Pride Month 2023: Disparities And Self-Advocacy In Healthcare Settings

June is Pride Month, a national event in the United States and worldwide to celebrate the historical gay liberation movement. The goal of holidays like Transgender Day of Visibility and Pride Month is to celebrate the LGBTQIA+ community and pay homage to the 1969 Stonewall Uprising. 

Many of the efforts made by LGBTQIA+ historical figures directly responded to disparities. Although it can be seen as a "thing of the past," disparities still impact the LGBTQIA+ community, which can be seen in several settings, including healthcare. Understanding these disparities can allow you to find support for yourself or those you love in the US who are part of the LGBTQIA+ community. 

A history of pride month 

In the United States and major cities worldwide, June is a synonym for gay pride marches and pride parades, gay rights events, parties, equal rights demonstrations, celebrations, and the rainbow flag. However, LGBTQIA+ pride month has a rich and emotional history that informs how the celebrations are observed today. In addition, it is a reminder of how specific communities still face disparities and prejudice. 

June as Pride Month was credited to the Stonewall Riots of 1969. Frustrated by the relentless persecution by New York City police and authorities, patrons of the Stonewall Inn, a gay bar located on Greenwich Village's Christopher Street, decided to fight back as the police raided the tavern after midnight on June 28th, 1969. A Black butch lesbian named Stormé DeLarverié was one of the first to throw a punch during the initial raid.

Black self-proclaimed drag queen, Marsha P. Johnson, was a prominent figure in the riots who continued a legacy long after the occurrence. Although many stories about Stonewall's history have been discussed, Marsha P. Johnson and Sylvia Rivera deny being the first to fight back against the police. Regardless, they played a significant part in the event and the activism after the riots for the Black trans and gay communities. 

After 13 people were arrested, part of the community protested, pouring into the West Village to demand civil and gay rights. The demonstrations soon turned into six days of violent riots, which, in turn, became the tipping point for the gay liberation movement. Within months, the Gay Activists Alliance (GAA) and Gay Liberation Front were created because of the events. 

Several decades later, in 2000, President Bill Clinton officially made June "Gay and Lesbian Pride Month." In 2011, President Barack Obama issued a second Presidential Proclamation, declaring June "Lesbian, Gay, Bisexual, and Transgender Pride Month." The month is now known as "Pride Month" to include all that belong within the community. 

Disparities in healthcare and the LGBTQIA+ population

Disparities in healthcare affect a range of minority groups. Below are a few of the disparities LGBTQIA+ people often face. 

Discrimination based on gender or sexuality 

One out of every six lesbian, gay, bisexual, transgender, and queer adults reports avoiding healthcare due to anticipated discrimination, and 16% report being discriminated against in healthcare. Discrimination of people in the gay community in non-healthcare settings also affects health directly and is more prevalent statistically. 

Minority stress is a well-studied risk factor, and other disparities, like wage or income level disparities, also impact it. For example, transgender people are substantially more likely to face unemployment, experience food insecurity, or lack stable housing. For this reason, they may also face more significant healthcare disparities. 

Absence of recognition for healthcare needs

Even in cases where there is no direct discrimination based on gender or sexuality, there are many circumstances where care is not created with the LGBTQIA+ community in mind. One example of this is reproductive healthcare. For example, a gynecologist's office might not make space for transgender, non-binary, or gender-nonconforming people. 

When these spaces are branded as women's health spaces alone or are otherwise not inclusive, it may feel unsafe for someone to attend their appointment or discuss their gender needs. Similarly, for transgender, non-conforming, and non-binary people, the process of pregnancy and giving birth may come with specific challenges in healthcare settings. 

The absence of recognition can also look like oversight about sexualities or genders in mental or physical healthcare settings. For example, a doctor might assume one is straight, use the wrong pronouns and names, or assume someone's pronouns based on appearance. In addition, a doctor might assume a pregnant individual is in a heterosexual relationship. For example, a pregnant lesbian might be asked about their "husband" or "the father" when they attend appointments.

