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

June is Pride Month, a national event in the United States and an important celebration of the 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 disparities impact the LGBTQIA+ community, which we see in several settings, including healthcare. So, what are those disparities, and how can you advocate for yourself?

A Brief History 

In the United States and major cities around the world, June is a synonym for gay pride marches and pride parades, gay rights events, parties, equal rights demonstrations, celebrations, and, of course, the quintessential rainbow flag popping up in corporate social media profiles, coffee shop windows, and front yards. But what we have come to know as pride day and LGBT pride month has a rich (and painful) history that informs how the celebrations are observed today. This is a brief recollection of the events that gave rise to this month.

This month is largely credited to the Stonewall Riots of 1969. It all began when, frustrated by the relentless persecution by New York City police and authorities, patrons of the Stonewall Inn, a gay bar located in Greenwich Village’s Christopher street, decided to fight back as the police raided the tavern during the early morning of June 27th. After 13 people were arrested, part of the community decided to protest, 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, both the Gay Activists Alliance and Gay Liberation Front were created because of the events of Christopher street day and the uprising of LGBT people against police brutality

Several decades later, in 2000, President Bill Clinton officially made June “Gay and Lesbian Pride Month,” and in 2011, President Barack Obama issued a second Presidential Proclamation, declaring June “Lesbian, Gay, Bisexual, and Transgender Pride Month.”

Disparities In Healthcare And The LGBTQIA+ Population

Disparities in healthcare affect a range of minority groups. Here are some of the disparities in healthcare that people of the LGBTQ community may encounter:

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 even more prevalent statistically. Minority stress is a well-studied risk factor, and other disparities, like disparities in wage or income level, also impact. For example, transgender people are substantially more likely to face unemployment, experience food insecurity, or lack stable housing.

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 (e.g., a gynecologist’s office that does not make space for transgender, nonbinary, 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 one may be less apt to get necessary screenings. 

Similarly, for transgender, non-conforming, and nonbinary people, the process of pregnancy and giving birth may come with specific challenges and worries in healthcare settings. It can also look like oversight of different sexualities or genders in mental or physical healthcare settings; for example, the assumption that one is straight, using the wrong pronouns and name after a person has presented them, or the assumption of someone’s pronouns. Lack of understanding of common healthcare needs or disparities that affect the LGBTQIA+ community may be an issue. 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. Mental health concerns that disproportionately impact the LGBTQIA+ community include:

• Depression and anxiety. 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 nonbinary youth) experienced symptoms of generalized anxiety disorder in the past two weeks at the time of the survey. Similarly, 62% of LGBTQIA+ youth (including two out of every three transgender and nonbinary 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 1.3 to 47.6% among lesbian, gay, and bisexual (LGB) individuals.

• Eating disorders. Over 50% of LGBTQIA+ adolescents have been diagnosed with an eating disorder and even more experience symptoms.

• Substance use disorders. LGBTQIA+ individuals are significantly more likely to experience various substance use disorders, including alcohol use disorder and opioid use disorder.

Please contact the National Eating Disorders Association Helpline at 1-800-931-2237 via call or text if you or someone you know is or might be living with an eating disorder.

Please contact SAMHSA at 1-800-662-HELP (4357) if you or someone you know is or might be living with a substance use disorder.

Suicide and suicidal ideation also have a much higher prevalence across the lesbian, gay, bisexual, transgender, and queer communities, including youth and adults. This is especially true in instances where a person is part of the LGBTQIA+ community and another minority group.

If you or someone you know is experiencing suicidal thoughts or ideation, please contact the National Suicide Prevention Lifeline 24/7 at 1-800-273-8255.

You can also reach out to the Trevor Lifeline (LGBTQIA+ youth) by calling 1-866-488-7386 or texting “START” to 678-678.

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 of some kinds also appear in higher numbers among this population. These include heart disease, asthma, some types of cancer, and chronic pain.

