When it comes to accessing quality healthcare in the United States, people in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community may still be experiencing discrimination due to their sexual identity or HIV status.
According to a Lambda Legal report published in 2010, LGBTQ patients frequently face refusals of care, discriminatory treatment, prejudicial policies, and disrespectful attitudes.
How have things improved since this landmark study was released?
The disproportionate number of gay and transgender people living with HIV makes this group especially vulnerable to discriminatory treatment.
Dr. Alexis Chavez, a resident psychiatrist at University of Colorado Health (UCHealth) and the leader behind Colorado’s first LGBTQ clinic, told Healthline that “LGBTQ patients with HIV that I’ve seen have told me that sometimes healthcare providers don’t really want to touch them as much, or the provider used some excessive precautions even though it’s well-treated, well-controlled HIV where the rates of transmission are very low.”
Chavez thinks the situation has improved, but not enough.
“I think that things are getting better over the years. The report from Lambda Legal was published in 2010. This was before gay marriage was legalized. It also would have been before Medicare removed the transgender exclusionary ban, so I think some things are certainly improving. But, I think that we definitely have quite a ways to go from here.”
The report found that more than 10 percent of LGB respondents have dealt with harsh language from healthcare professionals. A similar percentage report having had healthcare professionals use excessive precautions or refuse to touch them. More than 12 percent of respondents reported being blamed for their health status.
Nelson Vergel, a 34-year HIV survivor and founder of PoWerUSA.org and ExcelMale.com, recalled, “In the ’90s, most of us would not disclose our HIV status to dentists since they were particularly ill-informed. As recently as the early 2000s, I saw a colorectal doctor who made it obvious that he was terrified to examine me. My response was to inform my online community not to see him, ever.”
Discrimination is an ongoing issue
More than half of all respondents reported having experienced some form of discrimination when trying to access healthcare.
Chavez considers this an ongoing issue.
“I would say that there’s certainly still discrimination, and on a number of different levels. Whether it’s providers refusing to use certain pronouns or people asking excessively about your genitals when you’re only going in for a cold or the flu — you know, things that don’t really matter,” she said.
“For many years, even though I had health insurance, it refused to cover any care for me. There was an exclusion on transgender care which my healthcare providers interpreted to mean that they wouldn’t provide any care at all to transgender people, routine stuff, like going to the doctor or getting my cholesterol checked. I couldn’t do any of this because I had to pay for everything out of pocket, even though I had insurance,” Chavez explained.
Dr. Philip J. Cheng has seen it personally.
Cheng, a urology resident at Harvard’s Brigham and Women’s Hospital in Boston, nicked himself three years ago while preparing a patient living with HIV for surgery.
Cheng recently told The New York Times that after the accident, he took a one-month course of Truvada, an antiretroviral therapy, to prevent transmission.
After that month, he continued taking Truvada to protect himself while having sex with other men.
However, when Cheng tried to purchase long-term disability insurance, he was told by his health insurer that he could only have a five-year policy because he was taking Truvada.
So, Cheng stopped taking it, and got a lifetime disability policy from another insurer.
Cheng and other healthcare experts told The Times this is discrimination that punishes people who practice preventative medicine.
One likened it to not insuring motorists because they wear a seat belt.
Affordable Care Act’s impact
Nonetheless, experts say there has been some improvements under the Affordable Care Act.
According to Dr. Hector Ojeda-Martinez, an infectious disease specialist affiliated with the LGBTQ health division of infectious diseases and STAR Program at the SUNY Downstate Medical Center in Brooklyn, “Since the Affordable Care Act became law, access to care has increased among LGBTQ individuals. This is important as LGBTQ people have higher rates of HIV, particularly among black and Latino [men having sex with men], sexually transmitted infections, higher rates of depression, and cigarette smoking.”
Ojeda-Martinez adds that “changes are being made to ensure that LGBT individuals have positive experiences when accessing care. While there are still disparities that exist, I am hopeful that we will continue to see improvements in safety, inclusivity, healthcare metrics, and other measures of equality in the coming years.”
It chips away self-esteem
Healthcare discrimination can be subtle.
“Most doctors know they can be sued, so they won’t say anything straight out,” said Vergel. “But, they will act dismissively and may refuse to set up a follow-up appointment. It happened to me with a doctor who made me feel that I was a contaminated and irresponsible human being. I should have said something right then, but was too shocked to act. Every time someone discriminates against you, a chip is taken off as if you were a stone sculpture.”
Vergel says discrimination is still a problem.
“Yes, there is still discrimination, for sure. I still hear horror stories from LGBTQ people in my online networks about healthcare discrimination, particularly when someone is HIV-positive,” he said.
However, he sees some progress.
“Most people don’t know that HIV care is the most successful socialized medicine model in the United States for a particular disease,” Vergel said. “The Ryan White federally funded system treats men and women with HIV who have no insurance for free or at a very low cost in all bigger cities in the U.S.”
“The unfortunate reality is that we still see this kind of discrimination,” Chavez added. “That’s one reason why, here at UCHealth, we started a clinic specifically for LGBTQ folks at the mental health clinic.”
Helping healthcare providers
UCHealth is making a difference with training.
“Although we can say that every provider should have a certain level of competence with these things and be able to see any patient without discrimination, the unfortunate reality is that we still see it and it’s still happening,” Chavez said.
“So we’re trying to take the lead on training people and helping people understand how they can give the best care to the LGBTQ community,” she explained. “Many people want to do the right thing, but they don’t know how, and I optimistically like to extend them that benefit of the doubt.”