LGBT+ Barriers to Health Care
LGBT+ patients frequently encounter ignorance and discrimination when seeking healthcare. Although instances of homophobia and transphobia among healthcare providers are decreasing, they remain present. According to the National LGBT Cancer Network, one out of five transgender patients have been turned away by a healthcare provider. Many well-intentioned providers lack sufficient training or experience with the LGBT+ population and its specific health risks. On average, medical students receive less than five hours of education on LGBT+ issues throughout their entire medical training. Additionally, 30% of transgender or nonbinary individuals reported having to educate their doctors or other healthcare providers about transgender or nonbinary issues to receive appropriate care.
Health disparities in the LGBT+ community arise from various factors. There are no inherent biological or physiological differences between LGBT+ individuals and heterosexual individuals. Instead, these disparities result from a combination of social and economic factors and behaviors, many of which stem from the stress of living as a sexual or gender minority in the United States. Recognizing these barriers is the first step toward overcoming them.
Social Determinants of Health and Risk Factors
Social determinants of health are the conditions in which people are born, grow, live, work, and age that influence their health outcomes. These include factors like economic stability, education, social and community context, health care access, and environment. For the LGBT+ community, specific examples include discrimination, stigma, and lack of economic opportunities.
Cigarette smoking among gay men is nearly double that of the general population. Smoking is responsible for 80% of all lung cancers, but it also increases the risk for many other cancers, including colon cancer, esophageal cancer, and anal cancer. In a large U.S. study of women ages 50-79, bisexual women reported higher rates of any type of cancer than their heterosexual or lesbian counterparts. Breast cancer hits this demographic the hardest, where risk factors such as never having given birth to a child are at their highest. Bisexual women were twice as likely to have never given birth compared to heterosexual women, putting them at greater risk for ovarian and endometrial cancers. However, among women who had given birth, bisexual women were twice as likely as heterosexual women to have done so during their teenage years, which also has health implications.
Lack of Screening
Negative responses from providers, and the fear of them occurring in the future, can stop many LGBT+ individuals from seeking regular care and cancer screenings. Gay men who do not share their sexuality with their doctors are less likely to be tested for cancers that are less common among heterosexual people, such as anal cancer. Lesbians report lower rates of mammograms, colonoscopies, and cervical tests compared to heterosexual women. Bisexual women are the most likely among the LGBT+ group to have never had a mammogram or cervical test. These tests are important in reducing the rates of cancer in the general population.
Lack of Insurance
LGBT+ people are less likely to have health insurance than their heterosexual counterparts, partially because most employers do not offer coverage for unmarried domestic partners. Transgender people have the lowest insurance coverage of all groups. For LGBT+ people with health insurance, gaining access to the appropriate care can still pose difficulties. For instance, a transgender individual will not be covered for any procedure or cancer screenings that are inconsistent with the gender marked on the insurance card, such as a Pap smear for a transgender man with an intact cervix.
Lack of Research and Data
None of the major national cancer registries and surveys on cancer incidence gather data on sexual orientation or gender identity. This omission leaves lesbian, gay, bisexual, and transgender cancer survivors hidden within the extensive data these surveys provide for other groups. Without specific information on LGBT+ individuals, researchers and healthcare providers lack critical insights into the unique cancer risks and outcomes faced by this community. This absence of data makes it difficult to develop targeted prevention and treatment strategies. Additionally, it hinders the ability to identify disparities in cancer incidence and survival rates among LGBT+ individuals. Consequently, healthcare providers may be less equipped to address the specific needs of LGBT+ cancer patients. Ignoring sexual orientation and gender identity in cancer research perpetuates health inequalities and undermines efforts to provide comprehensive and inclusive cancer care.
Treating a Concealed Identity
For various social, familial, and religious reasons, LGBT+ individuals may choose to keep their true sexual identity private. Without this information, healthcare providers might overlook critical aspects of their patients’ medical history, potentially impacting their overall healthcare. A lack of understanding about a patient’s sexual orientation or gender identity can lead to misdiagnoses or inappropriate treatment plans. This gap in knowledge might result in healthcare providers failing to offer necessary preventive care measures, such as specific screenings or vaccinations. For instance, transgender individuals might need hormone therapy or particular cancer screenings that would not be considered without full disclosure. Additionally, gender-affirming hormone therapy used by transgender patients can interact with other medications in unique ways. The absence of this vital information can result in suboptimal care, posing significant risks to the patient’s health and well-being.
Alienating Caregivers
Some LBGT+ families have a hard time in a healthcare setting because the staff does not pause to consider they may be a couple. Spouses are ignored or assumed to simply be supportive friends. This problem was exasperated in the past before same-sex couples could legally marry in all 50 states. Although there are now laws in place that protect the rights of same-sex spouses during hospital visits, it can still feel extremely alienating when a member of a medical team asks a gay patient “is your wife here with you?”. Even if the professional had no intention to offend the couple, this might be enough to discourage the patient from attending their next appointment.
Conclusion
Thankfully, LGBT+ rights have made a lot of progress throughout the years. One effective solution might be for LGBT+ patients to seek out providers who are knowledgeable and sensitive to their specific concerns, or a member of the community themselves. Implementing policies that explicitly prohibit discrimination based on sexual orientation or gender identity can help build trust and encourage more open communication between patients and providers. Simply asking patients their preferred pronoun and respectful follow up questions about sexual behavior can build respect between patients and providers. By actively working to improve cultural competence and sensitivity, healthcare facilities can ensure that all patients receive respectful and tailored care.
At Pillar Patient Advocates, our board-certified patient advocates are here to listen to your unique problems and advise you on how to move forward to receive the care you deserve. We provide one-on-one guidance to help you navigate the healthcare system and ensure you receive the best possible care. Contact us today to learn more about how we can support you.
