Panel Discusses Training Healthcare Providers to Better Care for the LGBTQ Community

Members of the LGBTQ community not only face discrimination when it comes to issues like housing and employment, but also their healthcare. Nearly 1 in 5 has avoided seeking medical care, according to a 2017 poll from NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health. However, this population is at risk of worse health because of the discrimination they experience in their everyday lives.

During a panel discussion presented by NPR and the Harvard T.H. Chan School of Public Health, experts highlighted the discrimination that the LGBTQ community faces, the health consequences of that discrimination, and how the healthcare community can improve care for this population.

The poll from 2017 was unique in that it asked people to identify their own experiences with discrimination, not just provide their beliefs about what discrimination they think is taking place, explained Logan Casey, PhD, research associate, Harvard Opinion Research Program. The poll found that 57% of the LGBTQ population had experienced anti-LGBTQ slurs and 53% had experienced offensive or insensitive comments specifically about their gender orientation or identity.

The poll also found that 16% of respondents said they experienced discrimination at the doctor’s office or at a health clinic because they are an LGBTQ person, and 18% admitted they avoided seeking medical care altogether because of fears they would be discriminated against, Casey said.

Experiencing discrimination is associated with a range of health outcomes, but not going to the doctor on top of that discrimination will only “compound the effects of discrimination,” he said.

The poll also found that there are significant racial differences in these experiences among the LGBTQ community, Casey explained. People of color in the community were twice as likely as white people to report instances of being discriminated against when applying for jobs and during interactions with the police. In addition, LGBTQ people of color were 6 times more likely to avoid calling the police for fear they would be discriminated against because they were LGBTQ.

There has been a significant development in the area of disparities for LGBTQ people, said Sari Reisner, ScD, assistant professor, Department of Epidemiology, Harvard T.H. Chan School of Public Health. The National Institutes of Health are making LGTBQ people a priority population for research purposes because their health outcomes are worse and because they face specific stressors in addition to the stressors faced by other populations.

There are also plenty of differences in outcomes within the LGBTQ community, Reisner pointed out. For instance, black transgender women are particularly burdened with HIV: Half of that population has HIV. It’s important, he said, to understand that the different pathways where people are positioned matter.

“I think the biggest challenge is that healthcare system is woefully unprepared to provide care for LGBTQ people,” said Kenneth Mayer, MD, co-chair and medical research director, The Fenway Institute.

The health community is just now beginning to understand that there is a whole field of sexual and gender minority health that providers need to be trained on, he added.

Mayer discussed creating affirming environments. For instance, in society these groups may experience communities that are nonaffirming of their sexual orientation or gender identity, which leads to internalized stigma. Health providers have to be taught to provide an affirming environment for these people and to “create a space where individuals can disclose and discuss behaviors” and get treatment they might need.

Data collection remains an issue for this population. The move toward more use of electronic health records provides a tremendous opportunity to gather more information and standardize it, Mayer said. However, in the past, providers have been uncomfortable asking questions around sexual orientation or gender identity.

“I really feel the hook, and it’s the right hook, for providers is: you’re going to do a better job providing patient care,” Mayer said. “Did you really go into this profession to provide bad care?”

There also needs to be more data and information around transgender health in particular, Reisner said. So far, information has been focused around medical treatments and care, but more is needed on how policies might impact the health of transgender populations overall.

“Having more data is imperative,” Casey added.

Just because there are no data on something, doesn’t mean there isn’t a problem, so more polling of this community to gather research is important. It’s only when the questions are asked, that there can be an understanding of the issues affecting the community. Casey provided the example of food scarcity: People don’t really think of food scarcity as an issue of the LGBTQ community, but this population is disproportionately living in poverty.

One audience member asked about health and insurance issues specific to transitioning individuals, such as transgender men who might be traumatized by the fact that they need to still get a Pap smear. Mayer agreed that a great deal of training is needed for providers to deal with transgender men or gender-nonconforming patients in these instances.

As for insurance issues where transgender patients need to change their name or gender for coverage, the ease of doing so will vary across the country. In some states, it will be fairly easy for a person transitioning to change his or her documentation, but in other states it remains very difficult to do so.

“These issues need to be fought on a state-by-state basis,” Mayer said.