A lack of understanding of common healthcare needs or disparities that affect the LGBTQIA+ community can cause LGBTQIA+ individuals to feel unheard and unseen. Both explicit and implicit biases can impact the treatment or quality of care one receives.

A higher prevalence of mental health concerns

The LGBTQIA+ community faces a higher prevalence of mental and physical health concerns. 

Statistics from 2021 on LGBTQIA+ youth released by the Trevor Project found that 68% of LGBTQIA+ youth (including three out of every four transgender individuals and non-binary youth) experienced symptoms of generalized anxiety disorder. Similarly, 62% of LGBTQ+ youth (including two out of every three transgender and non-binary youth) experienced symptoms of major depressive disorder.

While the general adult population experiences PTSD at around 6%, the prevalence of PTSD across the LGBTQIA+ population is much higher, between 17.8% to 42% among transgender and gender diverse (TGD) individuals and 13% to 47.6% among lesbian, gay, and bisexual (LGB) individuals.

Over 50% of LGBTQIA+ adolescents have been diagnosed with an eating disorder, and even more experience symptoms. In addition, LGBTQIA+ individuals are significantly more likely to experience various substance use disorders, including alcohol use disorder and opioid use disorder.

Contact the National Eating Disorders Association Helpline at 1-800-931-2237 via call or text if you're experiencing a crisis related to an eating disorder. You can also contact SAMHSA at 1-800-662-HELP (4357) if you want resources for a substance use disorder. 

A heightened likelihood of physical health conditions

Mental health conditions are not the only conditions for which the LGBTQIA+ population is at a higher risk. Physical health conditions also appear in higher numbers among this population. These include heart disease, asthma, cancer, and chronic pain. As many physical health conditions are partly caused by stress and mental illness, and vice versa, a lack of quality support services can contribute to both. 

Self-advocacy in the LGBTQIA+ community

With the disparities that impact the LGBTQIA+ community in mind, you may ask yourself how you can advocate for yourself in healthcare settings in your community. Below are a few ways to get started.  

Find the right care team for you 

If possible, build an LGBTQIA+-friendly care team. If you are uncomfortable with your current provider(s), seek out physicians you are more comfortable with, if possible. Some providers make it a point to ask questions about their client's sexual orientation and gender identity to guide treatment. 

You can look at physician reviews and search for affirming providers near you to consider your options. Some online directories allow you to search for those with experience treating LGBTQIA+ individuals or working with gender-affirming care. 

Stay informed 

Know your rights, and if you suspect that you may have a physical or mental health concern that you need care for, do your research. That way, you can present it to a medical professional and ask for the proper tests and referrals. Doctors may not be equally informed on every medical or physical health condition, so being informed can allow you to stand up for yourself if something wrong occurs.

If your doctor refuses to offer tests, referrals, or support that you believe you would benefit from, ask them why. You can then ask them to note in your chart that they refused to offer this service and the reason. 

Prepare what to say 

Consider the questions and concerns you might want to discuss with your doctor. If it helps, you can write a list beforehand. If your doctor is unkind about you bringing in a list of your symptoms or concerns, ask for a new doctor. 

Get a second opinion 

If your first doctor is unkind, doesn't offer support, or invalidates your physical symptoms, you can see another provider for a second opinion. Many experts have found that women and LGBTQIA+ people are often subject to medical gaslighting, being told that their symptoms aren't accurate or that they're "just stressed" or "just anxious." These types of statements can undermine real concerns and place a stigma on mental health. Regardless of whether someone is anxious, experiencing a medical problem, or both, they deserve support and quality treatment. 

Seek informed consent 

If you have connections to medical spaces that offer informed consent for hormone replacement therapy (HRT) and other forms of care, like gender-affirming surgery, it may make the process easier, as you may need to complete fewer steps to avail of that care. Informed consent means allowing trans and non-binary individuals to consent to gender-affirming care without requiring a "gender dysphoria" diagnosis from a therapist. This type of service can be helpful for those who worry about discrimination impacting their ability to get gender-affirming care. In addition, some non-binary or trans people may not want to transition surgically and may instead be looking for hormones or non-invasive procedures alone. In these cases, doctors can offer support for those who don't have gender dysphoria. 

