Clinicians still receive little training or preparation in providing care for LGBTQ patients. According to an Association of American Medical Colleges report, while 76% of the schools responding said they covered some LGBTQ themes, the LGBTQ-related curriculum at half of those schools consisted of three or fewer lectures, discussions, or other learning activities. As a result, LGBTQ people often have a fraught relationship with the healthcare system; their experiences can be disturbing, inadequate, and even alienating. Those in larger urban areas may seek out clinics specializing in LGBTQ healthcare, but many feel betrayed and rejected by care providers and avoid seeking treatment even for serious conditions.
What is missing from our healthcare system’s approach to LGBTQ patients? How can we equip nurses and doctors with a better understanding of LGBTQ patients and their health needs? To obtain an expert perspective on these issues, DailyNurse interviewed Perry N. Halkitis, Dean of the Rutgers School of Public Health, Director oF The Center For Health, Identity, Behavior & Prevention Studies, and editor of the journal Annals of LGBT Public and Population Health.
DailyNurse: Are there some essential steps we can take toward improving the relationship between LGBTQ people and the US healthcare system?
Perry N. Halkitis: Healthcare systems need to create welcoming environments for LGBTQ people, and doctors and nurses need to be trained to fully address LGBTQ needs. Also, systems need to include sexual orientation and gender identity data on intake forms, to help create a sense of normalcy. However to date, this is not the norm. Also, many healthcare providers are not aware of the specific issues that gay men face, that lesbians face, that bisexual people face, that trans people face, and much more training is needed in that regard. To this point the PGBTQ population is not monolithic and each of the groups that constitute the population face their own nuanced health challenges. For example, when I heard HIV affects the LGBTQ population I am quick to reply, HIV burdens gay and bisexual men, especially Black and brown gay and bisexual men.
DN: What sorts of knock-on effects are LGBTQ people experiencing during the pandemic?
PNH: It would not be surprising if we find that LGBTQ people experience COVID at higher rates than other parts of the population. We know that marginalized communities tend to exhibit higher risk-taking behavior, and as a result are more vulnerable to certain diseases, so COVID-19 should be no different. However, some behavioral factors are also at play here that I believe are driven by social conditions. Most recently, in some resorts where LGBTQ people socialize, there have been parties without masks and without social distancing that may have spread the disease within the population.
And so, we find ourselves in a situation where LGBTQ people are stressed because of their sexual orientation and gender identities and are sometimes engaging in risk behaviors that may not be in their own best interest. They’re not engaging in those behaviors because they have nothing better to do; but society creates conditions that make them extremely vulnerable to engaging in risk.
DN: What basic changes need to be made to medical and nursing school curricula to give students a better grounding in LGBTQ care?
PNH: It is not enough for schools to offer a one-time training for a few hours on LGBTQ health issues. I think that every health condition taught in medical and nursing schools must address those issues as it relates to all aspects for all populations. So, we talk about cancer as it appears in women, gay men, and trans people; we talk about aging as it appears in women and gay men; and we should look at minorities and gay people. What I’m trying to say is that all training should embed all populations in the curriculum around every topic or nursing and medical school much like US history classes should address every events in relation to all segments of the population rather than celebrating isolated and separated history months. Separate is not equal. Inclusion means presence in all aspects and components of s curriculum.
DN: Can you suggest a few “dos and don’ts” that could help nurses develop a trusting, positive relationship with their LGBTQ patients? Are there particular questions they should ask? Questions to avoid?
PNH: Speak to us openly and non-judgmentally about our identities, our lives, our sexual behaviors, our health challenges. Don’t “other” us; I think that LGBTQ people tend to feel “othered” by most healthcare providers. Create an environment for your patients that is totally inclusive. There are signals you can give: there are posters you can put up and magazines you can put out that signal to people that this is an LGBTQ-friendly environment. Also recognize that we possess multiple intersectional identities; we are not defined solely by our sexual and gender identities but also our race, culture, geography, and so forth. We are complex people with multiple identities, just like everyone else. In short, treat us like you would want to be treated: with dignity and respect.
To access current research on LGBTQ public healthcare issues, visit the first issue of Annals of LGBTQ Public and Population Health (all journal articles are free through 2022).
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