While HIV/AIDS prevention and treatment remains a prominent issue in the lesbian, gay, bisexual and transgender community, staff at health centers such as Howard Brown Health Center in Chicago know it is not the only public health issue of concern to the population.
Take smoking, for example. With research showing smoking rates are higher in the LGBT population, the center partnered with the University of Illinois at Chicago to launch “Bitch to Quit,” a smoking cessation study and intervention that provides nicotine replacement therapy and trained smoking cessation counselors to help people quit. More than 250 LGBT smokers have joined the study since 2012.
“There are very high rates of smoking in the LGBT population, particularly among bisexual men and women, as well as lesbian women,” said David Munar, Howard Brown’s president and CEO. “We’re excited about it because nicotine addiction and smoking correlates with so many chronic health conditions.”
Health centers geared toward LGBT health, such as Howard Brown, are scattered throughout the nation. But while there are go-to places, LGBT public health advocates know that to fully address these needs, health care facilities and health professionals nationwide need better education on LGBT health issues.
Those issues are many and varied. For example, according to the “Women’s Health USA 2011” report from the Health Resources and Services Administration, lesbian women were less likely than heterosexual and bisexual women to get a Pap smear, a preventive exam that could detect cervical cancer. The report also said lesbian and bisexual women were more likely to smoke and binge drink compared to heterosexual women.
Older LGBT adults and seniors are more likely to have higher rates of chronic mental and physical illness, higher rates of HIV/AIDS and more likely to forgo necessary medical care, according to a report released in 2010 by the National Resource Center on LGBT Aging. Related issues include not having health care professionals experienced in dealing with with an aging LGBT population or being placed in nursing facilities that may be unwelcoming to LGBT seniors, the report stated.
Other prominent issues for the LGBT population lie in chronic disease, such as cardiovascular disease and diabetes, said Grant Farmer, PhD, MPH, MA, an adjunct assistant professor at the St. Louis University Center for Outcomes Research, postdoctoral research fellow at the Washington University in St. Louis and member of APHA’s LGBT Caucus of Public Health Professionals.
“We have the demonstrated evidence-based interventions for HIV and STDs, which are primarily for gay and bisexual men, but we don’t really have a good intervention for reducing cancer risk among lesbian and bisexual women,” Farmer told The Nation’s Health. “We don’t have good interventions for smoking (among LGBT people). We try to tailor them but we’re really lacking (evidence) in that area.”
Recent changes made under the Affordable Care Act are expected to have an impact on LGBT health care access. For example, LGBT people with pre-existing conditions, such as diabetes or HIV/AIDS, who previously did not qualify can now sign up for insurance plans and also access care through the health insurance marketplace, which opened Oct. 1. Some LGBT adults may also have access to health insurance for the first time in their lives if their state expanded Medicaid benefits. The law also stresses the importance of improving cultural competency among health care professionals so they better understand how to treat LGBT patients.
The path to better LGBT health was also paved by a June 2013 Supreme Court decision to change a section of the Defense of Marriage Act. A portion of the law in which the federal government did not recognize same-sex marriage when it came to accessing federal benefits was declared unconstitutional. Because of the decision, people in same-sex marriages are now eligible for spousal protections and benefits such as Medicare, Social Security and retirement benefits.
While awareness of LGBT health needs is growing, advocates say research needs to play catch-up with health issues. Research is lacking on health disparities among LGBT youth, elders and racial and ethnic groups within the LGBT community, according to “The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding,” a 2011 Institute of Medicine report. Research tends to focus more on gay men and lesbians, and less on bisexual and transgender people, the report stated.
Transgender people are less likely to access health care and face higher rates of discrimination, suicide and HIV, according to a 2010 report from the National Gay and Lesbian Task Force and the National Center for Transgender Equality.
Some health providers are working to address those issues, however, including Callen-Lorde Community Health Center in New York City, which offers a transgender health program with prostate, chest and breast exams, sexually transmitted infection screening and hormone care. The center served about 1,200 transgender patients in 2013, said Peter Meacher, MD, FAAFP, AAHIVS, Callen-Lorde’s chief medical officer.
Oftentimes, discrimination, stigma and feelings of exclusion keep people from across the LGBT spectrum from accessing health care. Making small changes, such as using the words “partner” instead of husband or wife on patient intake forms, can make people feel more welcome in health facilities, said Harvey Makadon, MD, director of the National LGBT Health Education Center.
Such information can be shared via LGBT health training for public health workers and medical professionals, which is often lacking, Farmer said.
“On average, doctors don’t get a lot of time within their medical training dealing with health disparities in general,” Farmer told The Nation’s Health. “And most of them don’t have any exposure to LGBT health issues. So when they encounter these people within their setting, not all of them know what to do.”
But programs such as the LGBT Health Initiative at Columbia University Medical Center in New York City are working to address that. The initiative began in 2012 as a way to assess the university’s needs in training physicians how to care for LGBT patients and integrate LGBT curricula into medical school coursework, said initiative co-director Walter Bockting, PhD, professor of medical psychology in psychiatry and nursing at Columbia University.
The initiative has resulted in a medical school student rotation with Callen-Lorde to get students comfortable with serving LGBT populations. Bockting also teaches a course that focuses on LGBT mental health for psychiatric resident doctors, and is also working with Columbia’s School of Nursing on developing a research agenda for LGBT health.
“We feel academic health centers such as Columbia University Medical Center have a really important role to play to promote LGBT health, given (that it’s) been neglected in medical education,” Bockting told The Nation’s Health. “It’s something they want to be able to respond to, and feel competent, but they’re not getting enough training.”
For more information on LGBT health, including training opportunities, visit www.hrsa.gov/lgbt or www.lgbthealtheducation.org.
Editor's note: This article was corrected post-publication.
- Copyright The Nation’s Health, American Public Health Association