Self-Advocacy In The LGBTQIA+ Community

With the disparities that impact the LGBTQIA+ community in mind, how can you advocate for yourself in healthcare settings as part of the LGBTQIA+ community? Depending on your goals, consider these tips:

• Find the right care team for you. If possible, build an LGBTQIA+ friendly care team. If you are not comfortable with your current provider(s), do not hesitate to seek out physicians you are more comfortable with (if possible). Some providers make it a point to ask questions about their patient’s sexual orientation and sexual identity to help guide treatment. You can look at physician reviews and search for affirming providers near you online to find out about your options.

• 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 right tests, referrals, etc. Doctors are not equally informed on every medical or physical health condition, so this is a general rule that people in various communities can benefit from.

• Prepare what to say in advance. Think about the questions and concerns you might want to bring up with your doctor.

• Get a second opinion. Never hesitate to get a second opinion from another provider if you need to.

• Seek informed consent. If you have connection 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 that care. This can be helpful for those who worry about discrimination impacting their ability to get gender-affirming care.

• 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, or medical advocate.

It is deeply important to advocate for yourself. It can be tiring to self-advocate so frequently when you are part of a marginalized group, and safeguarding your mental health is necessary.

How Can People In The LGBTQIA+ Strengthen Their Mental Health?

What can people in the LGBTQIA+ community do to defend and strengthen their mental health in adversity? Here are some tips:

• Find your 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 even more critical to use coping skills and give yourself the go-ahead to take a break from the news.

• Brush up on sleep hygiene. According to research, the LGBTQIA+ population is at a higher risk for sleep disorders, alongside other concerns.

• Get regular checkups and screenings. Mental and physical health screenings matter, as they can aid the detection of mental or physical health concerns. Self-advocacy and seeking affirming providers can help one achieve this goal.

• Make time for what you love. Hobbies can positively impact well-being (both physical and mental), and you deserve time to do the things that you enjoy.

• Work with a therapist. Treatments like mental health therapy can help address some of the concerns that disproportionately impact the LGBT community, like PTSD from hate crimes or other anxiety disorders. Therapy can also help with life stress, relationships, family life, etc.

Get Involved This Month of Pride

Wondering how to get involved during this month in 2023 beyond attending the annual pride parade? Here are some things you can do:

• Support a cause directly. For example, you may donate to charities, non-profits, and local organizations.

• Attend a pride parade or event. Pride parades and events have, historically, taken place in person. However, there are also online events, which have increased in popularity in recent years.

• Learn about LGBTQIA+ history. You can find information online, read personal accounts of events that brought us to where we are today in books (such as memoirs), and more. You can also learn about allyship using guides or directly from LGBTQIA+ individuals.

• Spread awareness. Spread awareness of the issues that impact the LGBTQIA+ community, whether through word of mouth, social media, or other channels.

• Speak up. Unfortunately, discrimination still exists, affecting many in the LGBTQIA+ community. Making your voice heard and being an advocate for the rights of LGBTQIA+ individuals can make a difference in promoting equity. Consider reaching out to the White House, your political leaders, or local advocacy groups.

It is important to fight for LGBTQIA+ rights all year, and many of these efforts can be ongoing. Awareness days can be tough for individuals directly impacted by discrimination and disparities—but reaching out for support can help.

Get Help Online

Online therapy is backed by research revealing that internet-based therapy is effective in treating mental health disorders (such as depression, general anxiety disorder, and PTSD) while being cost-effective and accessible. When you sign up for BetterHelp, you will answer a brief series of questions that will help us match you with the most suitable therapist for you based on your answers. You can even opt to see an LGBTQIA+ affirming provider if you choose. If you need to change therapists or cancel services at any point in time, you can do so with ease. BetterHelp plans are cost-effective, and financial aid may be available for those who need it.

Ready to get started? Click here to join BetterHelp, or read our FAQ and therapist reviews to learn more. No matter how you find a professional to work with, you deserve to get the help you need.

A few additional commonly asked questions:

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