LGBT+ Health Awareness Week: Non-Discrimination

According to the largest-ever study of transgender and gender non-conforming people in the United States, about 56% of those surveyed had experienced discrimination while trying to seek medical treatment. A 2016 survey found that 68.5% of LGBT+ people who experienced discrimination in the year before had been negatively affected psychologically, about 43.7% said discrimination had adversely affected their physical well-being. For all the legislation and speech-making about trying to reduce and eliminate discrimination against the LGBT+ community, discrimination across the board continues to be an issue.

When it comes to discrimination in the healthcare setting, the Center for American Progress found that 8% of lesbian, gay, and bisexual people and 29% of transgender respondents reported a healthcare provider’s refusal of service because of their sexual orientation or gender identity. LGBT+ people and transgender people especially continue to face high rates of healthcare discrimination.

So, what does does healthcare discrimination look like? Here are some examples:

  • A healthcare provider refuses to provide needed care.
  • The provider refuses to touch the LGBT+ patient or uses excessive precautions.
  • A provider uses hard or abusive language on the patient.
  • The patient is blamed by the provider for their health status.
  • The healthcare provider is physically rough or abusive toward the LGBT+ patient.

Discrimination in the Veterans Health Administration (VHA)

It would be wrong to state that LGBT+ Veterans do not experience discrimination even though the Department of Veterans Affairs (VA) falls within the jurisdiction of the federal government where there are rules and regulations on providing care for LGBT+ people.

The issue of discrimination within the Veterans Health Administration (VHA) is difficult to gauge because health care throughout the VA is remarkably subjective to specific locations. An LGBT+ Veteran seeking care in San Francisco may run into issues when he/she/they tries to seek care across the bay in Martinez. That’s because SF and Martinez exist is different VA health care systems but within the same region. Additionally, an LGBT+ Veteran seeking care in a more rural location like Chico or Redding may experience different care than if he/she/they were referred to a facility closer to a major population center like Mather. Even though Chico, Redding, and Mather exist within the same health care system, provisions of care and levels of discrimination may vary or not exist altogether.

That said, LGBT+ Veterans do indeed experience discrimination even though providers are mandated to undergo training to diversify their knowledge. A provider may not be up-to-date on current VA policy regarding provisions of care for transgender and intersex Veterans. The provider may misgender the Veteran, calling him/her/them by the gender inputted into the electronic health record instead of the Veteran’s preference. A VA provider may provide care but throw in a dose of microagressions along with the way. Unfortunately, discrimination happens and it can be more stinging in a sense because the patient happens to have been part of the 10% of Americans that volunteered for military service. As VA providers, they are perhaps held to a higher standard because of the clientele; however, if you were to do some off-the-bat thinking on if you’ve ever heard of LGBT+ discrimination within the VA, you may be hard-pressed to find any ready examples. The thing is, the VA handles issues like discrimination in-house as much as possible. Unless the LGBT+ Veteran decides to bring the issues to light outside of the VA, the matter is adjudicated and responded to using the VA’s patient advocacy processes.

One major reason you may not find data on LGBT+ Veterans experiencing discrimination is because the VA does not consistently collect data on the sexual orientation or self-identified gender identity (SIGI) of LGBT+ Veterans according to a GAO report published in October 2020. In the report, the GAO reported the following findings:

  • The VA does not consistently collect sexual orientation or SIGI data which limits the assessment of health outcomes for LGBT+ Veterans.
  • The VA does not have a standardized method of recording data on LGBT+ Veterans‘ sexual orientation and thereby does not know how many are in the VA system.
  • While the VA collects SIGI data that can be used to identify transgender Veterans, SIGI data recording is inconsistent; about 89% of Veterans’ records lacked SIGI information.
  • The VA’s use of SIGI information is confined to the administrative system which is not linked to Veterans’ electronic health records resulting in data blindness by VA providers who cannot see the SIGI data during clinical visits. Though the VA has planned to link SIGI data across systems, the plan has been postponed several times leaving the information unlinked.

The last point may provide a semblance of coverage for some unintentional discrimination; however, it does not excuse it. In fact, healthcare discrimination experienced by Veterans and non-Veterans should not be tolerated.

What Can You Do About Healthcare Discrimination?

The good news is that we, as a community and our allies, can do something about healthcare discrimination. There is an ever-growing body of information regarding recommendations for combatting discrimination. Below are some things you can do for yourself and for your fellow members of the LGBT+ community:

  • Contact your Congressional representatives and urge them to enact the Equality Act or other legislation that would prohibit discrimination based on sexual orientation and gender identity in all federally-funded healthcare programs.
  • Ask your Congressmembers to also enact the Do No Harm Act which would prevent the Religious Freedom Restoration Act from being used to carve out exemptions from federal laws and protections regarding nondiscrimination, labor, children’s rights, and health care.
  • Contact your State legislators to prohibit discrimination on the basis of sexual orientation and gender identity in all state-funded healthcare programs and activities.
  • Ask your State legislators to repeal sweeping religious exemptions that allow insurers and providers to deny healthcare services because of a person’s sexual orientation or gender identity.
  • Contact health care systems and ask to increase cultural competency as a main method for healthcare providers to address discrimination experienced by LGBT+ people and people living with HIV.
  • Ask to review your healthcare provider’s policies on nondiscrimination, fair visitation, and other policies to ensure they prohibit bias and discrimination, convey commitment to service equality, recognize families of LGBT+ people and their wishes, and provide processes for reporting and redressing discrimination if/when it occurs.

As an LGBT+ individual or ally, you can take the following actions on discrimination:

  • Educate yourself and your family/friends/coworkers on LGBT+ rights, and when possible, educate health care providers about the needs of LGBT+ patients and those living with HIV.
  • Advocate for improved laws and policies.
  • Report unfriendly, discriminatory practices and share referrals to friendly providers and institutions.
  • Share stories of healthcare discrimination with organizations like Lambda Legal, as well as with policymakers, friends, relatives, and trusted coworkers.
  • Create as much protection as possible for yourself and your loved ones using appropriate, existing mechanisms like advance directives, medical powers of attorney, and other legal documents as well as formal legal relationships such as domestic partnerships, civil unions, and marriage, where that is a couple’s choice.
  • Fight back when discrimination occurs and contact legal and advocacy organizations or a local attorney.
  • Lastly, continue to fight attempts to roll back LGBT+ rights.

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