DiversityNursing Blog

Health disparities are the health differences experienced between different groups based on race, ethnicity, disability, sex/gender, socioeconomic status, educational level, and more. Unfortunately, the LGBTQ+ community is no exception to health disparities.

Health differences in the LGBTQ+ community can include how many people contract a specific disease, how severe the condition becomes, the complications associated with the disease, how many people die from an illness, access to healthcare, and how many people can access preventative health screenings.

Health disparities within the LGBTQ+ community can affect every aspect of a person's life, including physical and mental health. As healthcare providers, we are responsible for identifying health disparities and continually working toward bridging these gaps so every person can receive quality healthcare and routine health screenings.

Barriers to Healthcare in the LGBTQ+ Community

Research has revealed that LGBTQ+ individuals are less likely to have access to quality healthcare for a variety of reasons, including

• A lack of inclusive and competent healthcare providers with knowledge of LGBTQ+ health and health issues affecting transgender persons.
• The concern of stigma or discrimination from healthcare providers
• Prior negative experiences from LGBTQ+ persons
• The financial burden of affording health insurance or paying out of pocket for care
• Being refused care due to sexual orientation, gender identity, or gender presentation

Regardless of the reason behind healthcare barriers within the LGBTQ+ population, there are several health disparities that healthcare workers must educate themselves upon to help better serve the community. Here are some of the most prominent health conditions affecting LGBTQ+ people and what you can do to help better serve your patients.

Sexually Transmitted Infections (STIs)

Gay, bisexual, and other men who have sex with men are more affected by certain STIs, including HIV (human immunodeficiency virus) and HPV (human papillomavirus), than other individuals. Many people in the LGBTQ+ community hesitate to seek medical care due to the potential stigma and judgment they may receive about their lifestyle, which can lead to worse medical outcomes. As medical providers, we must create a safe, inclusive, and judgment-free space for people within the LGBTQ+ population to receive medical care.

To better serve the LGBTQ+ population, Nurses must educate themselves on the increased health risks of the LGBTQ+ community and ensure that every patient receives routine health screenings and health education. It can be difficult and embarrassing for any person to seek medical care for sexual health concerns or screenings, so it is essential to create a nonjudgmental, inclusive, and caring environment for patients to feel comfortable disclosing sexual information and receiving care.

Anxiety and Depression

It is estimated that up to 60% of the LGBTQ+ population deals with anxiety and depression at some point. Unfortunately, LGBTQ+ people experience worse mental health outcomes than other communities. Factors behind anxiety and depression in LGBTQ+ people can range from discrimination, bullying, lack of acceptance from friends and family, lack of representation in school and media, lack of inclusive language, and less access to community support.

As a healthcare professional, you can better support the well-being of the LGBTQ+ community by creating and welcoming a safe environment free of judgment and stigma. We can also work to provide better mental health services. The Trevor Project is a fantastic resource for LGBTQ+ patients struggling with anxiety and depression. The Trevor Project offers trained counselors who can be reached 24/7 by phone or text. Every counselor is trained to understand the unique challenges of the LGBTQ+ community, and every conversation is 100% free and confidential.

Drug and Alcohol Abuse

Statistics show that people within the LGBTQ+ community are twice as likely to suffer from drug and alcohol abuse than other populations. This is mainly attributed to the fact that the LGBTQ+ community faces discrimination, social stigmas, and a general lack of support despite the growing acceptance from strangers, acquaintances, friends, and family. Drugs and alcohol are often used as a coping mechanism for those struggling with anxiety, depression, and other insecurities.

To better support the LGBTQ+ community struggling with drug and alcohol abuse, healthcare providers can use motivational interviewing and screening tools to better identify individuals who may be struggling so we can better provide care and support. Furthermore, healthcare professionals should approach these situations with kindness and understanding while using inclusive language to help patients navigate recovery.

