Though LGBTQ folks have made enormous leaps in legal protections and decreasing cultural stigma, that progress is deeply uneven across identity and geography. Many people in our communities still struggle to find a health care provider who shows us respect and understands our needs, and community health centers serve a special role in meeting those needs.
And we do have specific needs – for example, lesbian and same-gender-loving women are at higher risk for breast cancer, but get routine screenings far less frequently. Transgender care is a whole field of specialty unto itself, and providers are almost never equipped with appropriate training in school. Gay and same-gender-loving men in Baltimore, a city with one of the highest rates of HIV in the US, deserve to be educated about protecting themselves with PrEP. Bisexual women deal with intimate partner violence at the highest rates of any population group, have extremely high rates of substance abuse, and are at highest risk in the community to die of smoking-related causes.
When doctors aren’t trained or interested in our needs, they can’t give us the care we deserve. We need to have places where our health disparities and cultural norms are known and held with honor.
When you’re sick, living with a chronic condition, or worried about your health, mounting a search for an affirming provider feels especially urgent and especially daunting. Fear and weariness about finding the right doctor can become a barrier to care. Many LGBTQ people come to Chase Brexton Health Care because they heard we have a history serving the community and they simply don’t know where else to turn.
Beyond the LGBTQ-responsive specialty care Chase Brexton offers, community health centers are most likely to serve patients who are low-income or use medical assistance as their insurance. Because of income inequality within our communities, especially for trans and gender-diverse people and older LGBT adults, finding a provider who takes medical assistance or uses a sliding scale for payment is critical.
All ethical, competent medical providers should be able to treat LGBTQ people with warm acceptance, and many do want to welcome queer and trans individuals to their practice. But they don’t know what they don’t know! When I hold trainings on LGBTQ health with clinicians, many health and human service workers say “I don’t need special training. I treat everyone the same!” This is a case where treating everyone the same is not a good goal. We have culturally-specific concerns, we need culturally-specific care.
Even when a private practice in the community is well-versed in LGBTQ care, prospective patients may not know how to find them. It’s so hard to find a care provider you can trust, and even harder when you are a member of one or several marginalized groups whose bodies have been mistreated, under-treated, or turned away from care in the past. Whether mistreatment happened to you personally, or you just heard too many terrible stories from other people like you, many LGBTQ folks are reasonably suspicious of health care systems.
Sometimes the issue is not the provider’s incompetence – it’s the patient’s reluctance, based on experience, to trust that any doctor is giving them appropriate care. Regardless of the origin, that mistrust impacts the therapeutic relationship. Until the world comes to value and nurture LGBTQ lives unequivocally, we will continue to need a niche in health care where we know we are safe and seen. That niche is often filled by community health centers.
For more about The Center for LGBTQ Health Equity, visit www.chasebrexton.org/
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