Essay: Disparities faced by the LGBTQIA community and their effects

In the United States, lesbian, gay, bisexual, transsexual, and transgendered individuals repeatedly face barriers and stigma when trying to access healthcare. As a result, the lesbian, gay, bisexual, transsexual, transgender, queer, intersex, and asexual (LGBTQIA+) community is at higher risk of developing depression, substance use disorders, sexually transmitted infections, and other health complications than cisgender (non-transgender) and heterosexual individuals. In order to amend and combat these health disparities, research devoted to the LGBTQIA+ community must increase, funding for health initiatives and programs must increase, health services that could directly address these health disparities within these communities must be created, and a more established health education system that would acknowledge the concepts of gender and sexuality must be formed. Through these initiatives, the barriers and stigma that many individuals consistently face will be eliminated.
The disparities that the LGBTQIA+ population face are often rooted in historical stigmatization. Despite the fact that homosexuality has been present across countless societies throughout history, the concept of sexuality did not enter the realm of medicine and science until the nineteenth century (“Context for LGBT”). These deviations from the established standards of gender and sexual “normalcy” were deemed abnormalities and were thus targeted for extensive scientific examinations. The contemporary interpretations of sexual orientation were shaped as a result of these investigations. Sigmund Freud in particular was influential in the formation of perception of sexuality. In his “Three Essays on the Theory of Sexuality,” Freud described homosexuals as “absolutely inverted” individuals who cannot “perform the normal sexual act” (Freud 8). While Freud did believe that homosexuality was less optimal than heterosexuality, he did not see it as an illness (Freud 9). However, many of his contemporaries considered homosexuality as a pathological behavior (Rado 197). As a result, same-sex behavior was viewed as a classification of mental illness throughout most of the twentieth century. Accordingly, homosexual behavior and activity was largely illegal throughout most of the twentieth century (“Context for LGBT”). These societal pressures ultimately shape the experiences of the LGBTQIA+ community. Despite social conditions improving over the recent years, the LGBTQIA+ community still faces these ingrained ideologies in countless settings.
These stigmatizations penetrate deeply into all aspects of health including research and public health. Ultimately, this contributes to inadequate health research devoted to LGBTQIA+ health. Researchers Coulter, Kenst, Bowen, and Scout found that while The National Institutes of Health funds large amounts of medical research, it has historically contributed very research to this field (Coulter et al. 109). Because of this lack of research, many of the health disparities that these populations are suffering from cannot be amended. In a study done by the Institute of Medicine, only 0.5% of studies were devoted to LGBT health between 1989 and 2011 (Coulter et al. 107). Of these studies, 79.1% focused primarily upon the HIV and AIDS epidemic while sub, alcohol use, tobacco use, and health care services were studied on a much smaller scale (Coulter et al. 107). In addition to the lack of research done on other disparities plaguing these communities, the majority of funding went towards research devoted towards men in the LGBTQIA+ community, while research on transgender health and women’s health were insufficient by comparison (Coulter et al. 107). Because of the social repercussions that could arise from identifying as LGBTQIA+, many individuals do not disclose their sexuality or gender identity.
Many gender-variant individuals do not identify within traditional gender identities, therefore when given restrictive options to describe their identity in a survey, complications can arise (“Conducting Research” 91). Research methods that do not encompass the multiple facets of the LGBTQIA+ community can lead to the reporting of incorrect data, further complicating the research involving these populations.
One of the most infamous examples of health disparities in the LGBTQIA+ community was the AIDS and HIV epidemic in the 1980’s and 90’s. Early into the outbreak, AIDS was often referred to as GRID, Gay-Related Immune Disease, and was typified as an illness that affects homosexual men almost exclusively (Altman). Through the formation of this social construct, the disease became connoted with the LGBTQIA+ community as a whole. Subsequently, the stigma against these populations intensified greatly. Despite the fact that this issue arose nearly twenty years ago, a great deal of difficulty in ending this crisis still remains. There was only a small decrease of cases, from 17,357 in 1998 to 14,383 in 2009 (Gómez). This marginal decrease in the amount of AIDS cases can be attributed to a myriad of shortcomings in the American healthcare system. There is not universal distribution of anti-retroviral drugs in the United States. Instead, many individuals suffering from AIDS find themselves on a waitlist to receive drugs (Gómez). The sheer costs of antiretroviral drugs impede many from being able to get the treatment that they need. Even if an individual has insurance, their co-pays can often make cost-of-care expenses skyrocket (Vann and Haines). In a report released by the CDC, 60% of HIV-positive young people are unaware of their status, and approximately 26% of new HIV infections occur in people ages 13-24, a majority of which identify as gay or bisexual (Reynolds). The CDC and Congress have not created any programs that could fiscally support cities in need of combatting HIV and AIDS. The last program that was created was the Ryan White/CARE program in 1993, which provides health and support services to cities in need (Gómez). AIDS activists were present in the United States, but they were never integrated in the efforts to combat the AIDS crisis. Although the CDC reached out to activists throughout the 1980’s, the activists were never truly included in the agency’s actions (Gómez). Despite health initiatives to combat the AIDS and HIV epidemic, more must be done in order to effectively end the crisis. In addition to AIDS and HIV, LGBTQIA+ people also experience health disparities in mental health.
