Addressing health inequities for LGBTQ communities: During PRIDE month and 365 days a year

By Nissa Shaffi, NCL Associate Director of Health Policy

Last summer drew striking parallels to the summer of 1981, when another public health threat raged on: the HIV/AIDS crisis. Exactly 40 years ago, the first cases of AIDS were reported by the Centers for Disease Control and Prevention (CDC). Similar to COVID-19, patients struck by a novel illness desperately sought answers to what was ailing them. An absence of public health guidance led to a culture of paranoia, stigma, and discrimination that ostracized patients already vulnerable and afraid.

It wasn’t until 1985 that President Reagan officially publicly uttered the word “AIDS.” Inaction on part of the Reagan Administration to identify AIDS as a public health emergency, and fear-based messaging targeting the LGBTQ community, egregiously mischaracterized AIDS as a “gay plague.” His reticence up until that point hindered urgent dialogue and impeded critical funding for research for the disease.

Since its initial reporting, more than 32 million people have died from the disease and 38 million currently live with the HIV virus, which can later develop into AIDS. Exacerbated by an ill-coordinated and inadequate response, HIV/AIDS was once a death sentence. Over time, thanks to concerted public health efforts, our society has made great strides in HIV testing, education, and prevention strategies. Presently, with credit to biomedical advancements in treatments, such as antiretroviral therapies, the illness is now a treatable and manageable chronic condition.

As we celebrate these monumental victories in medical ingenuity, we must also acknowledge the vast health inequities that continue to persist for LGBTQ individuals. In 2016, the National Institutes of Health (NIH) formally recognized LGBTQ individuals as a health disparity population. There is mounting evidence that indicates the disproportionate disease burden experienced by the community with regard to mental health, diabetes, hypertension, cancer, heart disease, and exposure to violence.

Research shows that LGBTQ individuals who live in communities with high levels of anti-LGBTQ prejudice die sooner—12 years on average—than those living in more accepting communities. Queer and Trans people of color (QTPOC) face even higher rates of fatal violence, as 44 transgender and gender non-conforming people died to anti-trans violence in 2020.

Due to workplace discrimination against sexual and gender minorities (SGMs), there is a high prevalence of health coverage insecurity among LGBTQ individuals. As Johns Hopkins professor, William Padula, elaborates, “most employer-based healthcare plans are cookie cutter plans, meaning they are the same for everybody. People in the LGBTQ community may need a little more, especially those who are transgender.”

Early data from the COVID-19 pandemic reveals LGBTQ individuals have faced higher rates of unemployment than non-LGBTQ people. Due to the various vulnerabilities experienced by this community, data also shows that LGBTQ people are more inclined to adhere to social distancing, vaccine uptake, and general pandemic-related precautions. This is an interesting revelation when considering the general weariness many LGBTQ people have towards health care providers due to fear of stigma and discrimination.

LGBTQ and QTPOC individuals are identity rich people that often navigate multiple intersections in society. In order to better serve the needs of these patients, health providers and advocates will need to become increasingly adept in providing culturally competent care. Inclusive practices as simple as asking a patient what their pronouns are can help reduce anxiety and foster trust when seeking care. The CDC has culled a comprehensive state-by-state list of LGBTQ affirming healthcare facilities, hotlines, and resources.

June marks PRIDE month, a celebration of the impact the LGBTQ community has made on all aspects of society to assert everyone’s dignity to love and live in alignment with their truth. NCL supports the Equality Act and commends the Administration’s $6.7B investment in the CDC’s Ending the HIV Epidemic initiative that aims to reduce new HIV cases by 2030. To honor the legacy and sacrifices of LGBTQ persons, we need to advance legislative efforts that support access to healthcare, increase funding for research, and encourage meaningful, affirming change for our LGBTQ friends, family, and peers.