THE STATE OF LGBTQ HEALTH & WELLNESS

BY DAMIAN BAYLES

Lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) people are members of every community. They are diverse, come from all walks of life, include people of all races and ethnicities, all ages, all socioeconomic statuses, and from all parts of the country. Even with the positive steps that have been taken over recent decades, LGBTQIA people continue to face significant barriers to accessing healthcare services including discrimination from insurers and medical providers, as well as the delays or denials of care. The healthcare needs of LGBTQIA people are sometimes unique and often overlooked, contributing to health disparities experienced by vulnerable populations.

Experts report that LGBTQIA people often avoid seeking out medical care or refrain from “coming out” to their healthcare provider. Marginalized people can face discrimination in any venue, and LGBTQIA patients could be made to feel that their gender identity or sexual preference is itself an illness or mental disorder. This compromises an entire community of lesbian, gay, bisexual, transgender, nonbinary, gender fluid, intersex, and asexual people who are at increased risk for several health threats when compared to heterosexual or cisgender peer groups:

1. Gay men are at higher risk of HIV and other sexually transmitted infections.

2. Lesbians and bisexual women are less likely to get cancer screenings.

3. Transgender people (people who identify as a different gender from what they were assigned at birth) are among the least likely to have health insurance, can face certain health risks from gender affirming hormone therapy, and may experience atypical heart attack symptoms and/or cancers.

4. Nonbinary and gender fluid people (people who identify as neither or both male and female) are at greater risk of violence and negative mental health outcomes. Intersex people (people born with reproductive or sexual anatomy that doesn’t fit the binary definitions of female or male) often have trouble finding doctors familiar enough with their bodies to provide appropriate care, or even filling out forms/paperwork with only binary gender options.

5. Asexual people (people with little-to-no sexual attraction towards others) commonly have aspects of their care neglected by providers.

Mental health is a major concern for LGBTQIA people often dealing with physical or emotional abuse, body dysmorphia, depression, or feeling unsafe at school or work, and there are areas of the United States where finding sympathetic and appropriate help can be prohibitively difficult. Research has found that LGBTQIA people are 29% more likely to experience memory problems as compared to peers with similar characteristics such as age, gender, race and ethnicity, marital status, and income. Other studies have found that

LGBTQIA people are more likely to report feeling sad or hopeless for periods of at least two weeks and having contemplated or attempted suicide. Even as youths, LGBTQIA people are at higher risk of violence, substance abuse, homelessness, and other suicide-related behaviors. While LGBTQIA people have not been found to be more susceptible to contracting COVID-19, the mental strains of the ongoing pandemic have affected their communities in unique and harmful ways. Some health habits common among LGBTQIA people have raised additional concern among health professionals. LGBTQIA people use tobacco at a rate 50% higher than the general population and COVID-19 often presents as a respiratory illness that has proven especially harmful to smokers. Higher rates of HIV and cancer in the LGBTQIA community mean a larger percentage have a compromised immune system which increases vulnerability to coronavirus infection.

The Affordable Care Act (ACA) had helped over 10 million Americans gain insurance during the Obama administration, including many LGBTQIA people. The ACA prohibited health insurance marketplaces from discriminating based on sexual orientation and gender identity, and the 2015 Supreme Court ruling of Obergefell v. Hodges recognizing marriage between gay and lesbian couples throughout the United States led to more married couples to access their spouse’s health insurance.