Open forum: LGBTQIA2S + health disparities are still a significant problem

Gay Pride Day revelers, 2020 (photo submitted)

All Tea, No Shade to many who pioneered positive queer representation in the US Virgin Islands. However, we really have to say a huge thank you to the St. Croix community for the support and representation of the LGBTQ + community they received during the ongoing PRIDE 2022 events. The organizers say they did not anticipate the love and acceptance that they met on June 18, 2022. For a moment it was as if we were all the same, united, as one people on Strand Street, in the city of Frederiksted. The beloved Ingeborg Nesbitt Clinic was adorned with a rainbow of diversity. FHC has provided a great inspiration, as a Host. We are grateful for the incredible presence of the FHC nursing team led by LaTonya Nesbitt, Director of Nursing. Nesbitt is a direct descendant of the historic building of the same name.

Together, many people from our community went out and celebrated each other’s uniqueness with dancing and laughter. There was no division. For a moment everything and everyone was beautiful. We felt confident that we were Crucian, Black, Latin, Brown or White and LGBTQIA2S + (an acronym for Lesbian, Gay, Bisexual, Transgender, Queer and / or Questioning, Intersex, Asexual, Two-Spirit and the countless affirmative ways in which people choose to identify themselves).

We are grateful to the unstoppable spirits of Masserae Sprauve Webster (FHC-CEO, Edwin Nieves (FHC-DSCP), Robert “Bobby” Thompson (VI-DOH and 1LUV), STX Pride Inc. and the owners of Sand Castles Resort and the many stakeholders who have attended the health fair.

However, we cannot take our eyes off the oppressive forces that lurk in the halls of injustice. According to GLAAD, black and brown LGBTQIA2S + people are likely to experience economic insecurity compared to their non-LGBTQIA counterparts, with the majority (56%) of black LGBTQ people living in low-income households and in the southern United States (51.4 %), where most states do not have protections against discrimination. This marginalized population of people has their own unique lived experiences, different from their non-black and brown and non-LGBTQIA2S + LGBTQIA2S + counterparts.

It is important that media and communications professionals in the public and private sectors of the US Virgin Islands are aware of these statistics and not, unwittingly or otherwise, perpetuate stereotypes or spread the stigma associated with these factors. Also, consider the ways in which language use, source selection, and framing could exacerbate the already unstable conditions of this community in these Virgin Islands.

LGBTQIA2S + health disparities are still a significant and increasing problem because they are influenced by so many external factors. Physical, emotional and mental health of our people (meaning queer people), including lower incomes, lack of paid sick leave, and discrimination in access to health care due to class, race, sexual orientation, gender identity and / or gender expression. Proximity to environmental hazards can also have health implications. Additionally, LGBTQIA2S + people and young people experience health disparities due to lack of support at home, school or other unsafe social spaces across our islands. In other words, the key to LGBTQIA2S + health is not a theoretical difference in the biology or behavior between LGBTQIA2S + people and heterosexual cisgender people, but in the many challenges and stigma that make LGBTQIA2S + people vulnerable to disease. Indeed, LGBTQIA2S + has been identified as a population with health disparity since

The National Institute on Minority Health and Health Disparities needs more research from the National Institutes of Health. LGBTQIA2S + health data is missing. One of the biggest obstacles to understanding the reality of LGBTQIA2S + health is the lack of data collection. Many national LGBTQ organizations made data collection one of the most critical priorities during the COVID-19 pandemic, when data on the impact on LGBTQ people was not collected until a few months after it began. Existing data shows profound disparities for LGBTQ people and significant differences between LGBTQ patients and providers, including the misconception by providers that most patients will not discuss sexual orientation or gender identity if asked. This lack of data will have ongoing and aggravating effects on LGBTQ people, including the study and impact of other diseases and epidemics such as cancer rates.

Frederiksted Health Care Inc. has taken great steps to ensure that they have medical professionals who are allied to the LGBTQIA2S + community. The FHC team receives continuing education in LGBTQ sensitivity and medical professionals such as Dr. Annetta Alexander, Josephine Kozloff, medical assistant and Janette Bowers, professional nurse, P.HD., has medical training and certifications in addition to health care of HIV foundation to assist patients live longer healthier lives.

