High Stakes for the Health of Sexual and Gender Minority Patients of Color

  • Judy Y. Tan
  • Arshiya A. Baig
  • Marshall H. Chin
Perspective

Abstract

As clinicians, educators, and researchers, our ability to provide the best possible care to our patients who are sexual and gender minority (SGM) people of color is increasingly challenged. Relative to the general population, SGM patients often have worse health outcomes, and among SGM patients, racial and ethnic minorities are particularly vulnerable. Healthcare policies proposed by the current administration, along with an increasingly hostile and dangerous social climate, have the potential to seriously harm SGM patients of color. In this paper, we discuss these key policy issues impacting the health of SGM patients of color. We then suggest questions for clinicians to consider to help them decide which advocacy activities are right for them, recommending self-examination, skills development, and political action. We end by outlining concrete, actionable steps to advocate for SGM patients of color in patient care, healthcare organizations, medical education, research, and public policy.

References

  1. 1.
    Grant J, Mottet L, Tanis J, Harrison J, Herman J, Keisling M. Injustice at every turn: A report of the national transgender discrimination survey. Washington DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf. Accessed April 24, 2017.
  2. 2.
    Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: What we know and what needs to be done. Am J Public Health 2008;98(6):989.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Crenshaw K. Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Rev 1991:1241-1299.Google Scholar
  4. 4.
    Ng HH. Intersectionality and shared decision making in LGBTQ health. LGBT Health 2016;3(5):325-326.CrossRefPubMedGoogle Scholar
  5. 5.
    Byne W. Sustaining progress toward LGBT health equity: A time for vigilance, advocacy, and scientific inquiry. LGBT Health 2017;4(1):1-3.CrossRefPubMedGoogle Scholar
  6. 6.
    Congressional Budget Office. Budget reconciliation recommendations of the House Committees on Ways and Means and Energy and Commerce: American Health Care Act. March 13, 2017. Available from: https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf. Accessed April 30, 2017.
  7. 7.
    Collins S, Gunja M, Doty M, Beutel S. Americans’ experiences with ACA marketplace and Medicaid coverage: Access to care and satisfaction. The Commonwealth Fund. May 25, 2016. Available from: http://www.commonwealthfund.org/publications/issue-briefs/2016/may/aca-tracking-survey-access-to-care-and-satisfaction. Accessed April 30, 2017.
  8. 8.
    Himmelstein DU, Woolhandler S. Trumpcare or Transformation. Am J Public Health 2017;107(5):660-661.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gonzales G, Henning-Smith C. The Affordable Care Act and health insurance coverage for lesbian, gay, and bisexual adults: Analysis of the behavioral risk factor surveillance system. LGBT Health 2017;4(1):62-67.CrossRefPubMedGoogle Scholar
  10. 10.
    Baker KE. The Future of Transgender Coverage. [Published online April 5, 2017]. N Engl J Med 2017. DOI: 10.1056/NEJMp1702427
  11. 11.
    Office for Civil Rights of the US Department of Health and Human Services. Nondiscrimination in health programs and activities proposed rule. Web site. https://www.hhs.gov/civil-rights/for-individuals/section-1557/nondiscrimination-health-programs-and-activities-proposed-rule/index.html. Updated 2012. Accessed May 1, 2017.
  12. 12.
    Perone AK. Health implications of the Supreme Court's Obergefell vs. Hodges marriage equality decision. LGBT Health 2015;2(3):196-199.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Singh S, Durso L. Attorney General nominee Jeff Sessions threatens basic LGBT rights. Center for American Progress. January 6, 2017. Available from: https://www.americanprogress.org/issues/lgbt/news/2017/01/06/296093/attorney-general-nominee-B -sessions-threatens-basic-lgbt-rights/. Accessed April 30, 2017.
  14. 14.
    Singh S, Durso L. Tom Price would jeopardize LGBT people’s health and wellness. Center for American Progress. January 18, 2017. Available from: https://www.americanprogress.org/issues/lgbt/news/2017/01/18/296672/tom-price-would-jeopardize-lgbt-peoples-health-and-wellness/. Accessed April 30, 2017.
