A recent UCLA study found that members of the lesbian, gay, bisexual and transgender community are more likely to avoid seeking medical help than heterosexual individuals due to fear and social stigma.
The UCLA study, which also addressed the limited number of LGBT-competent physicians available, found that only 9 percent of medical practices in the United States have specific procedures outlined to connect patients to LGBT-competent physicians. It also showed that few study participants, including medical officers and medical school deans, were aware of the health disparities between members of the LGBT community and heterosexual, cisgender individuals.
To learn more about these health care problems, Daily Bruin contributor Meghan Hodges talked Thursday with Thomas Freese, the director of training for UCLA Integrated Substance Abuse Programs, about stigma against members of the LGBT community and why there may be a scarcity of LGBT-competent physicians.
Freese is currently working on assembling informational material for physicians related to the specific needs of members of the LGBT community. The work is part of a project by the Center of Excellence on Behavioral Health for Racial/Ethnic Minority Young Men Who Have Sex with Men and Lesbian, Gay, Bisexual, Transgender Populations based in Los Angeles.
Daily Bruin: Could you briefly define what an LGBT-competent physician is?
Thomas Freese: An LGBT-competent physician is, first of all, a good, license-carrying physician who is skilled in his craft, whether it’s primary care or some specialty care. But because of the stigma that many LGBT people face, they’re often afraid to be honest with their care providers about who they are, which can impact their overall health care. So to be competent, a physician would need to create an environment in which clients who are members of the LGBT community know it’s safe to disclose who they are and that they will receive good medical care that is targeted to their specific needs.
DB: What kind of training would a physician need to go through to become LGBT-competent?
TF: One of the things we’re working on diligently is creating training materials for health care providers that help them to understand how to provide a safe environment and culturally responsive treatment for the LGBT community. If we’re to really provide competent and sensitive care, a physician would need to know what the issues of gender are and how they work for LGBT people. These are trainings that help physicians to understand and identify the definitions, terms and lives of the people they might be serving as well as confronting their own biases about who people are and how they function.
DB: A recent study found that LGBT individuals between the ages of 18 and 44 and single are less likely than heterosexual individuals to have the money or insurance for care; furthermore, partnered gays and lesbians are twice as likely to be uninsured. Why do you think this is?
TF: I’m not sure we know the answer entirely, but I think there are a few issues. First of all, there’s an issue of job security. For many LGBT people across the United States, there are not protections in the workplace against being fired. Fortunately, California has those protections, so it’s not as big of an issue here, although we do know that many people do have difficulties if they don’t conform to social expectations exactly. They still have difficulty getting hired into jobs and into good jobs that might offer them health benefits.
One issue is simply access to the types of places that are offering health care. Because LGBT people are worried about facing discrimination, they are less likely to access services that may actually be available to them. They would rather suffer in silence, as it were, than reach out and face hostility or discrimination.
DB: How is treating members of the LGBT community different from treating heterosexual individuals?
TF: I don’t know that it’s dramatically different, except that we should be asking everyone much more broad and open questions. We don’t want to assume who the person is, based on what we see in front of us. It is important to ask people about their sexual relationships free from bias, so that you know whether the individual is having sexual relationships with men, women (or) both, and who they’re interacting with. There are different types of risks and different types of screenings that a person may need depending on what the answers to those questions are.
DB: What are some of the other major LGBT health issues and disparities?
TF: Because LGBT people are often reticent to access to health care, very often they are not screened for cancer. They are also at a higher risk for substance abuse and a higher rate of smoking than much of the population.
Compiled by Meghan Hodges, Bruin contributor.
You want to see some social stigma? Try asserting ethnic interests if you’re White.
Why do they have a higher rate of smoking and substance abuse? Is that just a geographic or cultural thing or have there been studies done on the impulse control abilities of LGBTQ people? Is it also related to the higher STD rates?