Healthcare Disparities in the LGBT+ Community

by Vaibhav Gupta

Three years ago, with the landmark Supreme Court ruling of Hodges v. Obergefell, the LGBT+ community celebrated its hard-earned victory of marriage equality. While justice has finally been recognized on love, LGBT+ individuals still suffer from the impact of health disparities that represent another arduous battle ahead.

Healthcare equity in the American LGBT+ community remains an unresolved issue. So far, there are few solutions and mounting evidence of unequal care in both prevention and treatment. A study conducted in a high school outside of Boston found that LGBT+ students were five times as likely to be suicidal and over three times as likely to participate in self harm behavior than heterosexual individuals. These mental health issues are attributed to two main factors: lack of acceptance by family members and society’s negative view of LGBT+ individuals. Despite definite progress, persistent discrimination can often result in what is called minority stress. Minority Stress, a term coined by the National LGBT Health Education Center, refers to the “discrimination, stigma and internalized homo- and transphobia experienced by LGBT individuals in their daily lives.” This stress has been correlated with higher rates of alcoholism, substance abuse, anxiety, depression and anorexia than are found in the general population. Estimates on the disproportionate impact of many other illnesses on the LGBT+ community remain unknown, as statistical studies are rarely conducted among non-heterosexual groups. However, as more research is being conducted, a new health risk has emerged: cancer.  

The mere mention of the word “cancer” shocks people to the core; a diagnosis can change lives in a matter of seconds. According to “Health Care Disparities Among LGBT Youth,” lesbian and bisexual women have a higher risk of breast, ovarian and endometrial cancers than non-LGBT women. They also tend to have fewer preventative screenings, such as mammograms. Similarly, gay and bisexual men have an increased risk of prostate, testicular or colon cancers but do not receive proportionate screening. This increases the risk that a cancer will only be discovered at its later stages, making it much more difficult to treat. These inequities can be traced in part to doctors who receive a “median of only five hours during all of clinical training [about] LGBT issues at United States and Canadian medical schools.” This lack of proper education fosters an incomplete understanding of the LGBT+ community, which further intensifies disparities in health care by putting more individuals at risk. Therefore, advocates for reform state that further medical training on LGBT+ issues is needed – a median of only five hours during all of medical school is simply unacceptable. This must change if society is to eliminate health inequality and usher in quality care for all individuals.

Although new aspects of LGBT+ health inequity are discovered every day, an age-old illness still remains. Human Immunodeficiency Virus, otherwise known as HIV, still haunts the LGBT+ community as the HIV and subsequent AIDS epidemic of the 1980s claimed the lives of countless individuals. While HIV prevention has been relatively successful, the disease still disproportionately affects LGBT+ indivduals, who represent about eighty-three percent of those infected. However, new treatments have emerged – most notably “cocktail therapy,” which relies on a mixture of drugs administered at once. Nonetheless, prevention is a much better option than management. This is where the introduction of a new drug known as PrEP (pre-exposure prophylaxis), which reduces the risk of HIV infection by more than 90 percent, has revolutionized care. The medication has gained traction but remains out of reach for the community due to a lack of exposure.

Sex education is another crucial aspect of prevention. However, a 2013 National School Climate Survey found that fewer than five percent of LGBT+ students received health classes with information specific to their sexual orientation. As a result, a majority of LGBT+ individuals are left unequipped with sufficient knowledge about safe sex. This lack of formal education combined with the fact that individuals may feel hesitant to research safe sex information themselves creates very real consequences – STD infection rates are significantly higher among LGBT+ individuals. Therefore, schools must redesign their sex education systems to increase inclusivity and reduce stigmatization for LGBT+ individuals so that all populations can benefit from safe sex.

Once shrouded in fear, the outlook for the LGBT+ community has now turned into one of tentative hope. As societal attitudes have become more accepting, health issues that plague the community are beginning to be brought to center stage. Given that being gay was considered to be a mental disorder only thirty years ago, the development of programs by medical schools targeted towards aiding the LGBT+ community represents the first step in an important shift. The battle for health equity will continue. However, much like the LGBT+ community has encountered and overcome numerous challenges like this before, health equity across the sexuality spectrum will one day be achieved.