Logie et al. (2019) report on a qualitative study of LGBTQ+ individuals living in the Arctic regions of Canada. Here health disparities are not only illustrated in terms of identity, but also in the isolated rural region. The researchers note that this landscape exacerbates the sexual and mental health disparities reported. The authors organized a conceptual framework to illustrate the complexity of the disparities. This includes concerns of confidentiality and limited resources, which is a product of the space in which they are living and seeking care as well as the bias or assumed bias of the provider and community. This intersects with the intersectional stigma associated with LGBTQ+ identity, HIV, and STI. I would also offer this intersectional stigma is a result of combined assumptions of health risks and behaviors. Finally, these intersect with heterosexism and cisnormativity which is based on certain biased assumptions that there is something wrong with someone who does not fit into certain identities and behaviors. The researchers propose that healthcare providers could adopt non-judgmental and gender-inclusive approaches. These approaches could acknowledge the disparities and attempt to close the gap in healthcare by engaging in meaningful conversations that honor and respect identities.
Krehely (2009) names three causes for the health disparities experienced by members of the LGBTQIA community. These include a lack of access to health insurance options from the employer, the stigmas against the community, and the lack of cultural competency in the healthcare system. People of color within the LGBTQIA community are affected even more by these factors. To lessen these disparities, further unbiased research is needed to provide lawmakers and providers more information about the specific needs of individuals. In 2009, President Obama’s directive order on same-sex domestic partner benefits was a great leap forward to ensure rights to insurance that are available to heterosexual partners. This directive recognizes that domestic partnerships in the United States are equal under the law concerning insurance rights no matter if they fit a heteronormative mold or not. This is extremely significant as its sets a precedent for further legislation and directives to ensure same-sex domestic partners have quality care. It is a shift in priorities to open more opportunities for diverse populations. Since the publication of the article and President Obama’s directive, the US Department of Health and Human Services has celebrated progress in including the protection against discrimination on the basis of sex, gender identity, and sex stereotyping. In their article published in 2016, the Department recognizes that many advances have occurred, but more support and representation are needed to irradicate the health disparities. Thus the Department has created a position for an advisor for LGBT Health.
This encounter with a healthcare professional is very uncomfortable for me. The assumptions that this doctor is making are shocking and inappropriate. First, the assumption that a homosexual individual needs to be tested for HIV, needs to occur after a discussion of sexual activity, a review and discussion of their safe sex practices, a discussion of whether or not the patient is concerned with STIs and HIV, and then letting them know that an HIV test would be able to determine if they had contracted the disease or were putting others at risk. Had the doctor waited to hear that the patient was not sexually active, the doctor may discuss other reasons to have the test as it would reflect a possible contraction in the past and other ways that HIV can be contracted. Also, different patients have different definitions of sexual activity and oral sex needs to be discussed as well. Also, the state “But I’m not having sex”, does not indicate if they were sexually active in the past. Next, the question concerning the patient’s drinking seems very inappropriate. The doctor should be asking if the patient drinks before asking how much. It seems this doctor has been told that homosexual patients exhibit several risky behaviors and this assumption is clouding their ability to provide appropriate care and their ability to document a proper patient history. These assumptions create barriers that keep patients from engaging with their healthcare providers. It leaves them disconnected, judged, and discouraged.
References
Advancing LGBT Health and Well-being: 2016 Report of the HHS LGBT Policy Coordinating Committee. HHS.gov. (2016). Retrieved 2 September 2021, from https://www.hhs.gov/programs/topic-sites/lgbtq/reports/health-objectives-2016.html.
Krehely, J. (2009, December 21). How to close the LGBT health disparities gap. Center for American Progress.
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