In April, the Missouri attorney general issued a new state directive that severely restricts gender-affirming treatment for both adults and minors by citing a consumer protection law normally used to prosecute fraudulent business practices.
This is just one of several unusual approaches Republicans have recently devised to deny care to people in the LGBTQ+ community. As of this writing in early May, 125 health care measures have been introduced in state legislatures in the 2023 legislative session, according to the American Civil Liberties Union (ACLU), many of them targeting access to medically necessary health care, like Medicaid, for transgender people and gender-affirming care. Sixteen measures have passed.
More than one in eight LGBTQ+ people now live in states where doctors and nurses can legally refuse to treat them, according to research by the Movement Advancement Project, an LGBTQ+ think tank. Many studies and surveys have found that LGBTQ+ people are often turned away or refused treatments, including those related to gender-affirming care. LGBTQ+ patients report that doctors and other health care providers have used harsh and abusive language or subjected them to unwanted physical contact. As a result, LGBTQ+ people may forgo health care and develop life-threatening conditions that end in disability or death.
Fortunately, the community has a powerful ally in overcoming discrimination. GLMA: Health Professionals Advancing LGBTQ+ Equality was founded in San Francisco as the American Association of Physicians for Human Rights and is now based in Washington, D.C. It has been at the forefront of the movement to provide quality health care for the LGBTQ+ community since the onset of the HIV and AIDS epidemic in 1981.
The percentage of U.S. adults who self-identify as LGBTQ+ is at an all-time high at 7.1 percent, according to Gallup, and GLMA Executive Director Alex Sheldon says this brings new challenges, such as protecting the well-being of young LGBTQ+ people, which is one of GLMA’s top concerns. According to Gallup, roughly 21 percent of adult Americans in Generation Z—those born between 1997 and 2003—identify as LGBTQ+.
More than one in eight LGBTQ+ people now live in states where doctors and nurses can legally refuse to treat them.
The increasing number of older LGBTQ+ adults also presents difficulties, because they often lack funds, as well as family and friends who can help them navigate the health care system, Sheldon says. A shortage of facilities and practitioners with expertise in gerontology and trained in diversity, equity, and inclusion—especially in rural areas—is another issue.
GLMA, known for many years as the Gay & Lesbian Medical Association, has come a long way since June 1981, when the U.S. Centers for Disease Control and Prevention (CDC) published an article noting that five previously healthy young gay men in Los Angeles had developed a rare lung infection and other unusual infections, indicating unidentified immunological problems. By the end of that year, 130 of the 337 adults and adolescents with severe immune deficiency—later identified as HIV and AIDS—had died.
“The AIDS pandemic taught us to anticipate and address inequalities of care and create environments where practitioners can provide the long-term treatments and emotional support that LGBTQ+ patients need,” Sheldon tells The Progressive.
Until 2002, the association was composed of physicians, but now its 1,000 members include nurses, physician assistants, behavioral health experts, and other clinicians who believe that the LGBTQ+ community has a right to access health care.
Sheldon notes that the interdisciplinary focus has extended the range of services for LGBTQ+ patients and increased attention on the impact of socioeconomic factors that influence health outcomes. Nurse educators help young people master good health habits to reduce their risks of contracting sexually transmitted diseases as well as heart disease, cancer, and other major killers. Mental health clinicians provide emotional support and other treatments for older LGBTQ+ individuals who are battling anxiety and depression caused by a lifetime of discrimination.
Finding these practitioners isn’t easy, so GLMA has created a directory of practitioners who have submitted profiles showing that they have skills, knowledge, and empathy to meet the needs of LGBTQ+ patients. Updated every day, the directory includes more than 2,000 practitioners in forty-nine U.S. states and Canada, as of this writing, as well as information about sensitive topics such as trauma, racial equity, and informed consent.
“Many LGBTQ+ individuals don’t know what issues to raise, so we developed lists of ten questions lesbians, gay men, and bisexuals [and transgender people] should ask their health providers,” Sheldon says.
The list for gay men covers everything from reducing the risk of hepatitis transmission to screenings for prostate, testicular, and colon cancer, to questions about healthy meals, stopping smoking, and decreasing anxiety, depression, and substance abuse.
To facilitate the patient-practitioner relationship, the association also compiled resources for practitioners that include suggestions for sign-in procedures, the proper use of pronouns and names, ways to resolve problems with insurance carriers, and care payment ideas for LGBTQ+ patients.
For many LGBTQ+ people, unemployment and poverty combine with other barriers to make it difficult for them to access care, a 2018 report by Human Rights Watch found. Although many people receive health coverage under the Affordable Care Act, the Census Bureau reported that employer-based insurance was the most common coverage in 2021, with 54 percent of Americans receiving it for all or part of that year.