There are many resources available to the LGBTQ+ community who are interested in living a sober life, including Gayandsober.org, where the LGBTQ+ community can connect with other LGBTQ+ people living a sober life, and Inspire Recovery, where the LGBTQ+ community can seek resources to achieve and maintain sobriety.  

Be an Advocate

Everyone, regardless of their age, gender, sexual orientation, or race, should receive competent, compassionate, and inclusive medical care. As Nurses, we must always advocate for our patients and strive to provide every person with the best possible care. To help reduce health disparities in the LGBTQ+ community, Nurses should educate themselves on how to care for people within the community and advocate for health screenings and competent medical care for every individual.  

To learn more about how Nurses can better serve the LGBTQ+ community, consider checking out these resources.

Center for Disease Control and Prevention: LGBTQ Health Services

Nurses(Heale)

GLMA: Health Professionals Advancing LGBTQ Equality

U.S Department of Health and Human Services

LGBTQ+ Pride month is celebrated every June in honor of the 1969 Stonewall riots, and works to achieve equal justice and equal opportunity for Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) Americans.

Pride month celebrations include parades, parties, concerts, educational events and speeches. Memorials are also held to honor members of the community who have been lost to hate crimes or HIV/AIDS.

Hospitals around the nation are taking this opportunity to show their support. 

The Downtown Somerville Alliance joined with Robert Wood Johnson University Hospital/Somerset and the Babs Siperstein Proud Center unveiled a 75-foot mural to celebrate influential figures in the LGBTQ+ community. 

The installation features icons like Harvey Bernard Milk, state icons like Christian Fuscarino of Garden State Equality, local icons like LGBTQ+ rights attorney Frank Morano of Bound Brook and many more.

Newark Beth Israel Medical Center and Children's Hospital of New Jersey, held a flag raising ceremony. President and CEO Darrell Terry Sr. said, "This month we are proud to raise the LGBTQ+ flag and to raise awareness about the disparities that impact this community."

The following flags will be on display in one of the hospital's main corridors throughout the month of June: Transgender Pride Flag, Philadelphia People of Color Flag, Gender Fluid Pride Flag, Intersex Pride Flag, Coexist Flag, Progress Pride Flag, Ally Flag, Pansexual Pride Flag, Nonbinary Pride Flag, Equality Pride Flag, and the Bisexual Pride Flag.

The University of Kansas Medical Center is hosting a Biographical Posters event where you can learn about the background and careers of several LGBTQIA+ community members as well as their journey to KU Medical Center. Spotlights will be shared via social media and the diversity intranet site. Digital posters can be seen here.

Johns Hopkins Medicine is hosting discussion panels, workshops, film screenings and listening sessions covering important LGBTQ+ topics.

As well as hosting educational awareness programs, UNC Health and UNC School of Medicine are handing out “Ask me about my pronouns”, “LGTQ Ally” and other pins and badges with information on LGBTQ Health Disparities.

More than half of patients in the LGBTQ community report having faced discrimination in a healthcare setting. In order to improve LGBTQ+ care, hospitals must become allies for this community and combat any discrimination. 

LGBTQ+ health is a growing national concern due to increasing evidence of health care disparities experienced by the LGBTQ+ community.

LGBTQ+ people face many barriers within health care, including discrimination, ignorance, and fear. So it can be difficult for these patients to confide in and trust healthcare providers. However, there are things that can be done to make patients feel more comfortable.

According to a Johns Hopkins Nursing article by Alex Nava, small but powerful expressions of affirmation and acceptance of support like wearing a rainbow pin, tells the patient that you see them and they are welcome there.

Increasing your knowledge of LGBTQ+ health can help you provide more culturally sensitive care. There is plenty of educational content out there like the field guide published by the Joint Commission called, Advancing Effective Communication, Cultural Competency and Patient and Family-Centered Care for the LGBTQ+ Community. Healthy People 2020 is another great resource to check out.