Historically, studies have touted that mental illness happens to the same degree in both heterosexual and homosexual populations. However, new research consistently contradicted these claims. It was found in recent studies that there are higher rates of major depression and generalized anxiety disorder in gay and lesbian youth, and higher rates of major depression in gay men than their heterosexual counterparts (DeAngelis). The contrast between these two populations leads many to question what conditions ultimately cause the higher rates of mental illnesses in the LGBTQIA+ populations. The root causes of these disorders is not yet determined, yet many feel that the social stigma and discrimination that many individuals face has a detrimental effect upon their mental health (DeAngelis). These social conditions have the potential to affect not only the mental health of these populations, but overall health as well.
Within LGBTQIA+ populations, alcohol and drug use is disproportionately high. Often times when faced with depression and mental illness, individuals will turn to alcohol, tobacco, and drug use in order to cope. Twenty to thirty percent of lesbian, gay, and transgender individuals abuse alcohol, while only 5 to 10 percent of the general population have problems with alcohol (Hunt). Lesbian, gay, and bisexual adults and youth are more than twice as likely to smoke cigarettes than heterosexuals (Krehely). In addition, men who have sex with men are 12.2 times as likely to use amphetamines and 9.5 times more likely to use heroin than men who do not have sex with men (Hunt). Ultimately, culturally incompetent healthcare services and societal pressures continue to perpetuate substance abuse in these populations.
When trying to amend the shortcomings of the American healthcare system when it comes to LGBTQIA+ health disparities, one of the first initiatives that must occur is the increase of funding in research devoted to LGBTQIA+ health. These research studies can bring the issues of substance abuse, mental health, HIV, and AIDS to the attention of more individuals within the LGBTQIA+ community. In recent years, Canada has greatly increased the funding of research on LGBTQIA+ health and HIV research studies. The increase in funding of this research occured largely in response to the surge in new HIV infections, especially amongst gay men (Lewis). As gay men and other members of the LGBTQIA+ community are becoming more involved in public health initiatives, interest in research pertaining to their communities’ increases (Lewis). The Canadian government was able to see how the present health conditions in these populations necessitated an increase in health research, and subsequently was able to provide these researchers with the resources they needed to understand the unique social determinants that these populations possess, and as a result the health disparities that disproportionately affect these populations can be better understood.
In the Boston Metropolitan Area, The Fenway Institute also contributes greatly to LGBT research initiatives. Dedicated to health and social research, The Fenway Institute is one of the leading centers focused on researching the disparities that the local LGBTQIA+ communities face. Through their innovative studies on HIV transmission and prevention, The Fenway Institute is recognized as one of the leaders of researching LGBTQIA+ health disparities (Weil 107). In 2007, The Fenway Institute was the first community-based organization funded by the National Institutes of Health (Weil 108). Through this funding, The Fenway Institute has been able to produce research on countless issues that pervade LGBTQIA+ communities.
In an attempt to solve the shortcoming of health research pertaining to the LGBTQIA+ populations, the United States must follow in Canada’s footsteps and invest more money in institutions that are dedicated towards researching health disparities and advancing the overall health of the LGBTQIA+ community. Rather than doing large and expensive studies, many researchers will elect to do smaller studies. Research done by Ilan Meyer found that these smaller studies are often done with convenience samples, comprised of people who are easiest to access, therefore the data tends to be erroneous or biased (Meyer “Why Lesbian, Gay, Bisexual, and Transgender Health?”). By increasing federal funding in institutions like The Fenway Institute, more large-scale research can be conducted. Health journals should be incentivized to fund more studies on non-HIV health issues, in order to shed light on LGBTQIA+ health issues that have been historically neglected. The improvement of research methods these studies use and the elimination of convenience samples in research would also allow for more accurate findings. Subsequently, the more research that is done on LGBTQIA+ health, the more informed the general public will be about prevalent health issues.
