March 26–30, 2012 is National LGBT Health Awareness Week, highlighting the disparities in access to culturally competent care and positive health outcomes between lesbian, gay, bisexual, and transgender (LGBT) people and their heterosexual counterparts. The health of the LGBT community has long been at the heart of Fenway’s mission; and while we have seen great progress, we still have a long journey to true health equity.
LGBT people have unique health and wellness needs and continue to be impacted by health disparities. For instance:
Compared to other men, MSM are at increased risk of major depression during adolescence and adulthood, bipolar disorder; and generalized anxiety.
- Lesbian women are more likely than straight or bisexual women to be overweight and obese, increasing their risk for cardiovascular disease.
- In 2009, men who have sex with men (MSM) accounted for an estimated 2% of the U.S. population but accounted for 64% of new HIV infections.
- In one survey, 41% of transgender respondents had attempted suicide.
- LGBT young people represent an alarmingly high proportion of homeless youths across the U.S.—an estimated 20–40%.
- Many LGBT people turn to substance abuse to cope with increased stress. An estimated 20–30% of gay and transgender people abuse substances, compared to about 9% of the general population.
However, there have been many recent advances in the field of LGBT health. A year ago, the Institute of Medicine (IOM) issued a historic report on LGBT health that highlights a number of issues, including:
- LGBT youth have an elevated risk for attempted suicide and depression.
- LGBT adults lack access to providers who are knowledgeable about LGBT health needs and fear of discrimination in health care settings.
- LGBT elders are more likely to rely on friends and others as caregivers than biological family members, at least in part because they are less likely to have children.
- Research has not been conducted evenly across sexual and gender minority populations, with more research focusing on gays and lesbians than on bisexual and transgender people.
- Research has not adequately examined subpopulations, particularly racial and ethnic groups.
LGBT elders have higher rates of disability, depression, and loneliness compared to heterosexuals of similar ages.
The report also includes recommendations to better understand and address the unique health needs of LGBT Americans.
The U.S. Department of Health and Human services details a number of accomplishments in the area of LGBT health, including better data collection on LGBT populations and a multi-year HRSA grant to The Fenway Institute to create a national LGBT health technical assistance and training center for community health centers.
Still, our work is far from over. This year’s National LGBT Health Awareness Week focuses on four core principles:
Consumer Empowerment
Lesbian, gay, bisexual, and transgender individuals need to be educated about their health and empowered to discuss sexual orientation and gender identity with their providers. If you don’t feel comfortable with your current provider, there are resources to help you find LGBT-affirming care, including the Gay & Lesbian Medical Association provider directory.
Culturally Competent Services
Health care providers need more information and resources to help them better serve the LGBT community. To that end, The Fenway Institute has released policy briefs on Why and How to gather sexual orientation and gender identity data in a clinical setting. The Fenway Institute has also launched a website for the National LGBT Health Education Center, which will provide educational programming and consultation for health care organizations with the goal of eliminating health disparities among lesbian, gay, bisexual, and transgender people.
More than 20% of transgender survey respondents reported having to teach their doctor about transgender care.
We must also continue to work toward better access to these services for LGBT individuals and support policies that make this possible. Lesbian, gay, and bisexual Americans are roughly twice as likely to be uninsured as the general population—partly due to unequal legal recognition of their relationships and employment discrimination, including insufficient protection against being fired for sexual orientation or gender identity. If all employers offered domestic-partner benefits, the uninsured rates for same-sex and different-sex unmarried couples would decrease by as much as 43%.
Inclusive Policymaking
Congressional briefings are scheduled during LGBT Health Awareness but you can always advocate for more inclusive policies by contacting your local, state, and national representatives.
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Pre-exposure chemoprophylaxis (PrEP)—taking antiretroviral medications to prevent HIV transmission—could be a “game changer” for HIV prevention. PrEP has demonstrated partial efficacy with men who have sex with men (MSM), transgender women, and heterosexuals in several recent studies. Recent modeling of PrEP implementation coupled with scaled up treatment predicts that PrEP could significantly reduce HIV incidence and prevalence. And if PrEP is accompanied by sustained care, behavioral interventions, and safety monitoring, PrEP need not lead to increased sexual risk behavior or drug resistance.