Take someone with you 

Some individuals find it helpful to take another person with them when they go to the doctor, such as a friend, family member, or medical advocate. It can be tiring to self-advocate when you are part of a marginalized group. With an individual by your side, you can ensure your doctors treat you ethically and take your concerns seriously. 

How to improve your health as an individual in the LGBTQIA+ community 

Below are a few ways to strengthen your mental health as an individual in the LGBTQIA+ community. 

Find community 

Research shows that social support matters when it comes to mental health. Positive social connections can improve stress management, decrease depression symptoms, and reduce anxiety symptoms.

Use self-care 

Self-care encompasses a range of different practices and actions. Self-care can include hygiene, nutrition, physical activity, and setting boundaries with yourself and others. At times of high stress, it may be more critical to use coping skills and give yourself the go-ahead to take a break from the news.

Prioritize sleep hygiene 

According to research, the LGBTQIA+ population is at a higher risk for sleep disorders. Sleep hygiene can include turning your phone off before bed, drinking herbal tea or hot milk, sleeping in a temperature-controlled environment, and eating a healthy meal an hour or more before sleeping. 

Get regular screenings 

Mental and physical health screenings matter, as they can aid in detecting mental or physical health concerns. Self-advocacy and seeking affirming providers can help one achieve this goal.

Participate in your hobbies 

Hobbies can positively impact well-being (both physical and mental). Find hobbies you enjoy and use time management strategies to fit them into your schedule. If you struggle to find time for your hobbies, use an app that helps you block your time into manageable areas of your day. 

Get involved for 2023 Pride 

Below are a few ways you can get involved in Pride this year: 

• Donate to charities, non-profits, and local organizations
• Attend a pride parade or event in-person or online
• Learn about LGBTQIA+ history and read personal accounts of the events that brought the community to where it is today
• Learn about allyship using guides or directly from LGBTQIA+ individuals you love or follow
• Spread awareness of the issues that impact the LGBTQIA+ community through word of mouth, social media, or other channels
• Speak up against disparity, discrimination, and hate crimes

Discrimination and hate in 2023: Standing up 

Discrimination still exists, affecting many in the LGBTQIA+ community. Making your voice heard and advocating for these individuals' rights can make a difference in promoting equity. Consider contacting the White House, your political leaders, or local advocacy groups.

Note that some individuals, including trans people of color, LGBTQIA+ BIPOC individuals, gay men, and lesbians, may be at higher risk of hate crimes in the community. Educating yourself on the struggles each community faces within the greater LGBTQIA+ community can allow intersectionality to exist so that the entire community does not speak for individual groups living with different experiences. 

It can also be essential to fight for LGBTQIA+ rights all year. June is a time for celebration and advocacy, but LGBTQIA+ people require support year-round. In 2023, over 490 anti-LGBTQIA+ laws have been put forward by state governments and officials, mainly targeting transgender rights. Speaking up to your government, writing letters, making phone calls, and protesting are ways to bring awareness to these events for the rest of the year and beyond. 

Counseling options for the LGBTQIA+ community 

Receiving quality mental healthcare can be difficult for those within the LGBTQIA+ community. Online therapy may be a safer option if you're part of this community and believe you would benefit from support. 

Through an online platform like BetterHelp or PrideCounseling, you can get connected with an LGBTQIA+ therapist and set your therapy goals before you are connected. Depending on your preference, you can also choose between phone, video, or live chat sessions. 

Online therapy is backed by research revealing that internet-based therapy effectively treats mental health conditions, including depression, general anxiety disorder, and PTSD while being cost-effective and convenient. For those with a disability or income disparity, alongside being LGBTQIA+, online therapy can be an advantageous and convenient choice.