The country celebrated Pride during the month of June, but healthcare leaders are concerned about numerous regulations, either passed or proposed, that strike down access to lifesaving care, from abortion to hormone therapy.
Experts and advocates continue to educate the public and urge lawmakers to protect healthcare as a human right. Instead, providers have been criminalized in numerous states for performing certain services.
With Pride Month drawing to a close, here are pressing health issues currently affecting members of the LGBTQIA+ community, according to industry leaders.
Telehealth expansion improves access to care
The COVID-19 pandemic and public health crisis exacerbated existing healthcare disparities for LGBTQIA+ Americans. Telehealth expanded the range of healthcare concerns that could be handled by a provider at much lower cost.
Care in a virtual setting is greatly beneficial in treating any marginalized population, according to Ley Cray, Ph.D., director of LGBTQIA+ programming at Charlie Health, a virtual mental health provider for high-acuity youth.
“Gender-affirming care is not a particular kind of treatment,” Cray said. “It’s an overall approach.” Many conditions afflicting this population are not caused by their identity, but by the way it is received in social environments. Nearly half of LGBTQIA+ youth seriously considered attempting suicide in the past year, and 60% who wanted mental health care could not get it.
Patients looking for inclusive treatment in person might be limited in their geographic location. With virtual care, the choice of clinicians can expand nationally, Cray said. Charlie Health is “much more able to curate groups around shared identity, around lived experience,” Cray said, “because we’re not just pulling from, like, a small county—we’re pulling from the whole country.”
Though Charlie Health, which was founded in 2020, does not yet operate in every state, it is expanding rapidly. In fact, the startup’s biggest concern is keeping up with demand, Cray said. By the end of 2023, the company hopes to be accessible to 80% or more of youth in the U.S.
Since people of younger generations are constantly on electronic devices as it is, there is an even greater opportunity to leverage telehealth with them, explained Caroline Fenkel, LCSW, the company’s co-founder and chief clinical officer. At Charlie Health, patients are sorted into curated groups where they hear about similar struggles of others. Engagement stays high, according to Fenkel: “Hearing ‘me too’ is really, really effective.” Charlie Health’s 90-day readmission rate is less than 10%, it claims.
Patients can also curate the space in which they receive therapy online, which is a comfort. “Affirming care allows the person to really have a sense of agency and authenticity and affirmation in themselves,” Cray said.
Parent participation is also a good indicator of outcomes. Family therapy plays a critical role in healing, especially if family dynamics are part of the patient’s struggles. Given that family therapy is not a required course in med schools, Fenkel noted, it’s all the more important to be trained on how to provide it.
Healthcare leaders say telehealth systems need to be scaled up and further integrated to increase accessibility and better serve the medical needs of the LGBTQIA+ population.
Public health messaging without stigmatizing
As cases of monkeypox spread across the U.S., it appears the most affected thus far are members of the LGBTQIA+ community. However, experts urge proceeding with extreme caution when communicating about the disease to prevent further stigmatization of an already marginalized group.
“We just don’t know yet the true scope and scale of this outbreak,” David C. Harvey, executive director of the National Coalition of STD Directors (NCSD), said. “Our field is front and center on monkeypox response because of how symptoms are presenting themselves, which mimic syphilis and herpes.”
On June 28, the Department of Health and Human Services announced a national strategy to enhance monkeypox vaccination access, prioritize distribution to high-risk areas and people and improve testing capacity.
An effective response, NCSD said, needs to include dedicated clinics to diagnose and treat common STDs and to recognize outbreaks like monkeypox. There also needs to be an expanded testing infrastructure, Harvey said, to help address the likely undercount of cases and to meet rising demand for testing and vaccines.
STD clinics face a heavy burden, Harvey said, already underfunded and struggling to manage the existing STI epidemic. Earlier this year, the House proposed to increase funding for HIV programs, but advocacy groups have argued it failed to include funding for a national PrEP access program. Since the monkeypox outbreak, NCSD has requested additional funding for STD clinics in anticipation of a surge in demand but has not yet been met with a positive response, Harvey said.
In the meantime, there is an urgent need for more public health communication to educate people on monkeypox symptoms and how to stay safe.
“We can educate communities without stigmatizing them,” Harvey said. “Everyone needs to be concerned about monkeypox.”
Expanding services for family building and fertility care
While insurance coverage and support for fertility services has expanded for heterosexual couples, many LGBTQIA+ couples have found themselves excluded from the same benefits.
The definition of infertility often used by insurance plans to determine eligibility for in vitro fertilization is impossible for some LGBTQIA+ individuals to meet. Under many health insurance plans, infertility is defined as failure to conceive after 12 months of unprotected heterosexual sex or after six to twelve cycles of therapeutic donor insemination.
The Biden administration is considering a requirement that some health plans cover fertility treatment for policyholders regardless of their sexual orientation or gender identity, Bloomberg Law reported.
Some providers are also focused on increasing their focus on meeting the healthcare needs of LGBTQIA+ patients, such as Global Premier Fertility, which builds, acquires and manages fertility clinics.
Several of the company's clinics, in Palm Springs and Orange County, California, are focused on the LGBTQIA+ population, with up to 40% of patients identifying with the community. “That’s actually fairly high,” said Luis Murrain, D.O., a reproductive genetics specialist and partner physician at the facility in Palm Springs. Typically, that figure is only 10% to 15% on the high end, he said. Since the clinic serves many LGBTQIA+ patients, it is mindful of being a safe space for gender-affirming, culturally appropriate care.
“When you're looking for a physician to provide care for you and especially for a field that's as delicate as fertility, you want to feel comfortable with your physician,” Murrain said. All providers at Global Premier Fertility go through training.
“When I train physicians and their teams, the goal is for them to establish trust and rapport with their patients,” Araba Hagan, senior director of referral development, said. The training focuses on educating providers about issues unique to different patient populations, like stigma around coming out or understanding legal rights as parents, using pronouns and making patients feel safe. “Our physicians have a deep compassion and commitment in helping the LGBTQ+ community and want to ensure they feel safe, seen, and heard in our clinics.”
The full-service Palm Springs fertility clinic also has logistics related to third-party treatment ironed out, like the legal documentation, financing options for patients and psychological interviews of surrogate candidates.
“For a clinic that doesn’t deal with LGBTQ+ patients very often, a lot of times they may be scrambling to coordinate the services,” Murrain said. “If you don’t have those systems in place, you'll find yourself calling around.”
Global Premier Fertility enables physicians to participate in a “fairly unique physician partnership model and that allows us to focus on patient-first experience,” Murrain said.