“Every person should be able to walk into their nearest clinic and get the care that they want or need.”
A woman in her mid-20s, who chose the pseudonym Jade for this story, told me recently of an appointment with her ob-gyn after beginning her first relationship with another woman. This physician had been Jade’s ob-gyn for years, and Jade felt comfortable with her. After all, the ob-gyn had been “completely unfazed” by any experiences with men that Jade had shared with her.
But at this appointment, Jade revealed she was now dating a woman, and recalled her trusted ob-gyn exclaiming “oh!” in a tone that made her uneasy—drawn out and high-pitched. “I could see the disdain on her face and could really feel the judgment,” says Jade.
She immediately looked for a new ob-gyn, saying the gyno office is the “last place” she would want to feel judged. She recalls, “For [her attitude] to change because of my sexual orientation was a little earth-shattering.”
Considering stories like Jade’s, it’s not surprising that many LGBTQ individuals feel uncomfortable in healthcare settings. Lingering discrimination, judgment, and ignorance about LGBTQ health issues can all make this patient population feel unsafe or rejected. Furthermore, when doctors make false assumptions about their LGBTQ patients, it can leave them feeling invalidated, disrespected, or belittled—not exactly the foundation of trust that most doctors seek with their patients.
One remedy might be a recent movement to open health clinics and programs specifically for LGBTQ individuals, in which healthcare professionals are uniquely trained in assisting and empowering LGBTQ patients. These clinics operate under a hefty goal: By providing a safe space, they hope to narrow the health disparities among LGBTQ Americans.
What Are LGBTQ Health Clinics?
To serve the unique health needs of the LGBTQ community, health clinics and services are opening up in cities throughout the United States. The Centers for Disease Control and Prevention currently lists over 100 locations throughout 47 states. Some are standalone clinics, some are centers within a larger healthcare facility, and others are a decentralized network of participating doctors.
One example of the decentralized model is the LGBTQ+ Center of Excellence at Denver Health in Denver, CO. Instead of having one facility within four walls, doctors and specialists around the Denver area can enlist in the program, allowing LGBTQ Denverites to see proficient and welcoming experts for whatever their health needs are—whether it’s an annual wellness exam or a gender-affirming surgery.
Not discriminating against an LGBTQ patient is not enough to serve this patient population adequately, according to Kari Kuka, Director of the LGBTQ+ Center of Excellence at Denver Health. “There are still many patients who never get asked what their sexual orientation, gender identity, or preferred pronoun is,” she says.
By contrast, healthcare providers trained in LGBTQ health services value the patient’s identity and make sure their words, actions, and quality of service reflect that. The affirmative culture helps the patients feel—whether they need help for strep throat, cancer, or top surgery—that their provider is qualified to serve them with the highest quality of care.
In Denver’s case, participating doctors are required to undergo training and continuing education to serve their LGBTQ patients best, which includes topics like health disparities, terminology, and appropriate questions to ask during an appointment, according to Kuka.
Due to the time and effort this takes, Denver Health refers to their participating doctors as “champions.” Kuka points out that these are doctors who work hard seeing patients all day, and then head to additional (and voluntary) training in the evenings or weekends for a patient population they want to serve. “To me, that makes them pretty champion-like,” says Kuka.
Behind the Health Disparities
LGBTQ health services don’t simply aim to be a safe space for this patient population, although that in itself is crucial. These networks and clinics have a very real opportunity to chip away at the health disparities between LGBTQ youth and adults and their cisgender, heterosexual counterparts.
Those who identify as LGBTQ have the highest rates of tobacco and alcohol use, according to the U.S. Office of Disease Prevention and Health Promotion. This increases their risk of heart problems and certain cancers. In fact, LGBTQ individuals have a higher risk of heart problems such as heart disease and heart attacks. They also are more likely to have mental illnesses like depression or anxiety, and are more likely to die by suicide.
“In order to care for LGBTQ folks, everyone needs to realize that we are no different than the rest of the patient population,” says Kuka. “We have higher disparities because of discrimination—not just in healthcare [but] nationally.”
Starting at a young age, LGBTQ individuals throughout the U.S. are subject to injustices and denial of human rights. For many queer adolescents, this is felt both at school—where they have a heightened risk of bullying, physical violence, and sexual assault from peers—and within their own homes.
“Young people are still getting kicked out of their houses by their parents for coming out as gay, lesbian, [or] trans,” says Kuka. In fact, LGBTQ youth represent a signification portion—as much as 40 percent—of homeless youth in the U.S., according to a 2017 study in Cureous journal.
Those adolescents who get kicked out of their homes often experience stress, depression, trauma, low self-esteem, or fears of abandonment that can plague them throughout adulthood—not to mention they may lose access to nutritious foods, financial resources, and health insurance.
The result? Without the emotional and financial support of their families or other loved ones, self-care to prevent chronic illnesses later on can be difficult and feel insurmountable. When that’s combined with lack of trust in healthcare professionals, the cause of the health disparities is obvious.
Providing High-Quality Care for the LGBTQ Population
Even doctors who consider themselves allies may not always meet the needs of their LGBTQ patients. Many clinicians (including psychologists and other mental healthcare professionals) are not adequately trained in issues that uniquely affect LGBTQ individuals, or to ask the appropriate questions.
For example, “there are a lot of primary care providers that don’t understand or know how to prescribe PrEP,” says Kuka, referring to the preventative medication against HIV infection for at-risk individuals, such as someone in a relationship with a partner who is HIV-positive. Other doctors may know about it but believe harmful myths about PrEP.
“There are benefits to having specially trained providers that know how to ask the right questions and understand certain types of medications that the general population may not need as often,” says Kuka.
Trans individuals, for example, may request hormone medication from their doctors. In many healthcare facilities, they will be sent to endocrinologists, but Kuka says this is unnecessary and that primary care providers can and should be knowledgeable about providing hormone medication to their transgender patients.
Finding qualified and identity-affirming surgeons is another big issue for trans individuals. A 2017 study of over 350 trans patients in Massachusetts found that 24 percent were unable to access transition-related care, 32 percent had to actually teach their clinician about transgender care, and 6 percent said their provider simply refused to treat them.
Under the decentralized model at Denver Health, multiple surgeons with different specialties are available, according to Kuka. For example, there are plastic surgeons who specialize in top surgery, otolaryngology surgeons who specialize in tracheal shaves (reduction of the Adam’s apple), gynecology surgeons who specialize in genital reconstructive surgeries, and so on.
A Better Future for LGBTQ Healthcare
While an increasing number of LGBTQ Americans have access to these unique services, there are still plenty of individuals who do not, such as those in rural towns far from metro hubs. Ideally, high-quality healthcare for LGBTQ individuals should be the norm at any facility in any town.
One promising sign: The U.S. Department of Health and Human Services added LGBTQ healthcare to its objectives in Healthy People 2020, a set of initiatives released each decade to improve the health of Americans. The LGBTQ objective acknowledges the lack of access to health services and the shortage of “knowledgeable and culturally competent” providers for LGBTQ health.
In the meantime, LGBTQ health clinics and programs provide a glimpse of what the future of healthcare might look like for this patient population.
“We believe in health equity,” says Kuka. “Every person should be able to walk into their nearest clinic and get the care that they want or need, so that’s what we’re trying to make available to our LGBTQ population here in Denver.”