Building A Body Beautiful, Part I

By Liz Massey, Jan. 1, 2015.

At the beginning of every New Year, much emphasis is placed on self-discipline in the pursuit of body-based goals, such as losing weight, firming up one’s midsection, eating better and so on.

However, when it comes to making strides toward a healthier lifestyle, the recipe for queer resolution-makers can be more complicated than just summoning up enough willpower.

First, there’s a litany of ways in which LGBT people grapple with health conditions at a much higher rate than the general population. The federal government’s Healthy People 2020 site notes that societal stigma and discrimination fuel higher rates of substance abuse, youth suicide, HIV/STD prevalence, and lower rates of receiving preventive screenings for diseases such as cancer among members of the LGBT community.

According to Hector Vargas, executive director of the Gay and Lesbian Medical Association (GLMA), a lack of education among doctors about common health issues in the LGBT community and a lack of familiarity or comfort in dealing with queer people can add up to health care environments being a very challenging place for those who are not straight or cisgendered.

“Health disparities affecting LGBT populations are significant and well documented,” he said. “The research also indicates health care providers often are not equipped or trained about these health concerns for LGBT people. When you add that health care environments are not always welcoming of LGBT people, and in some cases even hostile, you have a significant crisis in health care for LGBT people.”

As challenging as taking good care of oneself can be, help is available. Arizonans are participating in efforts to get LGBT people enrolled in health insurance offered as part of the Affordable Care Act (ACA, also commonly referred to as Obamacare) by the upcoming annual Feb. 15 deadline, and other advocates are educating health care professionals on both a clinical and social level to help them make their practices more welcoming to people of all sexual orientations and gender identities.

GETTING COVERED

The organization Out2Enroll is reaching out to LGBT Americans needing to select an insurance plan through the site HealthCare.gov. Steering committee member Katie Keith explained that targeting the LGBT community for special assistance became a priority for the U.S. Department of Health and Human Services (HHS) when a survey of low- and middle-income LGBT persons showed that nearly one-third of them were uninsured – a rate that is much higher than that of the general population. Out2Enroll operates an informational website (out2enroll.org) and partners with state and local coalitions to provide training and present live events that help LGBT consumers better understand what the Affordable Care Act provides for them.

Keith said that many who come to Out2Enroll events are unaware that the ACA contains broad protections prohibiting discrimination in health care coverage on the basis of sexual orientation and gender identity. In Phoenix, Out2Enroll has worked with the statewide coalition of Cover Arizona to provide LGBT-specific training for more than 100 “assisters,” who help consumers navigate the often-complicated health plan enrollment process. These assisters have been helping drop-in visitors to the Phoenix Pride LGBT Center on Wednesdays for the past several months.

Robert Hess, a local healthcare consultant who has been supervising the assisters at the center, said that his charges had received more than 40 hours of instruction on how to help LGBT people with enrollment issues specific to them, and continued to receive updates on nuances in the law daily.

Hess and Keith were gearing up at press time for a “town hall” style event at the center later this month, which is designed to address questions or concerns about the enrollment process. Hess said that in addition to a community dialog time, the evening event (tentatively scheduled for Jan. 28) would feature a presentation on “health literacy,” covering basic terms related to enrollment so that consumers could make better-informed choices.

Attendees can also receive assistance related to enrollment at the event.

Hess said that similar town halls held elsewhere in the country had provided valuable feedback to Out2Enroll and the federal government.

“The nice thing is that Out2Enroll has direct access to the White House and HHS,” he said. “Other events have taken unanswered questions to the top, resulting in executive orders being issued by President Obama. We can get issues resolved, and do something with that information.”

Out2Enroll hopes to aid the federal government in achieving its goals of enrolling 16 million persons nationally in ACA-sponsored health plans, including a hoped-for 300,000 persons in Arizona. Keith said that health insurance enrollment wasn’t the answer to all LGBT health issues, but it had the potential to make a significant difference in the health of the community.

“Access to health care is a first step,” she said. “It really helps address our disparities and ensures that we as a community are able to take care of ourselves.”

GETTING CARE

Once an LGBT person has health insurance, the next step is ensuring that he or she receives care from competent, welcoming care providers. Vargas said that a report by the Center for American Progress found that LGB individuals were more likely than their straight peers (29 percent vs. 17 percent) to delay or avoid medical care, in part because of past negative experiences with the healthcare system.

In the case of transgender patients, the situation can be even bleaker; Hess noted that prior to the ACA, some practices refused to admit trans people as clients, even for non-trans-related health concerns. It was also not uncommon for trans patients to arrive at their doctor's office better informed than their provider about the standards of care for hormone therapy and other common trans-related treatments.

Vargas said GLMA uses educational outreach to physicians, including webinars and an annual conference, to help them ask the right clinical questions to address common LGBT-related health issues. The organization also partners with other advocacy groups to increase the amount of LGBT medical content presented at health professional schools.

