimal health because of isolation and a lack of culturally appropriate social services and providers.
You can learn more about some of the proposed interventions to end these disparities at Healthy People 2020, an initiative of the U.S. Office of Disease Prevention and Health Promotion, which provides science-based, 10-year national objectives for improving the health of all Americans. Additionally, the National LGBT Health Education Center at The Fenway Institute, provides resources for patients and providers alike.