  15. 15.
    House Bill 3859. Texas Legislature Online Web site. http://www.legis.state.tx.us/BillLookup/History.aspx?LegSess=85R&Bill=HB3859. Updated 2017. Accessed April 30, 2017.
  16. 16.
    Bowleg L. Intersectionality: an underutilized but essential theoretical framework for social psychology. In: The Palgrave Handbook of Critical Social Psychology. Springer; 2017:507–529.Google Scholar
  17. 17.
    Krehely J. How to close the LGBT health disparities gap: Disparities by race and ethnicity. Center for American Progress. December 21, 2009. Available from: https://cdn.americanprogress.org/wp-content/uploads/issues/2009/12/pdf/lgbt_health_disparities_race.pdf. Accessed April 30, 2017.
  18. 18.
    Martinez O, Lee JH, Bandiera F, Santamaria EK, Levine EC, Operario D. Sexual and behavioral health disparities among sexual minority Hispanics/Latinos: Findings from the National Health and Nutrition Examination Survey, 2001–2014. Am J Prev Med. 2017.Google Scholar
  19. 19.
    Macapagal K, Bhatia R, Greene GJ. Differences in healthcare access, use, and experiences within a community sample of racially diverse lesbian, gay, bisexual, transgender, and questioning emerging adults. LGBT Health 2016;3(6):434-442.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Collins S, Gunja M, Doty M, Beutel S. How the Affordable Care Act has improved Americans’ ability to buy health insurance on their own. The Commonwealth Fund. February 1, 2017. Available from: http://www.commonwealthfund.org/publications/issue-briefs/2017/feb/how-the-aca-has-improved-ability-to-buy-insurance. Accessed April 30, 2017.
  21. 21.
    Doty M, Gunja M, Collins S, Beutel S. Latinos and Blacks have made major gains under the Affordable Care Act, but inequalities remain. The Commonwealth Fund. August 18, 2016; To the Point. Available from: http://www.commonwealthfund.org/publications/blog/2016/aug/latinos-blacks-major-gains-under-aca. Accessed April 30, 2017.
  22. 22.
    Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: A literature review. Risk Manag Healthc Policy 2015;8:175-183.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Wilson PA, Yoshikawa H. Improving access to health care among African-American, Asian and Pacific Islander, and Latino lesbian, gay, and bisexual populations. In: The Health of Sexual Minorities. Springer; 2007:607–637.Google Scholar
  24. 24.
    Kaufmann G. Why immigrants in California are canceling their food stamps. The Nation. March 17, 2017. Available from: https://www.thenation.com/article/why-immigrants-in-california-are-canceling-their-food-stamps/. Accessed April 30, 2017.
  25. 25.
    Gostin LO, Cathaoir KEÓ. Presidential immigration policies: Endangering health and well-being? JAMA 2017;317(16):1617-1618.CrossRefPubMedGoogle Scholar
  26. 26.
    Palazzolo SL, Yamanis TJ, De Jesus M, Maguire-Marshall M, Barker SL. Documentation status as a contextual determinant of HIV risk among young transgender Latinas. LGBT Health 2016;3(2):132-138.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Selk A. Seven transgender women have been killed this year. Democrats want Jeff Sessions to investigate. Washington Post. March 16, 2017. Available from: https://www.washingtonpost.com/news/powerpost/wp/2017/03/16/seven-transgender-women-have-been-killed-this-year-democrats-want-jeff-sessions-to-investigate/?utm_term=.2bab909510ac. Accessed April 1, 2017.
  28. 28.
    Torres A, Livingston L. Miami-Dade detectives investigate transgender woman's fatal shooting. ABC News. April 22, 2017. Available from: http://www.local10.com/news/crime/miami-dade-detectives-investigate-transgender-womans-murder. Accessed April 30, 2017.
  29. 29.
    Southern Poverty Law Center. More than 400 incidents of hateful harassment and intimidation since the election. Southern Poverty Law Center. November 15, 2016. Available from: https://www.splcenter.org/hatewatch/2016/11/15/update-more-400-incidents-hateful-harassment-and-intimidation-election. Accessed May 1, 2017.
  30. 30.
