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LGBT health disparities[edit]

[edit]

See also: LGBT issues in medicine

Sexuality is a basis of health discrimination and inequity throughout the world. Homosexual, bisexual, transgender, and gender-variant populations around the world experience a range of health problems related to their sexuality and gender identity,[1][2][3][4] some of which are complicated further by limited research.

In spite of recent advances, LGBT populations in China, India, and Chile continue to face significant discrimination and barriers to care.[4][5][6] The World Health Organization (WHO) recognizes that there is inadequate research data about the effects of LGBT discrimination on morbidity and mortality rates in the patient population. In addition, retrospective epidemiological studies on LGBT populations are difficult to conduct as a result of the practice that sexual orientation is not noted on death certificates.[7] WHO has proposed that more research about the LGBT patient population is needed  for improved understanding of its  unique health needs and barriers to accessing care.[8]

Recognizing the need for LGBT healthcare research, the Director of the National Institute on Minority Health and Health Disparities (NIMHD) at the U.S. Department of Health and Human Services designated sexual and gender minorities (SGMs) as a health disparity population for NIH research in October of 2016.[9]For the purposes of this designation, the Director defines SGM as "encompass[ing] lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms."[9] This designation has prioritized research into the extent, cause, and potential mitigation of health disparities among SGM populations within the larger LGBT community.

While many aspects of LGBT health disparities are heretofore uninvestigated, at this stage, it is known that one of the main forms of healthcare discrimination  LGBT individuals face is discrimination from healthcare workers or institutions themselves.[10] A systematic literature review of publications in English and Portuguese from 2004-2014 demonstrate significant difficulties in accessing care secondary to discrimination and homophobia from healthcare professionals.[11] This discrimination can take the form of verbal abuse, disrespectful conduct, refusal of care, the withholding of health information,  inadequate treatment, and outright violence.[11][12] In a study analyzing the quality of healthcare for South African men who have sex with men (MSM), researchers interviewed a cohort of individuals about their health experiences, finding that MSM who identified as homosexual felt their access to healthcare was limited due to an inability to find clinics employing healthcare workers who did not discriminate against their sexuality.[13] They also reportedly faced "homophobic verbal harassment from healthcare workers when presenting for STI treatment."[13] Further, MSM who did not feel comfortable disclosing their sexual activity to healthcare workers failed to identify as homosexuals, which limited the quality of the treatment they received.[13]

Additionally, members of the LGBT community contend with health care disparities due, in part, to lack of provider training and awareness of the population’s healthcare needs. [12] Studies regarding patient-provider communication in the LGBT patient community show that providers themselves report a significant lack of awareness regarding the health issues LGBT-identifying patients face.[12] As a component of this fact, medical schools do not focus much attention on LGBT health issues in their curriculum; the LGBT-related topics that are discussed tend to be limited to HIV/AIDS, sexual orientation, and gender identity.[12]

Among LGBT-identifying individuals, transgender individuals face especially significant barriers to treatment. Many countries still do not have legal recognition of transgender or non-binary gender individuals leading to placement in mis-gendered hospital wards and medical discrimination.[14][15] Seventeen European states mandate sterilization of individuals who seek recognition of a gender identity that diverges from their birth gender.[15] In addition to many of the same barriers as the rest of the LGBT community, a WHO bulletin points out that globally, transgender individuals often also face a higher disease burden.[16] A 2010 survey of transgender and gender-variant people in the United States revealed that transgender individuals faced a significant level of discrimination.[17] The survey indicated that 19% of individuals experienced a healthcare worker refusing care because of their gender, 28% faced harassment from a healthcare worker, 2% encountered violence, and 50% saw a doctor who was not able or qualified to provide transgender-sensitive care.[17] In Kuwait, there have been reports of transgender individuals being reported to legal authorities by medical professionals, preventing safe access to care.[14] An updated version of the U.S. survey from 2015 showed little change in terms of healthcare experiences for transgender and gender variant individuals. The updated survey revealed that 23% of individuals reported not seeking necessary medical care out of fear of discrimination, and 33% of individuals who had been to a doctor within a year of taking the survey reported negative encounters with medical professionals related to their transgender status.[18]

The stigmatization represented particularly in the transgender population  creates a health disparity for LGBT individuals with regard to mental health.[10] The LGBT community is at increased risk for psychosocial distress, mental health complications, suicidality, homelessness, and substance abuse, often complicated by access-based under-utilization or fear of health services.[10][19] Transgender and gender-variant individuals have been found to experience higher rates of mental health disparity than LGB individuals. According to the 2015 U.S. Transgender Survey, for example, 39% of respondents reported serious psychological distress, compared to 5% of the general population.[18]

These mental health facts are informed by a history of anti-LGBT bias in health care. [20] The Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a disorder until 1973; transgender status was listed as a disorder until 2012.[20] This was amended in 2013 with the DSM-5 when "gender identity disorder" was replaced with "gender dysphoria," reflecting that simply identifying as transgender is not itself pathological and that the diagnosis is instead for the distress a transgender person may experience as a result of the discordance between assigned gender and gender identity.[21]

While aspects of LGBT treatment are under investigation given the NIHMD designation, in the past, LGBT health issues have received disproportionately low levels of medical research, leading to difficulties in assessing appropriate strategies for LGBT treatment. For instance, a review of medical literature regarding LGBT patients revealed that there are significant gaps in the medical understanding of cervical cancer in lesbian and bisexual individuals[22] it is unclear whether its prevalence in this community is a result of probability or some other preventable cause. It is incorrectly assumed that LGBT women have a lower incidence of cervical cancer than their heterosexual counterparts, resulting in lower rates of screening.[22]  Such findings illustrate the need for continued research focused on the circumstances and needs of LGBT individuals.