You should be aware of using terms correctly and avoiding others that may offend someone. DiversityNursing.com offers a great glossary of terms to help you!

According to Nurse.org, a LGBTQ+ patient may “scan” an environment to determine if it is a safe place to reveal personal information. To make patients feel more at ease, they recommend your reception or waiting room area include:

• A visible nondiscrimination policy
• A rainbow flag, pink triangle, or other symbols of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ+ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

Your health organization should also use gender-inclusive medical forms.

You should ask the patient what pronouns they use. It is also important that you correct other staff members who may address the patient incorrectly, even when the patient isn't around.

Ask open-ended questions such as “Tell me about yourself? Are you involved in a relationship?” But don't assume anything, let the information they share guide the rest of your interview.

• Coming out
• Having children—reproduction or adoption
• Parenting and creating families
• Adolescence
• Aging
• Legal rights as parents and partners

We as Nurses can help LGBTQ+ patients feel safe and supported by implementing these suggestions.

LGBTQ+ people of all ages, races and ethnicities, religions, and social classes have experienced health inequalities.

According to the Office of Disease Prevention and Health Promotion (ODPHP) and healthypeople.gov, research suggests that LGBTQ+ individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBTQ+ individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBTQ+ individuals.

It is difficult to estimate the number of LGBTQ+ individuals and their health needs because most national or State surveys do not include sexual orientation and gender identity questions.

In order to document, understand, and address the environmental factors that contribute to health disparities in LGBTQ+ communities, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity (SOGI). This will allow researchers and policy makers to accurately characterize LGBTQ+ health and disparities.

The ODPHP and healthypeople.org research has found,

• LGBTQ+ youth are 2 to 3 times more likely to attempt suicide.
• LGBTQ+ youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• LGBTQ+ populations have the highest rates of tobacco, alcohol, and other drug use.

According to the Aging with Pride: National Health, Aging, and Sexuality/Gender Study, about 2.7 million U.S. adults 50 and older identify as LGBTQ+, including 1.1 million age 65 and older. Those numbers are expected to nearly double by 2060.

And among subgroups within the LGBTQ+ community, some are struggling with their health more than others:

• Both Hispanic and African-American LGBTQ+ older adults in the project are more likely to report having HIV than their white counterparts.
• Hispanic LGBTQ+ adults are more likely to report asthma, diabetes and visual impairment.
• African-American LGBTQ+ older adults are more likely to be obese and have high blood pressure.
• Native American LGBTQ+ older adults are less likely to report cancer than whites but more likely to report poor physical health, disability, obesity, asthma and cardiovascular disease.
• Asian/Pacific Islander LGBTQ+ older adults are more likely to have visual impairment.

Along with collecting SOGI information in national surveys and health records, other efforts needed to improve LGBTQ+ health disparities include,

• Better access to health insurance, employment, and housing
• More laws protecting against bullying in schools
• More social programs targeted to and/or appropriate for LGBTQ+ youth, adults, and elders
• Better access to health care providers who are knowledgeable and culturally competent in LGBTQ+ health
• Prevention of violence and homicide toward the LGBTQ+ community, and especially the transgender population

It is necessary that efforts are enhanced to improve LGBTQ+ health and eliminate disparities so LGBTQ+ individuals can lead long, healthy lives.

Healthcare organizations strive to provide culturally competent care for individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Recent changes in society, including the legalization of gay marriage have raised public awareness of LGBTQ issues. Yet many healthcare professionals lack knowledge in some areas when caring for LGBTQ patients.

Michael Johnson, PhD, RN, understands the barriers faced by LGBTQ patients and the assumption often made by healthcare professionals that all patients are heterosexual. 

According to a Nurse.com article, Johnson said, “Some members of the LGBTQ community avoid seeking healthcare services because of previous negative experiences in which they faced discrimination. Studies have shown most LGBTQ patients want to be able to share their sexual orientation or gender identity with their healthcare provider, but are often reluctant to open up because they fear they may be treated badly or even refused care."

