In honor of National LGBT Health Awareness Week, family nurse practitioner Amber Richert examines the unique health care needs of LGBT patients—and the destigmatization required to increase their access to LGBT-affirming health care.

Around 3.5 percent of Americans identify as gay, lesbian or bisexual, and roughly 0.03 percent identify as transgender. And while these individuals often have unique health care needs, many encounter serious obstacles when trying to access equitable, high-quality care.

Amber Richert, family nurse practitioner and adjunct lecturer in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work, specializes in the treatment of vulnerable populations. A large percentage of the patients she sees at Health Care for the Homeless are LGBT youth, a population that experiences unusually high rates of homelessness. In fact, according to research from the Williams Institute, up to 40 percent of the homeless youth served by agencies identify as LGBT.

In recognition of National LGBT Health Awareness Week, which this year falls between March 25 and 29, we sat down with Richert to discuss some of the major health care challenges the LGBT community faces—and what practitioners can do to deliver more equitable care for all.

Unique health risks for the LGBT community

A number of societal determinants of health contribute to lesbian, gay, bisexual and transgender individuals’ increased health risks. For instance, according to Richert, “If a person is questioning their gender identity or they experience rejection when they come out to their family as gay, these factors can play a significant role in increasing their risk for depression, anxiety or adjustment disorders.”

Further, lesbian, gay and bisexual youth are more likely to engage in risky sexual behaviors, proliferating sexually transmitted diseases, including gonorrhea, chlamydia and HIV, at twice the rate as non-LGB youth. What’s more, research reveals that gay men are at increased risk for prostate, testicular, anal and colon cancers, likely because they have limited access to LGBT-informed screening services. Similarly, lesbian and bisexual women experience higher rates of breast, ovarian and endometrial cancer than women who do not belong to a sexual minority, which may be a result of fewer pregnancies brought to term and a lower rate of preventative screening.

Health care disparities faced by the LGBT community

The increased health risks faced by the LGBT population are often compounded by two additional factors: the unique health care needs of many LGBT individuals and inadequate levels of LGBT-affirming care.

Some of the unique health care needs of LGBT individuals include STD testing, prescriptions for pre-exposure prophylaxis to mitigate HIV risk and hormone replacement therapy (HRT) for those who want to medically transition toward the biology that matches their gender identity. Additionally, some LGBT couples may require family planning care such as surrogacy, sperm donation, artificial insemination or in vitro fertilization.

“Unfortunately, many health care practitioners fail to provide an adequate standard of care to LGBT patients, either because they are undereducated and untrained in LGBT-specific care, or their practice is colored by conscious or unconscious biases,” Richert said.

Indeed, social stigma and personal biases often create additional barriers to care for LGBT patients. For instance, a practitioner may make inaccurate assumptions based on stereotypes about members of the LGBT community, they may feel uncomfortable addressing a patient’s sexual history or they may fail to use a patient’s preferred pronouns, unwittingly engaging in an erasure of the patient’s gender identity.

Closing the gap in health care

Making the nation’s health care narrative more LGBT-inclusive—and thus reducing unnecessary health risks for LGBT individuals—will require major systems-level changes.

“Destigmatization must be a collective commitment that sees an ongoing collaboration between social work, health care, policymaking and public health in order to reduce stigma and increase access to comprehensive care for LGBT people,” Richert said.

Beyond these big picture, societal changes, Richert believes that health care training and education programs must make a concerted effort to equip practitioners to deliver better, more comprehensive care to the full spectrum of their potential patients—irrespective of their unique needs.

“Special population practitioners are not enough—especially in geographic areas where members of the LGBT population may face additional challenges that inhibit access,” Richert said. “Every primary care and specialist practitioner should be educated about risks and treatment requirements specific to LGBT patients.”

Richert urges practitioners to confront their own biases. “Health care professionals have a personal responsibility to become more educated and more comfortable in addressing and providing LGBT-related care,” she said. “Every person—regardless of gender identity or sexual orientation—deserves comprehensive, safe and compassionate health care.”

Consult the following resources to find LGBT-affirming health care networks in your area:

• The Gay and Lesbian Medical Association’s provider directory
• OutCare’s list of public LGBT health resources
• GLBT National Resource Database
• The Human Rights Campaign’s2018 Healthcare Equality Index