    Tan JY, Xu LJ, Lopez FY, et al. Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: An intersectional approach to address a critical care gap. LGBT Health 2016;3(5):327-334.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    DeMeester RH, Lopez FY, Moore JE, Cook SC, Chin MH. A model of organizational context and shared decision making: Application to LGBT racial and ethnic minority patients. J Gen Intern Med 2016;31(6):651-662.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ruger JP. Health and social justice. Lancet 2004;364(9439):1075-1080.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Baig AA, Lopez FY, DeMeester RH, Jia JL, Peek ME, Vela MB. Addressing barriers to shared decision making among Latino LGBTQ patients and healthcare providers in clinical settings. LGBT Health 2016;3(5):335-341.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: What is it and how do we do it? Acad Med 2010;85(1):63-67.CrossRefPubMedGoogle Scholar
  35. 35.
    Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the social determinants of children's health: A cliff analogy. J Health Care Poor Underserved 2009;20(4A):1-12.CrossRefPubMedGoogle Scholar
  36. 36.
    Peek ME, Lopez FY, Williams HS, et al. Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. J Gen Intern Med 2016;31(6):677-687.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Cook SC, Gunter KE, Lopez FY. Establishing effective health care partnerships with sexual and gender minority patients: Recommendations for obstetricians and gynecologists. Semin Reprod Med 2017;(in press).Google Scholar
  38. 38.
    Chin MH, Lopez FY, Nathan AG, Cook SC. Improving shared decision making with LGBT racial and ethnic minority patients. J Gen Intern Med 2016;31(6):591-593.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Chin MH, Clarke AR, Nocon RS, et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Intern Med 2012;27(8):992-1000.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Safer JD, Coleman E, Feldman J, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes 2016;23(2):168-171.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Chin MH. Creating the business case for achieving health equity. J Gen Intern Med 2016;31(7):792-796.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Chin MH. Movement advocacy, personal relationships, and ending health care disparities. J Natl Med Assoc 2017;109(1):33-35.CrossRefPubMedGoogle Scholar
  43. 43.
    Brenick A, Romano K, Kegler C, Eaton LA. Understanding the influence of stigma and medical mistrust on engagement in routine healthcare among Black women who have sex with women. LGBT Health 2017;4(1):4-10.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta-analytic review. PLoS Med 2010;7(7):e1000316.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Eilperin J. Behind closed doors, Trump signs bill allowing states to strip federal family planning funds from abortion providers. Washington Post. April 13, 2017. Available from: https://www.washingtonpost.com/news/powerpost/wp/2017/04/13/behind-closed-doors-trump-signs-bill-allowing-states-to-strip-federal-family-planning-dollars-from-abortion-providers/?utm_term=.02de88b215ad. Accessed April 30, 2017.
  46. 46.
    Trotta D. Trump revokes Obama guidelines on transgender bathrooms. Reuters. February 27, 2017. Available from: http://www.reuters.com/article/us-usa-trump-lgbt-idUSKBN161243. Accessed April 30, 2017.
  47. 47.
    Bouris A, Everett BG, Heath RD, Elsaesser CE, Neilands TB. Effects of victimization and violence on suicidal ideation and behaviors among sexual minority and heterosexual adolescents. LGBT Health 2016;3(2):153-161.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Kellman L. No Category for LGBTQ Americans in 2020 Census Proposal. Boston Globe. March 29, 2017. Available from: https://www.bostonglobe.com/news/nation/2017/03/29/the-census-wouldn-count-lgbtq-americans-under-proposal/S5TmzHdVNYEF72P5NXFPpN/story.html. Accessed April 30, 2017.

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Judy Y. Tan
    • 1
  • Arshiya A. Baig
    • 2
  • Marshall H. Chin
    • 2
  1. 1.Division of Prevention Science, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of MedicineUniversity of ChicagoChicagoUSA

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