LGBTQIA Healthcare Disparities - Healthcare Guild

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Healthy People 2020 - Lesbian, Gay, Bisexual and Transgender Health

From: Healthy People 2020 -
LGBT individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs. Research suggests that LGBT
individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders,1 substance abuse,2, 3 and suicide.4 Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community.5 Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.6

The LGBT companion document to Healthy People 2010 highlighted the need for more research to document, understand, and address the environmental factors that contribute to health disparities in the LGBT community.

Why Is LGBT Health Important?

Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include:

  1. Reductions in disease transmission and progression

  2. Increased mental and physical well-being

  3. Reduced health care costs

  4. Increased longevity

Efforts to improve LGBT health include:

  1. Curbing human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) with interventions that work.8

  2. Implementing antibullying policies in schools.9

  3. Providing supportive social services to reduce suicide and homelessness risk among youth.9

  4. Appropriately inquiring about and being supportive of a patient’s sexual orientation to enhance the patient-provider interaction and regular use of care.10

  5. Providing medical students with access to LGBT patients to increase provision of culturally competent care.11

Understanding LGBT Health

Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.13

Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

  1. Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits

  2. Lack of laws protecting against bullying in schools

  3. Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders

  4. Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:

  1. Safe schools, neighborhoods, and housing

  2. Access to recreational facilities and activities

  3. Availability of safe meeting places

  4. Access to health services

LGBT health requires specific attention from health care and public health professionals to address a number of disparities, including:

  1. LGBT youth are 2 to 3 times more likely to attempt suicide.14

  2. LGBT youth are more likely to be homeless.15, 16, 17

  3. Lesbians are less likely to get preventive services for cancer.18, 19

  4. Gay men are at higher risk of HIV and other STDs, especially among communities of color.20

  5. Lesbians and bisexual females are more likely to be overweight or obese.21

  6. Transgender individuals have a high prevalence of HIV/STDs,22 victimization,23 mental health issues,24 and suicide25 and are less likely to have health insurance than heterosexual or LGB individuals.26

  7. Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.27

  8. LGBT populations have the highest rates of tobacco,28, 29 alcohol,29, 30 and other drug use.29, 31, 32

Continuing Issues in LGBT Health

A number of issues will need to continue to be evaluated and addressed over the coming decade, including:

  1. Prevention of violence and homicide toward the LGB community, and especially the transgender population

  2. Nationally representative data on LGBT Americans

  3. Resiliency in LGBT communities

  4. LGBT parenting issues throughout the life course

  5. Elder health and well-being

  6. Exploration of sexual/gender identity among youth

  7. Need for a LGBT wellness model

  8. Recognition of transgender health needs as medically necessary

The Affordable Care Act Helps LGBT Americans

From: The Affordable Care Act Helps LGBT Americans - Report Brief -

For too long, too many hard working Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hard-working families the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition. And it includes substantial new benefits for lesbian, gay, bisexual and transgender (LGBT) Americans.

All Americans will have the security of knowing that they don't have to worry about losing coverage if they're laid off or change jobs. And insurance companies now have to over your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.

Affordable Coverage Options

There is evidence suggesting that at least a portion of the LGBT community is disproportionately uninsured. The Affordable Care Act is making new coverage options available to Americans, including those without access to coverage through a domestic partner or employer and those with pre-existing health conditions:

• Already, more than 50,000 Americans who were uninsured due to a pre-existing health condition have accessed health insurance at an affordable rate through Pre-Existing Condition Insurance Plans.

• Young adults are able to remain on a parent’s health plan until they turn 26 if the plan covers dependent children and if coverage isn’t offered to them through their job. This means that over 2.5 million young adults have gained coverage because of the new health care law.

• In 2014, Affordable Insurance Exchanges, new competitive insurance marketplaces, will be established where millions of Americans and small businesses will be able to purchase affordable coverage and have the same choices of insurance that members of Congress will have. Tax credits will help middle class families afford health insurance.

• Also in 2014, the Medicaid program will be expanded to cover Americans with income at or below 133 percent of the federal poverty level. This expansion will increase access to care for low-income adults.

New Patient Protections

New benefits will make it easier for consumers to get and keep their health coverage. For example, the Affordable Care Act prohibits insurance companies from refusing coverage to, or limiting the benefits of, children (under age 19) because of a pre-existing medical condition. In 2014, discriminating against anyone with a pre-existing condition will be illegal. The law also prohibits insurance plans from canceling an individual’s coverage just because of a mistake on his or her paperwork. And because of the law, insurers can no longer turn someone away just because he or she is lesbian, gay, bisexual, or transgender.

LGBT individuals have encountered discrimination in the health care system for decades, and many studies have shown that LGBT people are affected by chronic disease at a higher rate than other Americans. The new law has already made significant progress toward ending some of the worst insurance company abuses and helping ensure that LGBT Americans have access to coverage when they need it most. For example, the Affordable Care Act ends lifetime dollar limits on key benefits and restricts annual dollar limits until they are ended in 2014, allowing for long-term comprehensive treatment of chronic diseases.

