I was so nervous the first time I went to the gynecologist. This isn’t unusual, since gynecologist appointments can be up-close and personal experiences, but my nerves set in early. I have friends who have been denied care by medical professionals because of their sexual orientation, so I focused on trying to find a doctor who I felt might make me feel safe and respected when it came to talking about my sexual health as an openly pansexual woman.
This anxiety concerning health care is all too common within the LGBTQ community and is heightened for nonbinary, intersex and trans folks. One Colorado, an LGBTQ advocacy organization based in Denver, is unique in that they collect LGBTQ-specific data related to health care in Colorado. In their 2018 “Closing the Gap: The Turning Point for LGBTQ Health” survey, One Colorado explains that more than 60 percent of participants report that they fear discrimination from health-care providers. Although the law requires doctors and others in the medical field to provide care for any individual regardless of gender identity and sexual orientation, One Colorado’s report also states that 34 percent of transgender respondents said they encountered situations where health-care providers denied them access to LGBTQ-specific medical services such as HIV medications, HPV vaccines, hormones and gender-affirming care. This strong and legitimate fear of discrimination prevents some from coming out to their health-care providers, causes others to postpone going to see a physician, and deters others from seeking medical treatment completely.
There are also concerns about finding doctors who are knowledgeable about LGBTQ-specific needs. Up until 1973, the Diagnostic and Statistical Manual of Mental Disorders (DSM) considered homosexuality a pathological disorder. The DSM finally stopped describing being transgender as a disorder in 2013. And practicing conversion therapy on minors only became illegal in Colorado a month ago when Gov. Jared Polis signed new legislation into law. Although macroscopic changes such as these attempt to shift how medical professionals perceive the spectrum of sexual orientation and gender identity, One Colorado’s report highlights routine discrimination against LGBTQ, especially trans, folks.
LGBTQ populations are also more vulnerable to and have higher rates of smoking, substance abuse and addiction, mental health conditions, sexual harassment, sexual assault and rape, and intimate partner violence than cisgender (those who identify with the gender they were assigned at birth) and heterosexual populations. These high-risk factors are all symptoms of one root cause: systemic discrimination. There is a glaring need for practitioners who acknowledge these disparities and understand their sociologically complex causes, especially since health-care studies rarely take gender identity and sexual orientation into account, creating a lack of medical data concerning LGBTQ populations.
Like millions of Americans, LGBTQ individuals worry not only about receiving quality health care, but also affordability. Seventy-six percent of those surveyed report that health care costs remain the greatest barrier to seeking care. Thirty-two percent say they lack sufficient choice and access to inclusive medical care that is within their insurance network. Finding affordable and non-discriminatory health care that gives coverage to same-sex partners and adopted children should not be a concern in 2019, but unfortunately, the fight for equity continues.
The Trump administration poses yet another threat for trans individuals. Before the Affordable Care Act, the medical community at large viewed being transgender as a pre-existing condition that legally allowed insurance companies to charge trans folks higher rates for the same services as their cisgender counterparts. With the ACA under threat from the current administration, further systemic discrimination could erase Obama-era inclusivity.
Safe, affordable and quality health care has been a controversial topic for years and will once again take center stage as the 2020 elections draw near. However, serving the LGBTQ community requires tackling systemic homophobia and discrimination and revamping the health-care system. Small but impactful changes include using gender-neutral language, asking a person's pronouns, having gender-neutral restrooms, posting non-discrimination statements and employing LGBTQ people. Changes like these cost little to nothing, but can catalyze long-needed change in making health care more equitable for the LGBTQ community.