Introduction: From 1969’s Stonewall to the 2015 Obergefell v. Hodges Supreme Court decision for equal marriage, the expansion of LGBTQ+ rights in the United States has been an important development in the past century. LGBTQ+ health is a crucial part of this progress.
While awareness of LGBTQ+ health and rights has been given more attention in the past decade, there is also legislation in multiple states seeking to limit LGBTQ+ visibility and efforts to create curriculum censorship. There is a trend of cutting back reimbursable gender-affirming health services and debating anti-transgender policies across the country.
Pride month is a great time to reexamine LGBTQ+ health disparities and highlight leaders, organizations, and the history of efforts to improve LGBTQ+ health.
LGBTQ+ Health Disparities: A systematic review found that LGBTQ+ people experience poorer physical and mental health compared with their heterosexual and cisgender peers. Disparities exist in mental and behavioral health, substance use, risky sexual behaviors, self-harm, and suicide. LGBTQ+ youth experience more suicidality, depression, and substance use than their heterosexual and cisgender peers. In another survey, researchers observed mental health disparities among the LGBTQ+ population in mental distress and in lifetime depression diagnoses. Intersectional differences are also a factor, as LGBTQ+ people of color may experience “double discrimination.” While these differences are real, the root causes of LGBTQ+ health inequities are too often rooted in stigmatizing values, norms, and institutions. Stigma is a social determinant of LGBTQ+ health. In addition, where LGBTQ folks live, their socioeconomic status, their socially constructed race, and ethnicity affect outcomes. Mistrust of the health care system, due to stigma, also contributes to poor health. Health care providers and public health practitioners can consider the multiple marginalized identities of the people they serve to best address disparities.
Initiatives for LGBTQ+ Health: LGBTQ+ leaders have long worked to bring attention, resources, awareness, and care to the health of their communities. The Gay Men’s Health Crisis (GMHC) and ACT UP were instrumental in bringing attention to the HIV/AIDS epidemic early in its emergence in the United States in the 1980s and 1990s. The persistence of their members led to improved awareness and health care access for LGBTQ+ people. In the years since, these organizations have fought for HIV/AIDS research and contributed to the development of Pre-Exposure Prophylaxis (PrEP) which can help to prevent HIV infection and antiretroviral therapy to treat HIV/AIDS and allow people with HIV to live longer, healthier lives.
Better Data: Federal Roadmap for LGBTQ+ Health Equity: Addressing disparities begins with measuring them to understand the magnitude and nuances of their sources. The federal government is seeking to collect sexual orientation and gender identity data wherever demographic data is collected. This initiative across agencies aims to improve the understanding of issues affecting LGBTQ+ people to direct the resources of the U.S. Department of Health and Human Services to serve their needs and work towards health equity.
Conclusion: We are at a crossroads for reducing homophobia and transphobia, creating inclusive policies, and improving LGBTQ+ health. But the anti-LGBTQ+ backlash sweeping the nation creates urgency in safeguarding rights and ultimately health. Interventions such as education about sex, gender diversity, bullying, and suicide prevention can mitigate disparities and create environments where LGBTQ+ are affirmed. Gender-affirming, culturally competent, and family-centered care are key to improving health equity for LGBTQ+ people.
Steps to improve laws affecting LGBTQ+ people include incorporating voices from the community, interviewing LGBTQ+ individuals and their families, elevating experts, focusing on facts and research over opinion, and examining the context of how bills impact LGBTQ+ populations. By incorporating these best practices when considering legislation affecting LGBTQ+ individuals, we can create systems which allow LGBTQ+ communities to flourish.
Interested in learning more?
Check out our webinar on LGBTQ+ health here.
Check out our podcast Understanding Representation in Methodology and the Effects of Policies on People of Color and LGBTQ+ People here.
Check out our partner organizations, HealthHIV and National Coalition for LGBTQ Health’s work related to this topic.