LGBTQ individuals have a long history of discrimination at the individual and institutional levels, including the healthcare system. They may check to see if the environment is a safe place to reveal personal information, especially about sexuality. Some things an individual may take note of during their time in your waiting room area include:

• Your organization’s nondiscrimination policy: Is it in a visible location?
• A rainbow flag, pink triangle, or other symbol of inclusiveness
• Availability of unisex restrooms
• Health education literature with diverse images and inclusive language, including information about LGBTQ health
• Posters announcing days of observance such as World AIDS Day, Pride, and National Transgender Day of Remembrance

To understand LGBTQ populations and their health needs, it is important to first define the distinct core concepts of sexual orientation and gender identity. You can read about key LGBTQ terms here.

LGBTQ health requires specific attention from health care and public health professionals to address a number of disparities, including:

• LGBT youth are 2 to 3 times more likely to attempt suicide.
• LGBT youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol, and other drug use.

 

Nurses should avoid asking any unnecessary questions. People are sometimes curious about LGBTQ people and their lives, which can lead them to want to learn more by asking the patient questions. However, like everyone else, LGBTQ people want to keep their medical and personal lives private. Before asking any personal questions, first ask yourself: “Is my question necessary for the patient’s care, or am I asking it for my own curiosity?" If for your own curiosity, it is not appropriate to ask. Think instead about: “What do I know? What do I need to know? How can I ask for the information I need to know in a sensitive way?"

Effectively serving LGBTQ patients requires you to understand the cultural context of their lives, and to modify your procedures, behavior, and language to be inclusive, non-judgmental, and helpful at all times. By doing this, healthcare staff can help ensure that LGBTQ patients receive the level of care that everyone deserves. What helpful information can you add regarding this topic?

The PRIDE study is the first of its kind. It aims to follow the same large group of LGBTQ people over the span of the next few decades. Enrollement is open to anyone who resides within the United States, identifies as a gender or sexual minority, and is over 18, its enrollment has surpassed 6,000 since launching in May.

We still lack a comprehensive understanding of the ways that being an LGBTQ person can influence one’s overall health, or of health disparities within the LGTBQ community itself. Researchers, Juno Obedin-Maliver and Mitchell Lunn, at the University of California–San Francisco are hoping to close that gap.

“Sexual and gender minorities make up between 2 and 6 percent of the population, however sexual orientation and gender identity are rarely asked about in health studies and they’re not included in fundamental metrics like the Census,” said Juno Obedin-Maliver, one of the principal investigators with the landmark effort, which is aptly titled the Population Research in Identity and Disparities for Equality Study — more simply referred to as the PRIDE Study. “It’s critical we have visibility into the health and health care experiences of these populations so we know where to direct our efforts. Without data, we’re flying blind.”

One of the big barriers we often found trying to encourage people to teach medical students, doctors or other health care providers about LGBTQ+ people was they said, “Well, there wasn’t enough evidence about the health care needs of the community.” And we kept giving lectures and complaining that the studies weren’t being done. We knew that health disparities were there, but we didn’t know how bad, how deep, how broad the problems were, or how comprehensive, because there wasn’t inclusion often in national studies. So Mitch and I said, “We’re both researchers, we’re both clinicians. Let’s stop complaining and do something about it.”

The goal is to eventually enroll about 100,000 people and follow them over the next 30 years, collecting data through an annual questionnaire. Questions will cover a range of health and social topics, such as physical activity, sleep, mental health, quality of life, insurance status, emergency care use, access to care, income, educational attainment, and family and social connections. 

“People are excited — it feels like they’re hungry to be heard and represented,” Obedin-Maliver said. “The PRIDE Study is by and for the community. Yes, it’s academically rigorous, but it’s also a labor of love and a commitment to giving back.”

For more information or to enroll in the PRIDE Study, which is based at the University of California-San Francisco, visit https://pridestudy.org.