LGBTQIA+, Race, Class, Disability, and Region: The American Healthcare System

By Sidney Wegener

Every time I visit a doctor, I am asked a series of questions which include those about my sexual health. “Are you sexually active?” Yes. “Do you need a pregnancy test?” No. Oftentimes, a physician responds by informing me that even if I use protection I can still get pregnant. My response triggers confusion and a moment of awkwardness: I’m a lesbian; my girlfriend can’t get me pregnant.

If you are queer (non-heterosexual) or trans (non-cisgender) and able to see a doctor, this experience might sound familiar. Like me, you have likely faced similar, potentially much more severe, circumstances. Perhaps you, or your partner, are transgender, and the question, “do you need a pregnancy test?” causes discomfort. For queer, non-binary, and trans people going to see a doctor could put one at risk of maltreatment or refusal of treatment. Transphobic attitudes among healthcare professionals have caused over a third of transgender patients to experience harassment and rejection, severly impacting not only their physical well being but their mental health. [1] Almost half of transgender people have attempted suicide, and it is estimated that every time a queer or trans person experiences violence or abuse, the likelihood of self-harm increases by 2.5 percent. [2] The moment of confusion and mild embarrassment my physician experiences after I inform them I’m lesbian is sometimes humorous. However, there are many other moments for the LGBTQIA+ (Lesbian, Gay, Transgender, Queer, Intersex, Asexual, and more) community which are uncomfortable and/or harmful.

How queer and trans people experience the healthcare system is also directly impacted by race, economic accessibility, geographical location, and (dis)ability. Queer and trans people of color often struggle with racial discrimination, resulting in a lack of mental and physical healthcare support. Transgender people of color attempted suicide rates are thirty-three times higher than America’s general population; yet, access to mental healthcare services frequently remains out of reach due to a lack of insurance and providers. [3] As a result of systemic racism, homophobia and transphobia in the United States, queer and trans people of color are more likely to be working-class. This further puts them at an economic disadvantage and limits their agency to utilize healthcare services.

Indigenous queer and two-spirit folx are ranked among the highest at risk for discrimination in the United States healthcare system as well as attempted suicides. No Native or Indigenous tribe/nation understands queer, trans, or two-spirit folx the same; however, mistreatment and ostracisizaiton of their LGBTQ+ and Two-Spirit community members are generally not a part of cultural traditions.[4] Accessing healthcare as a member of the LGBTQIA+TS Indigenous community comes with the challenges of navigating a state/federal healthcare system and involves confronting providers who may not accept them as patients. Finding mental health support is critical for this community, assexual violence and abuse committed against Indigenous women, queer, trans, and two-spirit folx is at an astronomically high rate.[5] Financial instability and lack of health insurance further impacts those LGBTQIA+ youths who are homeless, often due to their families rejecting them. Roughly 40% of the youth/young adult homeless population in America are queer or trans. Members of our community who are Black, Latinx, without a GED, or single parents, face even more severe challenges.[6] 

The three million LGBTQIA+ people who live in rural or underserved communities which are impoverished or working-class are also less likely to have access to physical and mental healthcare.[7] Lack of geographical access is also a large contributing factor for people in rural areas of the United States. For queer and trans folx, who are often particularly isolated in rural communities, gaining access to adaquate healthcare can be extremely challenging. Healthcare providers are often located further distances away than they are in suburban or urban regions. Queer and trans people, who are more likely to be poor or working-class, might lack feasable means to transport themselves to a doctor’s office. In addition to geographic isolation, many rural towns and communities across the country hold homophobic, transphobic, racist, and sexist political and personal beliefs. One large challenge queer and trans people face is that fewer laws and regulations protect and support the treatment of LGBTQIA+ people among healthcare professionals, meaning they are more likely to be refused treatment, face harassment, or experience abuse.

Members of the LGBTQIA+ community who are also disabled physically and/or mentally also face many obstacles in accessing healthcare. Whether public transportation limits access or a mental disability requires assistance in navigating a confusing and complicated health insurance system, queer and trans people are at serious disadvantages. Depending on the state, disability services may not cover all of the healthcare needs of any given individual, and those states which do not have laws protecting the rights of disabled, queer, and trans folx put them at exterme risk of maltreatment and/or abuse. [8] What if you are transgender, Latinx, living in a rural area, wheelchair dependent, in need of personal assistance, member of the working-class, and your family does not recognize or support your gender identity? How do you access a healthcare physician? How do these circumstances impact your mental health and physical well-being? How do you survive? When we consider how the American healthcare system serves, or does not serve, members of the LGBTQIA+ community, it becomes critical to consider the intersectional nature of how each of us experiences healthcare differently. The challenges discourage many of us from accessing adequate healthcare whether for our minds, bodies, or both. However, advocating for those who are at risk of maltreatment, abuse, or care refusal are ways to help.

Many of the endnotes have sources which offer support and information for LGBTQIA+ folx and their allies.

[1] “Doctors don’t treat trans patients poorly because they are uneducated. They’re prejudiced.” LGBTQ Nation. https://www.lgbtqnation.com/2019/02/bad-attitude-trans-people-worse-ignorance-study-found/

[2] “Facts About Suicide.” The Trevor Project. https://www.thetrevorproject.org/resources/preventing-suicide/facts-about-suicide/

[3] “Attempted Suicide Rates for Multiracial Transgender People.” National LGBTQ Task Force. https://www.thetaskforce.org/attempted-suicide-rate-for-multiracial-transgender-people-thirty-three-times-higher-than-general-population/

[4] “Why LGBTQ Indigenous Communities Struggle With Healthcare for the Homeless.” TVO.org. https://www.tvo.org/article/why-lgbtq-indigenous-communities-struggle-with-healthcare-for-the-homeless

[5] “Ending Violence Against Native Women.” Indian Law Resource Center. https://indianlaw.org/issue/ending-violence-against-native-women

[6]“LGBTQ Youth Disproportionately Experience Homelessness.” Human Rights Campaign. https://www.hrc.org/blog/new-report-on-youth-homeless-affirms-that-lgbtq-youth-disproportionately-ex 

[7] “Where We Call Home: LGBT People in Rural America.” LGBT Movement Advancement Program. https://www.lgbtmap.org/rural-lgbt

[8] “Disability, Mental Health, Sexual Orientation, and Gender Identity: Understanding Health Inequity Through Experience and Difference.” Health Research Policy and Systems. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-018-0366-1

Sidney is a first year MA candidate for Women’s History at Sarah Lawrence College. They are pursuing research on interracial lesbian relationships in United States women’s reformatories and penitentiaries during the early twentieth century.

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