Rainbow Access Initiative: Training Introduction

TOPIC INDEX

Breaking Down Barriers to
Culturally Competent Health Care

LGBT individuals have been marginalized by some segments of the health professions. Historically, their sexual orientations and gender diversity were labeled deviant or pathological by many in the medical and psychiatric community. As a result, many gays and lesbians do not disclose their sexual orientation to their health care providers (Cochran & Mays, 1988). Consequently, many LGBT individuals, particularly transgender individuals, are reluctant to use mainstream health care services and are medically underserved; however, LGBT health advocates and professionals have lobbied for changes in mainstream professional organizations that have resulted in policy statements addressing the needs of LGBT clients and the formation of official LGBT affiliates, such as the American Psychological Association's Task Force on the Status of Lesbian and Gay Psychologists and the American Psychiatric Association's Committee on Gay, Lesbian, and Bisexual Issues. Although these changes have been important steps in establishing ethical guidelines for appropriate care, many health and mental health treatment providers remain uncomfortable with sexual diversity and continue to discriminate against LGBT clients.

A survey of the membership of the American Association of Physicians for Human Rights (now called the Gay and Lesbian Medical Association) (1994) found that, of 711 members, 52 percent had observed the denial of care or the provision of suboptimal care to lesbian and gay clients. Eighty-eight percent heard colleagues make disparaging remarks about their lesbian and gay clients. However, 64 percent of the members stated that it is important for clients to reveal their sexual orientation but also noted they risk receiving substandard care when doing so. Transgender individuals are even more marginalized and are often denied care, and LGBT individuals of color may experience racial bias in addition to homophobia. Thus, sensing these prejudices, many LGBT persons have not used the health care system adequately. Their hesitation to seek health care may result in later diagnoses of illnesses, which results in poorer treatment outcomes. Many physicians are ignorant of the special health concerns of LGBT individuals, such as the possibility of anal warts in gay men or the surgical and hormonal treatment options for transgender individuals.
[The above is from "A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals," published by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatments (www.samhsa.gov), 2001]

LGBT people experience the same kinds of disparities as people of color. Both groups receive lower quality medical care than 'straights' and whites. The result is misdiagnosis, improper treatment, greater disease, and premature death. Among the many causes for this are a shortage of minority physicians, inadequate insurance coverage, and stereotyping and bias due to homophobia among nurses, doctors and medical students. (Some studies show that as many as 96% of lesbian women anticipate negative reactions from practitioners if they are open about their sexuality). And many insurance plans exclude illnesses and treatments specific to sexual orientation and gender identity. The shortcomings are many. Those in the health and human services field need to improve, but we needn't sit back and wait for them to become better. Those of us in the LGBT communities can help them along.

Two Major Barriers
Two of the major barriers to quality health care facing members of the LGBT community involve language and confidentiality.

Language
It's essential that your practitioner use the right language and understand its impact when addressing you. The language he or she uses should be inclusive, respectful, and comfortable for you. We've provided a list of definitions you can print out and provide to your practitioner to help him or her use the appropriate terms. You can also keep a copy of this list as a reference for the remainder of this course.

Confidentiality
Confidentiality is a ground rule for discussions of LGBT issues, but very often, within work environments, it's not possible to ensure protection for everyone. LGBT people are particularly vulnerable when it comes to confidentiality. For example, many of us may be uncomfortable attending open sessions. Providers should know this and they should do everything possible to assure that your confidentiality will be respected. If you have concerns about confidentiality, make them known.

Additional barriers to quality health care include internalized fears, external conditions, and institutional traditions and practices.

Internalized Barriers
Oddly enough, we may have grown up learning to hate those who are like us and develop a hatred of ourselves because of our gender identity or sexual orientation. But we know, at some level, that we are what we have been taught to hate. It's not unlike the reaction of many minorities who have been raised in the predominant culture. This is not something your provider can 'heal', but it is something you can become aware of and overcome. (For help with this, contact your coach.)

External Barriers
If our expectation is that we will to be treated differently by a practitioner or their support staff, we may feel anxiety and avoid seeking medical or mental health care. But we are just as entitled to quality health care as everyone else and since our medical and mental health are essential parts of our lives, we should expect treatment that is no different from that accorded to anyone else. If you sense, in any way, that the treatment you receive is not equivalent to that given to others, you should make it clear to your practitioner or provider that you expect nothing less. They may simply be uncomfortable with LGBT issues. More than likely they have not been taught in medical school how to deal with these issues and so it becomes incumbent upon us to guide them. Bring them material to read or refer them to the professional version of this course.

Institutional Barriers
Society's institutions (i.e.: churches, government, clinics and hospitals, the courts) have long-established practices that inhibit open and honest communication. For example, in a medical setting, practitioners may not allow a partner or significant other into into an exam room or make the partner or significant other feel uncomfortable when present. Likewise, barriers are created by HMO's that exclude gay and lesbian partners from health insurance benefits. The same is true of social agencies that deter LGBT's from legally adopting children or receiving reproductive technology. If this is the case with your church, clinic, hospital, or social agency, they need to be educated as well. Here are some things you can do to make that happen:

Identify appropriate training programs and have them contact your provider;

Refer the provider to these programs;

Ask the provider to change intake and assessment forms that routinely say "husband" and "wife;"

Explain to the provider that stereotypical assumptions about LGBT people are wrong and result in some LGBT people being "invisible." (There are LGBT people of color, LGBT poor, elderly LGBT's, and those living with disabilities, or for whom religion or parents make it difficult to come out to their medical professional);

Promote training in LGBT couple issues; identify therapists who specifically work with lesbian or gay male couples;

Provide your therapist with information on bisexual and transgendered people;

Encourage your employer to include health insurance programs that allow coverage for LGBT folk or their families;

Support the work of GLSEN and other organizations that are working to change attitudes toward LGBT youth who are often silenced or told that they are too young to know if they are gay;

Encourage your physician to routinely screen EVERYONE for STD's (They often make the assumption that because someone is married he or she does not engage in same-sex or non-monogamous sex.);

Provide information to physicians who make decisions about alternative reproductive methods, surrogacy, or adoption, or lawyers who provide advice on the legal implications of family-building within a homophobic culture;

CLICK HERE FOR