Take a look at the latest headlines on LGBTQ+ healthcare, and the landscape might seem clear-cut: on the right, states are restricting access to gender-affirming care, and on the left, there’s a commitment to protecting this vital need.
However, that’s not the whole story surrounding care access.
It is true that in the majority of the U.S. (including 28 states, five territories, and Washington, D.C.) access to transgender care continues to grow. In 14 of those states and Washington, D.C. a “shield” law actually cements that right, creating a much-needed haven for those fleeing states with cruel bans.
But while bans to gender-affirming care grab headlines, the health disparities affecting LGBTQ+ people are much more far-reaching. Nationwide, a shortage of providers trained in LGBTQ-affirming care continues to negatively impact every part of the queer community.
Ensuring more culturally competent providers in the U.S. is the answer.
According to the latest Gallup Poll, LGBTQ people make up 7.2% of the population. Members of this population have worse health outcomes than their heterosexual peers, including higher rates of certain types of cancer, heart disease, and mental health issues. Despite this urgent need, while 1,000 people graduated with a cardiology fellowship in the U.S. last year, few fellowships focus on LGBTQ+ health despite a similar size population (5-6% of U.S. adults have heart disease). Furthermore, approximately one in three LGBTQI+ adults reported encountering at least one kind of negative experience or form of mistreatment when interacting with a mental health professional in the past year; this includes four in 10 LGBTQI+ people of color and more than half of transgender or nonbinary individuals.
The issue is not a shortage of science, evidence, or guidelines. Every major healthcare association and specialty group has published meaningful documentation for providing care to LGBTQ+ people at every life stage. We know when to screen for cervical cancer in lesbian and bisexual women, how gay and bisexual men benefit from pre-exposure prophylaxis (PrEP), and how to provide hormone therapy to affirm gender expression in transgender and nonbinary people.
We also have quality case studies for what good care looks like. The success of the nation’s federally qualified healthcare centers like Whitman Walker in Washington, D.C., Howard Brown in Chicago, and Mazzoni Center in Philadelphia prove the LGBTQ community will flock to well-trained staff and accurate education programs to receive better care. Our hard fought for and self-organized nonprofit healthcare systems have filled in the gaps and millions of us have benefited from their support.
However, these advances have not translated into a major shift in the healthcare workforce’s understanding and ability to provide the care that the LGBTQ+ community needs.
LGBTQ+ people live everywhere and we deserve healthcare wherever we are, and within every specialty needed throughout our lifetime. As large healthcare systems and state governments stall progress, it’s the private sector that is now working to make this access possible.
Most recently, Gaingels, an LGBTQIA+/Allies private investment syndicate, reaffirmed its commitment to funding LGBTQ+ entrepreneurs. Among Gaingels’ portfolio are LGBTQ+ healthcare startups leading the charge in connecting queer people with culturally competent providers.
LGBTQ+ owned start-up Violet has stepped in to provide a “badging” system for cultural competency in LGBTQ+ care. The goal is to make a provider’s cultural competency training known to patients, so they will be more likely to seek care from them.
Plume is a transgender led start-up in the virtual care space that provides hormone therapy to thousands. On their platform, culturally competent and sensitive nurse practitioners, DOs, and MDs are credentialed in multiple states using evidence-based guidelines to inform patient care from the safety of their own homes. Many of these patients lacked access to care because of their location or the fear of facing hostility and discrimination locally. Plume’s ultimate goal is that after receiving the hormone therapy they need, they will be better able to engage more of the medical system for other primary care and specialty care needs.
For those of us in states who have affirmed the right to healthcare for transgender people and other LGBTQ+ people, it is time to raise the bar. As we continue to push for the large systemic changes needed to ensure everyone receives the care they need free from discrimination, I’m thankful for the start-ups picking up the baton to make a difference in new and creative ways. LGBTQ+ people deserve rights and innovation too.
Jessica Halem, MBA, is the senior director of Eidos, the LGBTQ+ Health Initiative at the University of Pennsylvania. She serves on the Board of the Tegan and Sara Foundation where she helped to launch the revamped LGBTQ+ Healthcare Directory.
Disclosures
Eidos works with Gaingels, Violet, and Plume but does not benefit financially from those relationships. Halem was employed by Howard Brown from 2004-2006.
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