Beyond clinical competence in gay- or trans-specific health issues, however, Vargas noted it was the way a health provider presented his or her practice to potential LGBT patients that was crucial to letting them know they would be safe there.

"An important aspect in this work is terminology – on forms and in provider-patient interactions, which can be extremely important cues for LGBT people about the welcoming nature and clinical competency of any provider," he said.

On the other side of the exam table, GLMA empowers queer health consumers by providing a searchable provider directory on its website and by publishing “top 10” lists for the subgroups within the LGBT community (lesbian, gay, bisexual, transgender, etc.) with information on what topics they should consider discussing with their physician.

Vargas asserted that coming out to health care providers when a safe and welcoming environment exists was an important first step for queer individuals wanting to advocate for their own best care. And on a societal level, he said, LGBT persons and their allies should start viewing medical issues with the same urgency as they do other equality issues.

"I’d encourage the LGBT community to think of and prioritize healthcare as an LGBT civil rights issue on par with employment non-discrimination and relationship recognition," he said. "There are so many things, especially in terms of addressing policy and education, that can be done on the national, state and local level to address the healthcare needs of LGBT people."

Health Care Challenges Faced By LGBT People

• LGBT youth are two to three times more likely to attempt suicide and more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide, and are less likely to have health insurance than heterosexual or LGB individuals.
• Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
• LGBT populations have the highest rates of tobacco, alcohol, and other drug use.
• More than half (56 percent) of LGB individuals surveyed by Lambda Legal in 2008 reported having at least one incident of discrimination in a health care setting; 70 percent of transgendered individuals surveyed reported having experienced discrimination in health care.

Sources: Healthy People 2020 website, Human Rights Campaign Healthcare Equality Index website.

How to Get Assistance Enrolling in Health Insurance

If you are an Arizona resident and wish to receive free assistance enrolling in a plan on the federal HealthCare.gov site, you may sign up for an appointment at the Phoenix LGBT Pride Center by following these steps:

1. Visit the site CoverAZ.org.
2. Tap on the "Find Local Help” widget on the site homepage.
3. Type in 85003 for the ZIP code.
4. Select the Phoenix Pride LGBT Center as your assistance site.

Sources: Out2Enroll, Robert Hess.

Things To Ask Your Doctor

The following are health topics that the Gay and Lesbian Medical Association recommends discussing with your physician in a safe and welcoming health environment.

For the complete list of top 10 lists for each subgroup within the LGBT community, visit glma.org/index.cfm?fuseaction=Page.viewPage&pageId=947&grandparentID=534&parentID=938&nodeID=1.

Lesbians

• Breast Cancer: Lesbians are more likely to have risk factors for breast cancer, yet less likely to get screening exams. This combination means that lesbians may not be diagnosed early when the disease is most curable.
• Gynecological cancers: Lesbians have higher risks for certain types of gynecological (GYN) cancers compared to straight women. Having regular pelvic exams and pap tests can find cancers early and offer the best chance of cure.

Gay Men

• HIV/AIDS, safer sex: If you are HIV positive, you need to receive medical care from a good provider who is knowledgeable about HIV. Safe sex is proven to reduce the risk of receiving or transmitting HIV. You should also discuss and be aware of what to do in the event that you are exposed to HIV (Post-Exposure-Prophylaxis), contacting your provider IMMEDIATELY following an exposure to explore your options. If you are in a relationship where one of you is positive, you should discuss options for prevention with your provider as well.
• Prostate, testicular, and colon cancers: Gay men may be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be harder for gay men because of not getting culturally sensitive care. All gay men should undergo these screenings routinely as recommended for the general population.

Bisexuals

• Fitness (diet and exercise): Problems with body image are more common among bisexuals and bisexuals are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. Being overweight or experiencing obesity are problems that also affect many bisexuals. These can lead to a number of health problems, including diabetes, high blood pressure, and heart disease and breast cancer.
• Depression/anxiety: Depression and anxiety appear to affect bisexuals at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those who remain in the closet or who do not have adequate social supports. Many bisexuals keep their orientation and sexual behavior a secret from their providers. Adolescents and young adults may be at particularly high risk of suicide because of these concerns.

Trans persons

• Hormones: Talk with your provider about hormone treatment. If you are starting hormones for the first time, ask about the things you need to watch out for while taking these medicines. If you are a transgender woman, ask about estrogen and blood clots, swelling, high or low blood pressure and high blood sugar. If you are a transgender man, ask about the blood tests you will need to be sure your testosterone dose is safe. Take only the hormones prescribed by your provider.
• Injectable silicone: Some transgender women want to look feminine and beautiful without having to wait for the effects of estrogen. They expect injections of silicone to give them “instant curves.” The silicone, sold at “pumping parties” by non-medical persons, may move around in the tissues and cause ugly scars years later. It is usually not medical grade, may be contaminated and is often injected using a shared needle. You can get hepatitis or HIV through shared needles. Silicone is dangerous and should not be used.

Source: GLMA.org.