LGBT minority group health disparities
editSexuality has become a major source of discrimination and inequity in health. Homosexual, bisexual, transgender, and gender variant populations experience a wide range of health problems related to their sexuality and gender identity.[1][2][3] One of the egregious inequities that faces LGBT individuals is discrimination from healthcare workers or institutions.[4] In a study of the quality of healthcare for South African MSM (Men who have Sex with Men), a cohort of individuals were interviewed about their health experiences. The researchers found that homosexually identified MSM felt that their access to healthcare was limited by their inability to find clinics that employed healthcare workers who did not discriminate based upon their sexuality.[5] They often faced "homophobic verbal harassment from healthcare workers when presenting for STI treatment."[5] Further, those MSM who did not identify as homosexuals did not feel comfortable discussing—and did not disclose—their sexual activity with healthcare workers, limiting the quality of their sexual healthcare.[5] Similarly, a 2010 survey of transgender and gender variant people in the United States revealed that transgender individuals faced a significant level of discrimination with 19% of individuals having experienced a healthcare worker refuse care because of their gender, 28% having faced harassment from a healthcare worker, 2% having faced violence, and 50% having a doctor who was not able or qualified to provide transgender care.[6] An updated version of the survey from 2015 showed little change in terms of healthcare experiences for transgender and gender variant individuals in the United States. In the 2015 survey, 23% of individuals reported not seeking necessary medical care for fear of discrimination and 33% of individuals who had been to a doctor within a year of the survey reported negative encounters with medical professionals related to their transgender status.[7]
Stigmatization, or the fear of it, by mental health professionals leads to an even greater health disparity for LGBT individuals in regards to mental health.[4] The LGBT community has increased risk of psychosocial distress, poor mental health, suicidality, homelessness, and substance abuse, often combined with a fear or access-based under-utilization of health services.[4][8] Transgender and gender variant individuals experience an even greater mental health disparity than LGB individuals. The Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a disorder until 1973 but still listed transgender status as a disorder as recently as 2012.[9] This was finally 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 this discordance between assigned gender and gender identity.[10][11] According to the 2015 U.S. Transgender Survey, 39% of respondents reported serious psychological distress compared to 5% in the general population.[7]
Furthermore, healthcare for LGBT populations is hindered by a lack of medical research on such groups. Without the appropriate studies, it is difficult to assess what the proper strategies are for treatment of these groups. For instance, a review of medical literature regarding LGBT patients revealed that there is a significant gap in our understanding of breast cancer, which is more prevalent among lesbian and bisexual women.[12] It is unclear whether this is a result of probability or another preventable cause. Similarly, the review notes that it is generally assumed that these groups of women have a lower incidence of cervical cancer than their heterosexual counterparts, and as a result they have low rates of screening, despite the fact that it is unclear whether they are actually at a decreased risk for the disease.[12] In addition, it is difficult to conduct retrospective epidemiological studies on LGBT populations as a result of the practice that sexual orientation is not noted on death certificates.[13] Recognizing this research need, 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.[14] 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."[14] This designation prioritizes research into the extent, cause, and potential mitigation of health disparities among SGM populations.
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- ^ Burke, Jill. "Understanding the GLBT community." ASHA Leader 20 Jan. 2009: 4+. Communications and Mass Media Collection.
- ^ Gochman, David S. (1997). Handbook of health behavior research. Springer. pp. 145–147. ISBN 9780306454431. Preview.
- ^ 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. 9 (2). Springer: 67–73. doi:10.1089/jwh.2010.2328. PMC 3130513. PMID 21668380.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ Office of Disease Prevention and Health Promotion. "Lesbian, Gay, Bisexual, and Transgender Health". HealthyPeople.gov. Retrieved September 16, 2017.
- ^ Understanding the Health Needs of LGBT People. (March 2016) National LGBT Health Education Center. The Fenway Institute.
- ^ Parekh, Ranna (February 2016). "What Is Gender Dysphoria?". American Psychiatric Association. Retrieved September 16, 2017.
- ^ Parry, Wynne (June 3, 2013). "Normal or Not? When One's Gender Identity Causes Distress". Live Science. Retrieved September 16, 2017.
- ^ a b Tracy, J. Kathleen; Lydecker, Alison D.; Ireland, Lynda (February 2010). "Barriers to cervical cancer screening among lesbians". Journal of Women's Health. 19 (2). Mary Ann Liebert, Inc.: 229–237. doi:10.1089/jwh.2009.1393. PMC 2834453. PMID 20095905.
- ^ 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.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b Pérez-Stable, Eliseo J. (October 6, 2016). "Director's Message". National Institute on Minority Health and Health Disparities. Retrieved September 16, 2017.