Looking at other countries and their responses to health disparities affecting the LGBT community, Brazil was able to effectively galvanize conversations about health needs and contemporary health issues affecting the LGBT community – in particular the AIDS epidemic. The Brazilian Congress in 1996 passed a federal law mandating for the universal distribution of antiretroviral medications (Gómez). Jose Serra, the country’s current Health Minister, made significant progress with access to medication. In 2001, the Brazilian government decided to break the patent on the antiretroviral drugs to treat AIDS and create their own generic forms of the drugs (Wadia). In addition to increasing the country’s budget for medical efforts committed to fighting AIDS, a sharp decline in HIV and AIDS cases was observed. In between the years 1996 to 2009, the number of cases dropped from 3,376 to 649 (Gómez). In addition to providing medication to populations in need, the Brazilian government also created programs that could provide financial support to cities trying to combat the disease. One of these programs, Fundo-a-Fundo Incentivos, provides cities in need with a monthly grant (Gómez). Funding for this program in particular has increased greatly over the past few years. In 2003, almost six hundred thousand reals were invested in the program, and in 2010 the funding increased to 1.5 billion reals, approximately 420 million dollars (Gómez). However, Brazil’s greatest asset in fighting AIDS was not only medical intervention, but also its engagement with civil society. By cooperating with activists in the LGBTQIA+ community and non-governmental organizations, the Brazilian government was able to format effective policies and inform the public through a variety of national programs (Gomez). Brazil’s progressive efforts to combat AIDS has contributed to eliminating one of the most prevalent health disparities that affects countless LGBTQIA+ communities across the globe.
Although progress has been made towards solving the AIDS crisis, several measures must be made in order to properly address the issue. By mirroring Brazil’s efforts, the United States can do so as well. One of the first initiatives to take would be to act on the inability of many people to access the drugs they need in order to treat HIV and AIDS. The federal government, like the government of Brazil, must invest more funding into initiatives directed towards those suffering from AIDS, particularly in the LGBTQIA+ populations. An increase in funding for anti-retroviral drugs would prove to have tremendously positive effects on those afflicted with HIV and AIDS, as seen with the sharp decline in cases in Brazil. By investing money into pharmaceutical companies to produce generic forms of these drugs, they could be easier to access by the entire population, and can ultimately allow those with HIV to be effectively treated. The federal government should also subsidize insurance companies that have lower co-pays on these drugs in order to incentivize them and to lower costs. The formation of programs to fiscally assist cities that need help with combatting the disease could also contribute to lower rates of HIV and AIDS cases, and bring more attention towards the issues as a whole. The Ryan White/CARE program was an important asset in that it was able to connect many individuals to the health resources that they needed, but more money must be invested in non-profit organizations and initiatives that address the HIV and AIDS epidemic in the LGBTQIA+ community. Through these efforts, health initiatives can be better established to access more resources through the increased amount of funding they received.
While the United States has had several small initiatives attempting to address the poor mental health present in the LGBTQIA+ community, their plight has largely been ignored. While mental health is a pervasive issue in LGBTQIA+ communities all over the world, Sweden has recently made many leaps and bounds with addressing the disproportionate amount of mental illness that these populations suffer from. In 2015, the Swedish capital Stockholm collaborated with the country’s feminist party, Feministiskt Initiativ, and the Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights to formulate a strategy that would reinforce efforts to improve the quality of life of the LGBTQIA+ communities in the country (Deacon). Aside from healthcare and social service reformation, the initiative also focuses on violence, discrimination, private life, culture, and civil society with the ultimate goal of increasing the awareness and acceptance of LGBTQIA+ people in society (“Stockholm Schools”). One of the foremost tasks in this strategy is the reformation of the education system in Sweden. Good mental health in students has often been tied to a positive school climate (Hurwitz and Weston 4). By promoting health issues, in particular mental illness, schools in Stockholm would be able to educate students and create a more positive environment in which students would not feel stigmatized and isolated. Stockholm announced that it would allot eight million kronor, approximately $950,000 to fund “LGBTQ” lectures in primary and secondary education (Deacon). These lessons would teach Swedish students the health problems that LGBTQIA+ people encounter, and would instill a more tolerant viewpoint in the students by the time they reach adulthood (Deacon). As a result of creating a more open-minded society that is educated on the issues that afflict the LGBTQIA+ community, more working professionals will have cultural competency towards these issues, and can create a safer and more hospitable environment for the community to live in (Deacon). In the future, this would lead to a healthier LGBTQIA+ population with better health and overall lower rates of mental illness. By collaborating with public health professionals and other activists, the Swedish government was able to construct education programs that could educate students on pertinent issues that LGBTQIA+ communities often encounter (Adelman and Taylor). Aside from the efforts made in Stockholm, the Swedish government has invested over six million kronor in initiatives dedicated to improving LGBTQIA+ education in schools and social services across the country (“A Strategy for Equal Rights”). The government is also increasing efforts against hate crimes and addressing the prejudice that exists within the frameworks of Swedish society (“A Strategy for Equal Rights”). The endeavors made by the Swedish government are helping to establish a more accepting society for all of its citizens, and will combat the mental illness epidemic that pervades throughout the LGBTQIA+ community in Sweden.
