A Call to Action to Bring LGBT Health Disparities out of the Closet

There are too many LGBT patients who are uncomfortable discussing sexual orientation or gender identity with health-care providers -- and there are too many providers who need training on how to have these discussions with patients.
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Twenty-five years ago, the AIDS Memorial Quilt was displayed for the first time in Washington, D.C., and hundreds of thousands of people participated in a march for lesbian, gay, bisexual and transgender (LGBT) rights. The U.S. can celebrate progress on a few measures of social justice for the LGBT community -- yet the nation has barely begun to address the silent crisis of health disparities in LGBT populations.

There are too many LGBT patients who are uncomfortable discussing sexual orientation or gender identity with health-care providers because they fear judgment or discrimination -- and there are too many providers who need training on how to have these discussions with patients. This means that many LGBT patients forgo prevention screenings or seek care late in their illness or disease. And it means clinicians lack important information needed to make a diagnosis or recommend treatment options. The resulting tragedy is that the LGBT community suffers from worse health status in a number of health indicators, including cancer, heart disease and depression.

Building momentum

National Coming Out Day was created to raise awareness of and embrace and empower the LGBT community. This day recognizes something simple, yet elusive -- the freedom of people to be who they are. That freedom is unattainable until the LGBT community feels welcomed by the nation's health-care system.

Fortunately, beginning steps are under way that will lead to more personal and equitable care for LGBT patients. For example, the Institute of Medicine (IOM) published a landmark report in March 2011 titled "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding." A few months after the IOM report, the U.S. Department of Health and Human Services (HHS) announced a key advancement -- a timeline for implementing an IOM recommendation to integrate questions about sexual orientation and gender identity into HHS population health surveys.

Research provides insight

To help address the critical need for research, the UC Davis Comprehensive Cancer Center recently completed an anonymous online survey of Sacramento-area LGBT individuals. The survey collected information about health status, experiences with the health-care system and information relating to cancer.

• Only one-fourth of respondents rated their health-care provider as "excellent" in relating to them in terms of sexual orientation; less than 20 percent rated their provider as "excellent" in gender identity.

• Less than one-third of female respondents reported having recommended mammograms; only 19 percent of male respondents had a recommended prostate cancer test.

• Nearly half indicated that providers did not discuss cancer risks or how to reduce them.

The Comprehensive Cancer Center's Lesbian, Gay, Bisexual and Transgender Cancer Health Task Force plans to use the results to identify needs that can be addressed with additional research and outreach to health-care providers and members of the LGBT community.

Model solutions

UC Davis Health System is already taking action on a significant survey finding: a majority of LGBT individuals prefer sexual orientation and gender identity to be included in their medical records. Toward that end, we encourage our primary-care providers to learn their patients' sexual orientation and gender identity and we soon will record the information in our patients' electronic health records.

Other initiatives are ongoing at the health system to better serve LGBT health care needs. UC Davis School of Medicine integrates LGBT health issues into medical school curricula, we created educational materials and training modules to guide our health-care providers in interactions with LGBT patients, and we are developing a web-based list of providers who identify themselves as LGBT-friendly.

Passion makes a difference

The devastating impact of HIV/AIDS on gay men was one of the reasons I became an infectious disease physician and researcher. I saw firsthand in the early days of the epidemic the tragic consequences of the disease -- too many people dying alone, rejected by family and society. I saw health professionals too often reluctant to provide clinical care. I saw too slow a public health response and too low a priority given to AIDS research funding. I saw the unconscionable impacts of discrimination, prejudice and stigma toward those suffering from the illness, which compounded the difficulties of fighting the virus. These experiences catalyzed my passion to advocate for those with HIV infection whose lives would improve with greater understanding from care providers and society. We have made much progress, but we still have far to go.

Every American has the fundamental right to know that health care will be provided without judgment or discrimination. As Martin Luther King, Jr. said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." National Coming Out Day is our opportunity to raise our voices together to proclaim that health-care disparities experienced by the LGBT community are unacceptable and that we commit to creating a health-care system that ensures better health for all.

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