Next week, March 28- April 1, marks the ninth annual LGBT Health Awareness Week, sponsored by the National Coalition for LGBT Health, an organization for which I am proud to serve as a board member. This year’s theme, “Come Out for Health,” represents a call to action for community members, advocates, service providers and governmental officials to recognize health and wellness as an essential part of the social-justice movement for lesbian, gay, bisexual and transgender individuals. The central goal of this year’s awareness campaign is to encourage LGBT people to speak to their health-care provider about their sexual orientation and gender identity. Only by making ourselves visible as individuals can we work to increase the body of knowledge about health issues affecting the LGBT population — and also to increase the availability of, access to and quality of physical, mental and behavioral health and related services for the LGBT population.
Back in 1997, our agency conducted a “needs assessment” of lesbian and bisexual women in the Philadelphia metropolitan area with regard to their health-care concerns. At that time, our survey revealed that only 7 percent of women were asked directly by their providers about their sexual orientation. Nearly half of the women surveyed (46 percent) had not disclosed their orientation to their primary care doctor — meaning half of them had not.
Ten years later, we conducted a similar survey and, while the responses showed some movement, we learned that 30 percent of lesbian or bisexual women were still not “out” to their provider. The reasons for lack of disclosure included embarrassment, fear of ostracism or refusal to treat, voyeuristic curiosity or breach of confidentiality. Some said they simply didn’t feel comfortable having the conversation. Yet nearly all of these women agreed that sharing this information would enhance the medical care they receive.
The good news was that most of the women in our survey reported a “good” relationship with their primary-care provider and, among those who didn’t, most were actively seeking a provider with whom they felt more comfortable. One woman wrote: “I would love to find a provider who will not be ‘surprised’ I sleep with women, and who knows what health concerns are relevant to the queer community.” Several women echoed this respondent, who told us: “I got tired of people asking if I might be pregnant!”
In health care, as with many other areas of our lives, straightness is typically assumed. That puts the burden on us as LGBT individuals to initiate conversations that aren’t always easy to have. I am happy to report that this is changing, as medical, nursing and other students across the health professions receive education and training around what we call “cultural competence” and sensitivity to the needs of LGBT and other minority populations. All of us who work in health care need to realize that making patients feel welcome is of critical importance — and that it’s ultimately about much more than someone’s feelings. When you don’t disclose personal information for whatever reason, when you delay visiting a doctor, put off tests or other procedures out of discomfort or fear, you put your own health at risk.
You may have read that lesbians, bisexuals, gay men or transgender individuals face an increased risk for certain cancers (breast cancer or ovarian cancer, for example), but that there are no specific data as to why. Lack of self-disclosure is part of the reason health professionals lack this hard data. Increased awareness — of our numbers, our geographic location, our behaviors, our concerns — leads to increased research, which ultimately leads to improved care and better health outcomes. It’s all related!
If you haven’t done so already, here’s one simple but meaningful step you can take for better health this year: Come out to the health-care providers in your life. You’ll be doing yourself and your community a favor. And if you don’t currently have a primary-care provider, or aren’t fully comfortable talking with the one you see, please consider visiting our website, www.mazzonicenter.org, to find out more about becoming a patient at Mazzoni Center.
Nurit Shein is executive director of Mazzoni Center, Philadelphia’s only LGBT health-care center.