“During the AIDS pandemic, our association helped physicians who wanted to come out in the workplace, which was often precarious,” Sheldon says. “Although the 2020 Supreme Court decision [Bostock v. Clayton County] ruled that the 1964 Civil Rights Act protects gay, lesbian, and trans employees from employment discrimination based on their sex, it is still challenging for many individuals” (see sidebar).
“The growth in the number of health professionals who have received training in caring for members of the [LGBTQ+] community will go a long way toward ending discrimination,” says GLMA Executive Director Alex Sheldon.
They add that research is another GLMA priority because scientific studies can provide the basis for improvements in patient care and reduce stigma. In 2016, for example, studies published in The New England Journal of Medicine and the Journal of the American Medical Association found that an HIV-positive person with an undetected viral load could not pass the virus through unprotected sex. The CDC agreed, prompting more newly diagnosed HIV patients to begin using suppressive antiviral therapy and live longer and healthier lives.
GLMA has hosted an annual scientific conference since its founding. Its forty-first conference will take place in late September, with a theme of “Power in Every Voice: Rising Up for LGBTQ+ Health Equity.”
“It is very difficult for researchers, especially those at the beginning of their careers, to obtain funds [for research] on LGBTQ+ topics from the National Institutes of Health and other major sources,” Sheldon says. “Pilot grants of $10,000 to $15,000 can produce promising findings that lead to large grants.”
To fill the gap, GLMA established the Lesbian Health Fund, which since 1992 has awarded more than $1.2 million in grants and funded 126 research projects.
“Researchers take a broad view by exploring prevention, treatment, and social supports,” Sheldon says. “They have done studies of how the risks and treatments of a major killer of women—breast cancer—and the bone loss of osteoporosis that leads to disability can be decreased, as well as how gender minority people of color living with polycystic ovary disease syndrome, a little-known condition, can be helped.”
Mental health topics have been a major focus because stress is a significant factor in the life of LGBTQ+ people and their families, they say. A previous study explored the mental health of lesbian parents and children of lesbian parents, while a longitudinal pilot study of the psychosocial factors and depressive symptoms among gender minority adolescents is underway.
The association often uses scientific studies to advocate for changes in public policy to overcome health disparities. Last March, the association called upon states to permit licensed psychologists who have completed master’s degrees and supervised clinical fellowships to prescribe psychotropic medications, such as antidepressants and anti-anxiety medications.
Research finds that LGBTQ+ people are at a greater risk for depression, suicide, and other mental health conditions, and living somewhere with limited access to psychiatrists who are allowed to prescribe these medications can make this worse.
“The same playbook that was used to demonize and dehumanize gays and lesbians in the 1980s is being used against [transgender people] today.”
In addition to endorsing a single-payer health care system in 2020, the association called for the expansion of Medicaid and programs to increase the availability of primary care in medically underserved areas in 2022.
For more than two decades, GLMA has advised the American Medical Association (AMA), a lobbying group, on matters that affect the LGBTQ+ community. Since 2013, GLMA has been a member of the AMA’s House of Delegates, its legislative and policy-making body, which facilitates direct input into national health policies as well as nominations and endorsements of AMA officials. GLMA also serves as an official diversity and inclusion partner of the U.S. Preventive Services Task Force, an independent panel of volunteer experts that seeks to improve the health of people across the country.
Earlier this year, GLMA began working with the National Minority Health Alliance to develop an agenda to support underrepresented groups.
Because abortion is also an LGBTQ+ issue, GLMA recently joined the Reproductive Health Coalition, which includes more than forty organizations representing more than 150 million practitioners and advocates from all fifty states. In April, the coalition filed an amicus brief in support of the approval by the U.S. Food and Drug Administration of the use of mifepristone to end pregnancies through ten weeks gestation.
Sheldon predicts that the health care needs of transgender people will be center stage in the coming decade.
“Our opposition has not changed,” they say. “The same playbook that was used to demonize and dehumanize gays and lesbians in the 1980s is being used against [transgender people] today. We have to fight back by challenging myths like the one that [transgender people] cannot be trusted to be around children by emphasizing the scientific evidence that proves this is false.
“The growth in the number of health professionals who have received training in caring for members of the [LGBTQ+] community will go a long way toward ending discrimination,” Sheldon says. “We are working not only with the American Medical Student Association but also the American Academy of Physician Assistants to develop educational programs and resources. But the most positive change is that an increasing number of Americans support health equity for the LGBTQ+ community.”
