How the LGBTQ Community Continues to Advocate for Affirmative Healthcare
Medical care in the U.S. is often centered on the assumption that patients are cisgender and heterosexual, often excluding LGBTQ people — particularly those who identify as transgender, gender non-conforming, or nonbinary. A recent article by Well and Good suggests that improvements can only be made possible when LGBTQ- and gender-affirming health care become more commonplace.
Proposed improvements include eradicating stigma and shame and affirming sexual orientation, gender identity, and gender non-conformity. This is particularly important because the LGBTQ community is at higher risk of contracting sexually transmitted infections (STIs) and HIV/AIDS, as well as suffering from higher rates of mental health disorders, homelessness, and domestic violence.
LGBTQ people have often avoided medical care due to experiencing homophobia or transphobia, compounding a belief they will continue to be discriminated against, or that provider ignorance will result in inadequate care. This is precisely why affirmative care is necessary.
Affirmative care can begin by setting the scene and creating a more welcoming environment. Dr. Andrew Goodman, medical director at Callen-Lorde in New York City, introduces his pronouns when first meeting with a patient. He believes this allows patients to feel as though their experience will be respected and that affirming care entails "not walking in with any assumptions, and understanding that knowing someone's sex doesn't mean you know things about their gender identity, who they have sex with or the care they might need. It means that you ask and you're open. It's treating a patient like they are the expert of their own experience."
This is particularly significant when assumptions are made based on rigid constructions of gender — such as the notion that "only women need pap smears, or that a man can't get pregnant," as Well and Good points out. Such concepts fail to include proper care for trans, nonbinary, and intersex people in need of reproductive care. Affirmative care takes into account the sexual experiences not just of heterosexual and cisgender people, but people of all genders — inclusive of hormone therapy, STI testing and treatment, contraception, and abortion, which are essential health services for many people, regardless of sexual orientation, gender expression, or gender identity.
Education is a critical factor in encouraging more affirmative approaches to medical care. Not only by patients visiting a doctor's office, but education within the medical field itself — so that patients can feel comfortable with their providers when they set foot inside an office. Dr. Bhavik Kumar, medical director of primary and trans care at Planned Parenthood Gulf Coast, explains that this begins first by "all the people involved in a patient's health-care experience [understanding] and [valuing] LGBTQ+ people." For instance, consciously using neutral language that avoids presumptions.
"We strive to make our health centers affirming spaces that are mindful of the indirect messages that can be so important to building trust and making our patients feel comfortable," Dr. Kumar says. Clarity regarding services and policies is crucial for appealing to a broad swath of LGBTQ patients regarding age, race, ethnicity, and more. The use of inclusive language on websites and visuals in the healthcare facility is also pertinent to affirmative care.
Most importantly, health care providers should advocate for their LGBTQ+ patients, even if it is beyond the scope of their expertise. "A primary care provider might not be comfortable with HIV care or hormone therapy, but it's important not to say, 'I'm not familiar with this and don't think you should get it.' Affirming care is 'I'm not familiar with this but let me go find out more about it and get you the resources you need,'" says Dr. Goodman.
Affirming care also extends to updating medical systems to allow accurate representation of patients, particularly where gender identity, non-conformity, and the risk of deadnaming are concerned, allowing providers to become more familiar with the patients they treat. But some systems, Susanne Fortunato (founder of Wingspan Health) explains to Well and Good, force "doctors to make medical decisions based on assigned sex at birth, and that can influence dosage amounts for prescribed medications or prompt the doctor to make improper preventative-care recommendations." Some advances are occurring. Developed systems are now capable of using patients' legal names and assigned sex at birth for insurance purposes while displaying their correct name and gender pronouns for front desk staff.
Dr. Goodman said, "you might think you're not in the position to question an experience, but you can give feedback to your provider." Doing so can instigate positive change. And if you're not comfortable with your provider, the Gay and Lesbian Medical Association (GLMA) offers a provider directory that can assist patients in finding affirming, adequate health care in the U.S. Similarly, resources for healthcare providers cover avoiding stereotypes and assumptions about patients, as well as how to create more inclusive environments from the front desk to the examination room. Resources include the University of California San Francisco's transgender care guidelines and Essential Access Health's guide to Providing Inclusive Care for LGBTQ Patients.
As Well and Good points out, providers who implement more significant changes for more inclusive care could push away some patients who aren't comfortable with change. They will likely have access to healthcare elsewhere — which is often not the case for marginalized communities. And this is perhaps the most important reason for embracing affirmative care.
"A lot of change starts small and is incremental," Dr. Goodman says. "Maybe right now all you can change is what happens in your exam room, but that can be so powerful."