In addition, the federal website designed to help all consumers find the health insurance best suited to their needs makes it easy to locate health insurers that cover domestic partners.'s insurance and coverage finder now includes a “same-sex partner” filter, allowing same sex couples to eliminate plans which would not cover both people from the list of plans available in their area. Consumers looking for information on domestic partner coverage will also have access to’s regular features, such as the ability to sort based on the enrollment, a plan’s out-of-pocket costs or other categories. The same-sex partner filter is also available for small employers looking for information on the small group market.

Preventive Care for Better Health

The Affordable Care Act is taking significant steps toward improving access to preventive care. Many health plans now must cover recommended preventive care services without charging deductibles, co-payments or co-insurance. Already, 54 million Americans have coverage for preventive services without additional cost sharing.

In addition, the Affordable Care Act is funding preventive efforts for communities, including millions of dollars to use evidence-based interventions to address tobacco control, obesity prevention, HIV-related health disparities, better nutrition and physical activity. The Department of Health and Human Services is working with community centers serving the LGBT community to employ proven prevention strategies.

Improving Care and Fighting Disparities

The Affordable Care Act is making other investments that will help address health disparities that exist within the LGBT community. Funding is going toward building a more diverse and culturally competent health care workforce, as well as investing in community health centers to serve up to 20 million more patients. And through increased research and data collection on health disparities, policymakers will have the knowledge and tools they need to continue to address in the health needs and concerns of LGBT people.

Small Business Tax Credits

Tax credits for small businesses included in the Affordable Care Act will benefit an estimated two million workers who get their insurance from an estimated 360,000 small employers who will receive the credit in 2011. In 2014, small business owners will get more relief with tax credits and affordable insurance choices in the new Affordable Insurance Exchanges in every State. For the first time, they will have a marketplace where they can see and compare their health plan options in one place, and insurers will have to actively compete for their business.


Historically, people living with HIV and AIDS have had a difficult time obtaining private health insurance and have been particularly vulnerable to insurance industry abuses. Currently, fewer than one in five (17 percent) people living with HIV have private insurance and nearly 30 percent do not have any coverage. The Affordable Care Act makes it easier for people living with HIV/AIDS to get coverage through the Pre-Existing Condition Insurance Plans. The ban on pre-existing condition exclusions will extend to all Americans in 2014, along with expanded Medicaid eligibility, the creation of Affordable Insurance Exchanges, and new tax credits for middle class families will help more Americans afford insurance.

People with HIV/AIDS also face barriers to obtaining care from qualified providers. Consistent with the goals of the President’s National HIV/AIDS Strategy, the Affordable Care Act makes considerable strides in addressing these concerns and advancing equality for people living with HIV and AIDS. Investments in prevention, as well as improving care coordination, will help people living with HIV/AIDS get the treatment they need.

Also see:  Building on the Affordable Care Act to Make the Health System Work for Young Gay Men

Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding

From: The Institute of Medicine of the National Academies - Report Brief - March 2011

Lesbian, gay, bisexual, and transgender individuals have unique health experiences and needs, but as a nation, we do not know exactly what these experiences and needs are. To advance understanding of the health needs of all LGBT individuals, researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. Building a more solid evidence base for LGBT health concerns will not only benefit LGBT individuals, but also add to the repository of health information we have that pertains to all people...(Click Here to download the full report)

Health of Lesbian, Gay, Bisexual, and Transgender Populations

From: The Lancet: The World’s Leading General Medical Journal, Volume 377, Issue 9773, Page 1211, 9 April 2011

The past 20 years have seen dramatically increased visibility of people who are lesbian, gay, bisexual, and transgendered (LGBT) in US society. This diverse and vibrant group are now active and welcome members of many communities across the country and are well recognized and praised for being a major force in the positive global response to the HIV/AIDS epidemic. Substantial achievements to advance their health status, such as the established partnership between LGBT organizations and foundations or corporations to access funding to address the HIV/AIDS epidemic, have been achieved. Yet, there is still a great deal to learn. Basic demographic data are lacking for LGBT populations in the USA. Many health practitioners are not well informed about how to care for LGBT populations, or about what constitutes healthy development of LGBT adolescents, and they do not understand enough about the development of sexual orientation, diverse gender identities, LGBT families, or the effect of stigma and discrimination on health.

To develop a more complete picture of the health status of people who are LGBT and to identify research gaps, the Institute of Medicine (IOM) released The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Using a life-course perspective, the report examines the health status of these populations in three stages: childhood and adolescence, early and middle adulthood, and later adulthood. The IOM finds that, although these populations share the full range of health risks with the rest of society, they are also exposed to a unique yet poorly understood set of additional threats. For instance, compared with their heterosexual peers, members of the LGBT community are at increased risk of suicide, depression, harassment, and victimization, and they may have higher rates of smoking and alcohol use. It is worth noting that for teenage lesbian and bisexual girls, pregnancy rates may be higher than those of heterosexual girls. Girls may deliberately attempt to get pregnant in an effort to define and strengthen an identity for themselves. In early and middle adulthood, lesbians and bisexual women may also be at higher risk for breast cancer and for obesity, while men who have sex with men, especially those who are HIV-positive, are at increased risk for anal cancer. Meanwhile, in some studies, lesbians were significantly more likely than heterosexual women to receive a diagnosis of heart disease.

