Welcome to week 7 of the 9-Week LGBTQ+ Equity Challenge! This week will give you an introduction to LGBTQ+ experiences in healthcare. The healthcare system presents many challenges to LGBTQ+ individuals, and we will not be able to cover all information. Please record your weekly feedback here.
Week 7: Healthcare
  • How can negative experiences with healthcare affect an LGBTQ+ individual's life?
  • What are some ways healthcare providers can make LGBTQ+ individuals feel more comfortable and understood during their interactions?
  • Consider LGBTQ+ experiences in other areas (the workplace, school, home, etc.). What is the effect of so many challenges compounding for LGBTQ+ individuals? 
  • How can the experiences of being an LGBTQ+ person of color differ from the experiences of white LGBTQ+ individuals in healthcare?
A Different Set of Needs
The fundamental ability to access healthcare services can be a challenge for many LGBTQ+ individuals. “Many LGBT people have difficulty finding providers who are knowledgeable about their needs, encounter discrimination from insurers or providers, or delay or forego care because of concerns about how they will be treated,” reports Human Rights Watch, a nonprofit organization that investigates and reports on human rights abuses. A study conducted by Lambda Legal in 2014 found that more than half of lesbian, gay or bisexual survey respondents and 70% of transgender people had experienced discrimination while seeking healthcare.
Another obstacle related to accessing healthcare services many in the LGBTQ+ community face is higher unemployment rates as the result of employment and education discrimination. This can have a compound effect from a healthcare perspective:
  1. Being uninsured for healthcare coverage. According to a March 2017 report, overall, LGBT people are more than twice as likely to be uninsured as non-LGBT people: 15% of LGBT respondents are uninsured, compared to 7% of non-LGBT respondents. Uninsurance is highest among transgender individuals: 25% of transgender respondents are uninsured, compared to 8% of cisgender respondents. (Source).
  2. Engaging in high-risk work as a means of survival. The most recent Transgender Discrimination Survey (transgender individuals have some of the highest unemployment rates in the LGBTQ+ community) found that 11% of respondents report having done sex work. Broken down by race, the study found that 33% of Latinx respondents and 40% of Black respondents reported participation in sex work. Additionally, homeless LGBTQ+ youth are seven times more likely than heterosexual-identified peers to trade sex for a place to stay.
When individuals access the healthcare system, they often present with a different set of needs than those who are not LGBTQ+. The unique needs of the LGBTQ+ are often the result of misinformation, marginalization, and other forms of discrimination.
  • Mental health/suicide: LGBTQ+ individuals, especially youth, experience higher rates of mental health struggles and suicide.
  • Illicit drugs: An estimated 20%-30% of the LGBTQ+ community abuse substances, compared to 9% of the non-LGBTQ+ population. Many in the LGBTQ+ community face unique daily challenges related to their self-identity including discrimination or stigmatization based on LGBTQ+ identity, hate crimes, emotional abuse, threats, public humiliation, rejection or shame from family or friends after coming out, and loss of employment. (Source).
  • STDs and HIV: Some LGBTQ+ groups experience higher rates of contracting sexually transmitted diseases and HIV than the general population.
Consider: Are there connections between experiences with oppression that can lead LGBTQ+ youth and adults down paths of decision-making and survival that non-LGBTQ+ are less likely to head down?
Trans and Gender Non-Conforming Healthcare
Transgender and gender non-conforming patients encounter significantly more barriers to healthcare than those who are LGBQ. According to a Center for American Progress report in 2021, nearly half of transgender people — and 68 percent of transgender people of color — reported having experienced mistreatment at the hands of a medical provider, including refusal of care and verbal or physical abuse. These providers misgender patients, refuse to use preferred names, and harass patients outside of medical anatomical discussion or discussion of sex assigned at birth.

As gender-affirming care becomes more broadly available, there are still serious challenges to transgender patients receiving care that addresses their health needs. While homosexuality was removed from the DSM (the diagnostic manual used for diagnosing mental disorders) in 1973, "gender identity disorder" was only recently removed from the DSM in 2013. This results in significant stigma with some still incorrectly assuming that transgender individuals are mentally ill. 

In 2021, legislatures in 22 states introduced bills to ban best-practice medical care for transgender young people (read more below). These bills aim to prevent gender-affirming care for transgender patients. Gender-affirming medical care encompasses a wide range of physical and mental healthcare and treatment that supports the recognition, acceptance, and expression of one’s gender identity.
Progress 
While there are many challenges and barriers for LGBTQ+ individuals in the healthcare system, providers are increasing efforts to provide more inclusive healthcare. One of these efforts includes the American Medical Association launching a fellowship program to address discrepancies in LGBTQ healthcare to ensure that LGBTQ+ patients receive the highest level of care. The inaugural institution hosting the fellowship is the hospital at the University of Wisconsin - Madison. Similar efforts are also being developed to provide more inclusive and diverse care within some local and regional healthcare systems and organizations. A better understanding of the benefits of gender-affirming care with both adult and younger patients is also leading to better access to care for gender-diverse patients.
With the questions and information above in mind, do at least one of the following:

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