  1. ^ Burke, Jill. "Understanding the GLBT community." ASHA Leader 20 Jan. 2009: 4+. Communications and Mass Media Collection.
  2. ^ Gochman, David S. (1997). Handbook of health behavior research. Springer. pp. 145–147. ISBN 9780306454431
  3. ^ Trettin, S.; Moses-Kolko, E.L.; Wisner, K.L. (March 2006). "Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population". Archives of Women's Mental Health. Springer. 9 (2): 67–73. doi:10.1089/jwh.2010.2328.
  4. ^ a b Burki T. “Health and rights challenges for China's LGBT community” The Lancet Volume 389, No. 10076, p1286, 1 April 2017 http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30837-1.pdf Retrieved September 30, 2017.
  5. ^ Brocchetto M. “Being gay in Latin America: Legal but deadly”. CNN. Updated March 3, 2017 http://www.cnn.com/2017/02/26/americas/lgbt-rights-in-the-americas/index.html. Retrieved September 30, 2017.
  6. ^ Soumya, Elizabeth Soumya Elizabeth. "Indian transgender healthcare challenges". www.aljazeera.com. Retrieved 2017-10-01.
  7. ^ Tracy, J. Kathleen; Lydecker, Alison D.; Ireland, Lynda (2010-01-24). "Barriers to Cervical Cancer Screening Among Lesbians". Journal of Women's Health. 19 (2): 229–237. doi:10.1089/jwh.2009.1393. ISSN 1540-9996.
  8. ^ CD52/18: Addressing the causes of disparities in health service access and utilization for lesbian, gay, bisexual and trans (LGBT) persons. 2013. http://www.who.int/hiv/pub/populations/lgbt_paper/en/
  9. ^ a b Meads, C.; Pennant, M.; McManus, J.; Bayliss, S. (2011). "A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands Region of the UK compared to published UK research". Retrieved 5 February 2014.
  10. ^ a b c Kalra G.,Ventriglio A., Bhugra D. Sexuality and mental health: Issues and what next? (2015) International Review of Psychiatry Vol. 27 , Iss. 5.
  11. ^ a b Alencar Albuquerque, Grayce; de Lima Garcia, Cintia; da Silva Quirino, Glauberto; Alves, Maria Juscinaide Henrique; Belém, Jameson Moreira; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; do Nascimento, Vânia Barbosa; da Silva Maciel, Érika (2016-01-14). "Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review". BMC International Health and Human Rights. 16. doi:10.1186/s12914-015-0072-9. ISSN 1472-698X. PMC 4714514. PMID 26769484.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  12. ^ a b c d IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press.
  13. ^ a b c Lane, T. et al. "‘They See You as a Different Thing’: The Experiences of Men Who Have Sex with Men with Healthcare Workers in South African Township Communities." Sexually Transmitted Infections 84.6 (2008): 430–433. sti.bmj.com. Web. 7 Feb. 2014.
  14. ^ a b "Rights in Transition". Human Rights Watch. 2016-01-06. Retrieved 2017-10-01.
  15. ^ a b "Transgender people face challenges for adequate health care: study". Reuters. Fri Jun 17 08:31:14 UTC 2016. Retrieved 2017-10-01. {{cite news}}: Check date values in: |date= (help)
  16. ^ "Ensuring an inclusive global health agenda for transgender people". World Health Organization. doi:10.2471/BLT.16.183913.
  17. ^ a b Jaime M. Grant, Lisa A. Mottet, & Justin Tanis. (2010). National Transgender Discrimination Survey Report on health and health care. National Gay and Lesbian Task Force.
  18. ^ a b James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
  19. ^ Office of Disease Prevention and Health Promotion. "Lesbian, Gay, Bisexual, and Transgender Health". HealthyPeople.gov. Retrieved September 16, 2017.
  20. ^ a b Understanding the Health Needs of LGBT People. (March 2016) National LGBT Health Education Center. The Fenway Institute.
  21. ^ Parekh, Ranna (February 2016). "What Is Gender Dysphoria?". American Psychiatric Association. Retrieved September 16, 2017.
  22. ^ a b Tracy, J. Kathleen; Lydecker, Alison D.; Ireland, Lynda (2010-01-24). "Barriers to Cervical Cancer Screening Among Lesbians". Journal of Women's Health. 19 (2): 229–237. doi:10.1089/jwh.2009.1393. ISSN 1540-9996.
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