Each June, communities across the country celebrate Pride month to commemorate the 1969 Stonewall Riots, which served as a key moment in the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) civil rights movement. However, over 50 years later, the struggle for LGBTQ+ civil rights remain tumultuous despite recent victories such as the Supreme Court legalization of same-sex marriage and the recognition of sexual orientation and gender identity in federal employment protections, LGBTQ+ communities continue to face numerous challenges to economic, social, and health equity. LGBTQ+ people continue to experience frequent discrimination in the places they live, work, learn, play, and age. They experience higher rates of uninsurance, lower ability to afford their medications, and sometimes, denial of health care services compared to their cisgender straight peers. To improve LGBTQ+ population health, researchers need to identify approaches within and beyond health systems to support LGBTQ+ communities.
Presenting at the 2022 Annual Research Meeting
Earlier this month, I presented research at the 2022 Annual Research Meeting on the potential benefits of having an LGBTQ+ affirming provider. This project was led by Professor Tara McKay and is joint with postdoctoral fellow Harry Barbee and undergraduate researcher Judy Min at Vanderbilt University’s LGBTQ+ Policy Lab.
Our research objective was to understand the potential benefits of having an LGBTQ+ affirming provider on a variety of health and prevention outcomes.
Why might having an LGBTQ+ affirming provider matter?
LGBTQ+ people often want to make sure they will be safe if they share their sexual orientation or gender identity with their health care provider. They want to avoid being asked invasive questions, mistreated, or asked to leave the office entirely. Many LGBTQ+ people go to great lengths to find an affirming provider. To some, LGBTQ+ affirming care might mean being addressed with the correct pronouns or being able to fill out a form accurately. To others, it could reflect the way a front desk staff person asks about a spouse or partner. These actions signal that health care workers will acknowledge and treat LGBTQ+ patients in a supportive and dignified manner.
Having an LGBTQ+ affirming provider was associated with uptake of preventative care
In our study, we used data from the Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS), a longitudinal panel of LGBTQ+ adults ages 50-76 across the South. We asked if people had an LGBTQ+ affirming provider, if they had completed preventive services such as flu shots, HIV tests, and cancer screenings, and how they were managing a chronic disease, such as diabetes or a mental health condition.
We found that having an LGBTQ+ affirming provider was associated with higher rates of annual checkups, flu shots, HIV tests, colorectal cancer screenings, and management of a chronic mental health condition, compared with individuals whose regular health care provider was not LGBTQ+ affirming. While there is ample research highlighting the consequences of health care discrimination, our work begins to identify protective factors.
In follow up studies, we will explore what it means more concretely to be an affirming provider— from speaking to LGBTQ+ people in a way that makes them feel dignified and respected (such as using inclusive language in person or on health forms) to understanding more specific health needs of this population, such as the use of preexposure prophylaxis (PreP) for HIV prevention.
What can you do?
Below we provide a few recommendations that can be implemented at different levels to help ensure more inclusive and equitable access to care for people who are LGBTQ+.
For clinicians looking to learn more about working with LGBTQ+ patients, The National LGBTQIA+ Health Education Center offers continuing education “with the goal of optimizing quality, cost-effective health care” for LGBTQ+ populations. SAMSHSA also offers free continuing education trainings. Also consider sponsoring local Pride events, advocating for rainbow pins and pronoun stickers for staff, or connecting with LGBTQ+ non-profits to meet the needs of LGBTQ+ patients, staff, and clinicians in your own community.
For leaders in clinical education, we must also ensure that the next generation of health care leaders has the tools to work effectively and compassionately with LGBTQ+ patients. Half of medical school programs spend fewer than five hours on LGBTQ+ health topics. Across schools of medicine, nursing, and pharmacy, knowledge about LGBTQ+ health issues, families, and identities must be a core part of training to ensure equitable access, reduce disparities in health and aging, and create LGBTQ+ affirming environments.
For health system administrators, your institution can opt-in to participate in the Human Rights Campaign’s Healthcare Equality Index— a step-by-step resource guide to help organizations implement best practices in equitable and inclusive care for LGBTQ patients. Hospitals,
Federally Qualified Health Centers, student health centers, and public health department clinics are all eligible to participate; and participants are encouraged to phase in adoption of the Index over several years to eventually be recognized as a Leader in LGBTQ+ Healthcare Equality.
For health care benefit managers, ensure that health insurance plan offerings cover gender affirming care, or ask insurers to update their offerings if they don’t. In 2021, Aetna became one of the largest insurers to cover breast augmentation for transgender women. Several states have passed laws banning private insurers from categorically denying services for transgender beneficiaries, especially if the same services are covered for beneficiaries of different gender identities.
Our research at ARM 2022 found that having LGBTQ+ affirming provider is associated with greater uptake of preventive care, better patient-reported management of mental health conditions, and lower cognitive impairment among older LGBTQ+ adults in the U.S. South compared with the same population that receives regular care that is not perceived as affirming. To address LGBTQ+ health disparities and improve the aging experiences of LGBTQ+ adults, clinical education and health systems must expand formal and continuing education opportunities around LGBTQ+ medicine and adopt best practices for LGBTQ+ affirming care.