LGBT individuals also are more likely to have health risks such as obesity, smoking, alcohol and substance abuse compared with national averages. For transgender individuals, the statistics are even worse. A 2010 study conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found transgender people had an HIV infection rate that was more than four times the rate of the general population, as well as a higher prevalence of behavioral health issues and suicide.
“One of the main barriers to overcoming (health) disparities is creating an inclusive and affirming environment so that LGBT people come and feel safe in a space where they are getting healthcare,” Makadon said. “Most disparities that are experienced are really the result of stigma and discrimination, and a lot of that has occurred in the context of getting healthcare.”
Discrimination against LGBT patients by healthcare professionals and institutions has a long history that continues to shape many people's attitudes about seeking care. The problem was highlighted during the HIV/AIDS epidemic in the early 1980s, when fear of the disease led to blatant discrimination against gay men, who were becoming infected at a higher rate than the rest of the population at the time.
“A lot of LGBT folks are sort of used to this history of discrimination in healthcare,” Hanneman said. “In fact, a lot of people will say a lot of the (health) disparities are because we don't seek healthcare because we're afraid of being discriminated against.”
Since that time, however, healthcare services for the LGBT population have grown, and they've evolved from focusing primarily on HIV/AIDS to a broader range of care, said Dr. Henry Ng, clinical director for Cleveland-based MetroHealth System's PRIDE Clinic, which serves LGBT patients “But there is still a strong stigma associated with being a sexual minority,” he said.
Dr. Barbara Warren has overseen the LGBT health services program at Mount Sinai in New York City since its inception in 2013. It's recognized as a leader in the field of addressing LGBT people's health needs.
The program teaches primary-care providers, residents and medical students how to initiate and manage hormone therapy for transgender patients, as well as how to provide reproductive and family care for LGBT patients who are starting families. Such efforts led to Mount Sinai two years ago creating the nation's first mandatory LGBT care curriculum for internal medicine and family medicine residents. Warren said her system has been sharing the curriculum with other systems around the country. Plans are underway to publish the curriculum online this fall as an open-access resource.
Mount Sinai providers are trained to take into consideration the patient's sexual orientation as a part of their basic clinical approach, whether or not the condition being treated is directly related to sexual orientation. Warren said identifying patients who are LGBT allows providers to screen for other conditions they might not have checked for a straight patient.