In later adulthood, LGBT are less likely to have a partner or children to provide them with health and social care, resulting in their greater dependence on friends, caregivers, and LGBT organizations. There has been clinical concern about rates of diabetes, ovarian disease, and stroke among transgender older people potentially as a result of long-term hormone treatments. Furthermore, HIV/AIDS remains a crucial health issue for gay or bisexual men, transgender women, and LGBT who inject drugs. Additionally, people who are LGBT face barriers to equitable health services in the USA, such as difficulty in obtaining health insurance, fear of discrimination from providers, and a shortage of providers who are well trained in their health needs.

When addressing health issues for people who are LGBT, researchers are confronted with many challenges, one of which is a lack of systematically or accurately collected data. The LGBT community make up a sometimes hidden minority of the population and it is hard to recruit sufficient numbers to studies to yield meaningful results. Moreover, the LGBT acronym does not represent a homogeneous group, and it can be difficult to define and measure sexual orientation and gender identity. Additionally, some LGBT individuals are reluctant to disclose details about themselves and take part in research, because research topics may be sensitive and can be perceived as intruding on privacy.

The availability of high-quality evidence is central to improvement of knowledge. The report calls for a research agenda to collect data, examine appropriate methodology, train researchers, and develop policy on research participation, provided that privacy concerns can be satisfactorily addressed. It also emphasizes several priority research areas—demography, social influences, health-care inequalities, and intervention research.

The IOM report is groundbreaking. Not only does it review the LGBT community's health needs comprehensively, but it also brings a sea change in establishing educational and research guidance for LGBT health. Actions in response to the report are already underway, such as integration of LGBT health education into medical school curricula. The full participation of the LGBT community in their health and wellbeing is crucial. Above all, scientific and clinical engagement is essential to improve awareness and understanding of LGBT health issues, and to incorporate them into mainstream health care.

The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth

Mark L. Hatzenbuehler, PhD

Mailman School of Public Health, Columbia University, New York, New York

Published online April 18, 2011  PEDIATRICS - Journal of the American Academy of Pediatrics (doi:10.1542/peds.2010-3020)

According to an April 2011 article in the Journal PEDIATRICS, “When communities support their gay young people, and schools adopt anti-bullying and anti-discrimination policies that specifically protect lesbian, gay, and bisexual youth, the risk of attempted suicide by all young people drops, especially for LGB youth.”  - Mark L. Hatzenbuehler, PhD

OBJECTIVE To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.

METHODS A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.

RESULTS Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]).

CONCLUSIONS This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation–related disparities in suicide attempts.

Read Pediatrics Journal Article

Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9--12

From: Centers for Disease Control and Prevention Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, June 2011


Problem: Sexual minority youths are youths who identify themselves as gay or lesbian, bisexual, or unsure of their sexual identity or youths who have only had sexual contact with persons of the same sex or with both sexes. Population-based data on the health-risk behaviors practiced by sexual minority youths are needed at the state and local levels to most effectively monitor and ensure the effectiveness of public health interventions designed to address the needs of this population.

Results: Across the nine sites that assessed sexual identity, the prevalence among gay or lesbian students was higher than the prevalence among heterosexual students for a median of 63.8% of all the risk behaviors measured, and the prevalence among bisexual students was higher than the prevalence among heterosexual students for a median of 76.0% of all the risk behaviors measured. In addition, the prevalence among gay or lesbian students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in seven of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management). Similarly, the prevalence among bisexual students was more likely to be higher than (rather than equal to or lower than) the prevalence among heterosexual students for behaviors in eight of the 10 risk behavior categories (behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management).

Across the 12 sites that assessed sex of sexual contacts, the prevalence among students who had sexual contact with both sexes was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 71.1% of all the risk behaviors measured, and the prevalence among students who only had sexual contact with the same sex was higher than the prevalence among students who only had sexual contact with the opposite sex for a median of 29.7% of all the risk behaviors measured. Furthermore, the prevalence among students who had sexual contact with both sexes was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in six of the 10 risk behavior categories (behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, and weight management). The prevalence among students who only had sexual contact with the same sex was more likely to be higher than (rather than equal to or lower than) the prevalence among students who only had sexual contact with the opposite sex for behaviors in two risk behavior categories (behaviors related to attempted suicide and weight management).

Interpretation: Sexual minority students, particularly gay, lesbian, and bisexual students and students who had sexual contact with both sexes, are more likely to engage in health-risk behaviors than other students.

Public Health Action: Effective state and local public health and school health policies and practices should be developed to help reduce the prevalence of health-risk behaviors and improve health outcomes among sexual minority youths. In addition, more state and local surveys designed to monitor health-risk behaviors and selected health outcomes among population-based samples of students in grades 9--12 should include questions on sexual identity and sex of sexual contacts....(Click Here to download the CDC report)

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