Current conditions of health education in the United States pale in comparison. Only thirteen states require the discussion of sexual orientation in health education, and four of these states require that only negative information about sexual orientation is taught (“Sex and HIV” 1). By perpetuating negative ideas about LGBTQIA+ individuals, the stigma will only intensify. Funding for public education can also interfere with access to health programs that pertain to sexual orientation and gender. Although a small portion of expenses are funded by the federal government, public schools must acquire the rest of the money for their payments through a variety of taxes (Williams). Often times, schools will eliminate health programs in order to cut costs.
These conditions in the education system in American serve to perpetuate the poor mental health of many LGBTQIA+ students and adults. Health education must undergo significant of reformation in order to properly cater to the disenfranchised LGBTQIA+ community. Increasing federal funding of state education programs can allow for the allocation of more money towards schools and programs that lack proper health education. Similar to Sweden, the United States government can fund educational initiatives directed towards educating students in primary and secondary school on subjects that pertain directly to LGBTQIA+ health. Mandating that sexual orientation and gender identity be taught in health education classes would also improve the school’s cultural competency, and could become a more positive and welcoming environment for LGBTQIA+ individuals (Slater). Health curricula must be strictly reviewed before approval, in order to prevent negative information about sexual orientation and gender from being taught. School systems could also collaborate with local non-profits and draft curricula that could accurately depict the issues that pertain to the local population. While there is not yet a definite cause of the poor mental health that these populations suffer from, through the facilitation of these programs and the formation of a more tolerant and competent society, the poor social conditions that LGBTQIA+ individuals face on a daily basis can be alleviated.
Epidemiologist Ilan Meyer asserted that if social conditions are negative, the stress and mental illnesses would serve to perpetuate several negative health complications (Meyer “Prejudice, Social Stress” 3). Similar to the other health disparities present in the United States, the root cause of rampant substance abuse in LGBTQIA+ communities is thought to be the poor social conditions, stigma, and the poor mental health that these populations suffer from as a consequence of these social conditions (Redding). For individuals brought up in an environment where they do not feel safe expressing their sexual orientation and gender identity, substances are often seen as an escape.
When it comes to addressing this issue, clinicians and case workers must be conscious of sexualities and gender identities at all times. While prevention programs for LGBTQIA+ youth work well, they are only effective if the material covered is relevant to their community (Redding). For adults that seek help for their substance use, many do not feel safe going to see clinicians for fear of facing discrimination (Redding). Accordingly, prevention programs and health care services must be culturally competent in order to make these populations comfortable and willing to speak about their issues. The Gay Affirmative Practice model, or GAP model, provides an outline for clinicians and case workers to follow when dealing with LGBT individuals (Crisp 116). Among the key guidelines in this model, sociocultural issues are addressed while still addressing the patient’s needs. By recognizing homophobia as a societal issue and increasing the clinician’s knowledge of homosexuality and the coming out process, the cultural competency of clinicians and case workers using this model will increase to encompass issues relevant to LGBTQIA+ communities (Crisp 116). Through the formation and implementation of care models similar to the GAP model, more LGBTQIA+ individuals suffering from mental illness and substance abuse will feel comfortable seeking treatment and medical attention. For cities and communities where mental illness and substance abuse has been observed to occur in higher magnitude, non-profit clinics and treatment centers that are dedicated to serving the LGBTQIA+ community could serve as a place of refuge for these individuals. By having a network of primary care physicians, licensed mental health counselors, and case workers, these communities would have access to a variety of resources that could help them address their health issues.
Health disparities within the LGBTQIA+ community persist through the perpetuation of stigma, negative beliefs about homosexual behavior, and a culturally incompetent workforce. With the implementation of more culturally conscious models of care and the formation of clinics that can cater to LGBTQIA+ health issues, these communities would be relieved of obstacles that prevent them from accessing care. Health education in schools could serve to increase the cultural competency of society as a whole, creating a more welcoming and tolerant community where LGBTQIA+ individuals would feel safe. Through the collaboration with the LGBTQIA+ community, the United States would be able to assuage the countless societal factors that constantly play against these populations. While these social conditions are deeply ingrained within American society, forming a tolerant and accepting healthcare system can overwhelmingly help diminish the health concerns that affect these populations.