Although blatant discrimination may be illegal, the health sector is still affected by social homophobia, biphobia and transphobia, which negatively affect the quality of health care that LGBTQ people receive. According to a 2021 public statement from GLMA: Health Professionals Advancing LGBTQ Equality, more than half of all medical schools have no LGBTQ-focused health training other than HIV treatment.

A 2018 Kaiser Permanente report shared that more than half of lesbian, gay and bisexual people reported facing cases of providers denying care, using harsh language, or blaming a patient’s sexual orientation or gender identity. as a cause of a disease. Up to 39% of transgender people have experienced some type of harassment or discrimination when seeking routine health care, including outright denial of care or violence in the health care setting. There are currently just over 200 LGBTQ-specific health centers in the United States, but not all of them provide services such as mental health or have pharmacies. Thirteen states have no LGBTQ-specific health centers at all. LGBTQ people living in rural areas or those 13 states have little or no access to LGBTQ-specific care.

Anti-LGBTQ activists are targeting access to health care. In May 2021, President Joe Biden overturned Trump-era policies and restored federal protections for LGBTQ people seeking health care. Although protections have been restored at the federal level, some states are still targeting and limiting LGBTQ health care.

In 2021, for example, Arkansas and Ohio passed laws that allow providers to deny assistance to LGBTQ people on the basis of religious objection. And two states, Arkansas and Tennessee, passed laws in 2021 that prohibit or limit gender-based care for transgender youth. Other states have proposed bills that penalize parents who provide gender-based care for their trans children, as well as bills that punish school employees who keep a student’s transgender identity from their parents.

Gay and bisexual men face far more health disparities than just HIV. Stigma and discrimination can lead to a range of mood and substance abuse disorders in gay and bisexual men, including depression, anxiety, post-traumatic stress disorder, and alcoholism. Gay and bisexual men also report higher levels of eating disorders, including anorexia and bulimia, than their straight counterparts.

Gay and bisexual men are also still subject to a discriminatory deferral period when donating blood or plasma. It’s now a three-month waiting period instead of a one-year or lifetime ban, thanks to advocacy efforts by medical organizations and LGBTQ organizations, including GLAAD. The GLAAD continues the Federal Department of Agriculture to remove the deferral period in favor of risk-based screening altogether, noting that basing any policy on sexual orientation alone is unscientific and discriminatory.

The American Medical Association has said that treatment for gender dysphoria is a necessary medical care that can involve changing the body to align with a person’s gender identity (the internal sense of one’s gender). However, until very recently, private insurance companies treated transition-related medical care as if it were cosmetic, regularly inserting “transgender exclusion clauses” into health insurance plans. This can make it difficult, if not impossible, for most transgender people to access treatment. In 2016, the Department of Health and Human Services issued a standard stating that under the Affordable Care Act of 2010, people are protected from discrimination based on gender identity and sexual stereotypes in health care facilities that they have a link to federal funds, which includes the vast majority of health insurance companies. This was a huge step forward in improving access to health care for the transgender community. However, not all procedures associated with medical transition are covered by this ruling, and any policy that does not receive federal funds can still discriminate. Additionally, even if a transgender person has a health insurance policy that covers medical transition, it can still be quite difficult to find health care providers who are knowledgeable about transgender health care and force many gay people to leave the island for medical treatment.

However, as these intersecting injustices have emerged into the forefront of public consciousness, several aspects of important and long-standing issues surrounding health care disparities have returned the movement, in some ways, to its protest-driven origins.

Here in the US Virgin Islands, we must celebrate every little victory as if it were a big event. However, staying steadfast with a territorial agenda for equality for all people, actively supporting national platforms for LGBTQ-IA people.

Rodney Santiago-Kidd

Editor’s Note: Rodney Santiago-Kidd is the director of human resources and corporate compliance at Frederiksted Health Care Inc. in St. Croix.

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