Creating LGBTQIA+ Friendly Communities in Healthcare & Education

Challenge: Underrepresentation in Healthcare Roles

One of the ways that healthcare providers fail to support LGBTQIA+ is a lack of knowledgeable staff members. For many individuals, particularly those in remote and rural communities, finding a healthcare provider with the necessary training or professional experience to treat people from all walks of life, including members of sexual and gender minority (SGM) groups, can be extremely difficult. Aside from feeling comfortable and free of discrimination and ostracism, LGBTQIA+ patients will receive the best care from culturally-sensitive and informed healthcare providers, including those providers who are part of the LGBTQIA+ community themselves.

According to an article published by the Harvard Medical School, this limited access to affirming healthcare causes staggering health disparities among SGM groups. The article cites recent research conducted by the U.S. Department of Health and Human Services which showed that transgender people, for example, experience extremely high rates substance abuse, HIV and other sexually transmitted diseases, suicide, and homelessness.

Solution: Recruitment & Retention of LGBTQIA+ Staff

Medical facilities need to actively recruit and work to retain LGBTQIA+ staff members. While this may not solve all related staffing issues for facilities in remote locations, the effort to hire individuals with the proper training and backgrounds increases the likelihood that patients will receive the care they need.

Solution: Policies that Mandate the Hiring of a Certain Number of LGBTQIA+ Providers

Hospitals and clinics should be required to retain a certain percentage of LGBTQIA+ members on their staff. In addition to having more informed medical professionals working in one facility, a diversified community creates a more welcoming environment. Patients who feel affirmed and safe are more likely to return to a facility for regular care or seek out medical treatment when needed.

Challenge: Discrimination by Healthcare Providers

Discrimination against LGBTQIA+ patients can exist in many forms. From an uninformed, culturally insensitive staff to outdated medical forms and literature that assumes that all patients are heterosexual. Those they may seem like minor or insignificant characteristics of a discriminating provider, they do not go unnoticed by LGBTQIA+ patients and allies. A facility’s insensitivity to LGBTQIA+ patient needs, or lack of knowledge thereof, can prevent individuals from receiving the medical care they need.

Solution: Anti-Discrimination Policies

Healthcare providers and related organizations should have a visible non-discrimination policy. Facilities need to ensure their medical literature, posters, or any other visible content in the office incorporates diverse images and symbols of inclusiveness. Medical forms should ask for patients’ preferred names and pronouns so that staff may address them correctly.

Solution: Cultural Competency Training

Healthcare providers can ensure their staff receives cultural competency training, including the use of inclusive and gender-neutral language. Staff members need to develop communication and listening skills that help them engage with patients on their terms and in a sensitive manner.

Challenge: Lack of Training on LGBTQIA+ Related Health Issues

The lack of proper medical care for LGBTQIA+ patients is, in part, directly tied to professionals’ inadequate medical training in relevant health issues. Patients of all backgrounds want their doctors to understand them and their medical history. LGBTQIA+ patients deserve the same level of comfort and reassurance that they are consulting a medical professional that possesses the unique knowledge to treat them properly.

Recently, Harvard Medical School’s students, staff, and faculty created a three-year SGM health equity initiative to improve upon the doctoral curriculum at the school. Its intention is to ensure that faculty and students learn to provide holistic healthcare for LGBTQIA+ patients of all ages. The initiative also features a faculty reform component that strives to increase the school’s efforts to support and recruit students, staff, and other faculty with experience or medical interest in SGM health.

Solution: Additional Training for Doctors and Healthcare Providers

Similar to the efforts at Harvard Medical School, any type of continuing education courses for licensure or certification renewal needs to include detailed information on SGM health. This holds especially true for healthcare providers in specialized areas of the field where there is a fewer number of overall professionals.

Challenge: Knowing the Terminology

In healthcare settings, especially in clinics and hospitals, language is our primary source of communication. As a result, the words we use are extremely important, especially with patients in fragile physical or mental states. Medical professionals and laypeople alike should understand and use inclusive terminology and sensitive identifiers commonly used by LGBTQIA+ individuals. We include here a terminology table for reference.

Solution: Use of the Proper Terminology

One way to familiarize oneself with the proper terminology is to have a conversation with an informed individual or someone who identifies as part of the LGBTQIA+ community. While searching for terms on the internet can be helpful, you are more likely to use appropriate language if you learn from someone in-person.

Ally	An ally is an individual who speaks out and stands up for a person or group that is targeted and discriminated against. An ally works to end oppression by supporting and advocating for people who are stigmatized, discriminated against or treated unfairly.
Asexual	A person who does not experience sexual attraction; they may or may not experience emotional, physical, or romantic attraction. Asexuality differs from celibacy in that it is a sexual orientation, not a choice.
Assigned at Birth	Commonly utilized by trans individuals, the term illustrates that the individual’s sex (and subsequently gender in early life) was assigned without involving the person whose sex was being assigned.
Bisexual	A person who is attracted to members of more than one gender; does not have to be a preference for one gender over another.
Cisgender	Someone who identifies with the gender identity/expression expectations assigned to them based on their physical sex at birth.
Gay	A common term for men who are attracted to other men; also, an umbrella term used to refer to the LGBTQ community as a whole.
Gender Binary	The division of gender into two distinct and opposite categories (man and woman). The gender binary is recognized as a social construct, as there are many identities in-between and outside of these categories.
Gender Identity	The internal perception of one’s gender, and how they label themselves, based on how much they align or don’t align with what they understand their options for gender to be.
Heterosexism	The societal/cultural, institutional, and individual beliefs and practices that privilege heterosexuals and disparage LGBQ people. The critical element that differentiates heterosexism (or any other “ism”) from prejudice and discrimination is the use of institutional power and authority to support prejudices and enforce discriminatory behaviors in systematic ways with far-reaching outcomes and effects.
Intersex	A general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.
Pansexual	Attraction toward people of all genders, including those who identify as transgender, transsexual, androgynous, genderqueer, agender, and all other gender identifications, as well as those who do not feel they have a gender; pansexuality is often confused or intermeshed in definition with bisexuality.
Transgender	An umbrella term for people whose gender identity and/or gender expression does not conform to that typically associated with the sex they were assigned at birth.
Queer	n umbrella term which embraces a matrix of sexual preferences, orientations, and habits of the not-exclusively- heterosexual-and-monogamous majority; also a sexual orientation or gender identity label denoting a non-heterosexual and/or non-cisgender orientation.
Questioning	The process of exploring one’s own sexual orientation or gender identity, investigating influences that may come from their family, religious upbringing, and internal motivations.

Source: https://lgbtq.wfu.edu/resources/lgbtq-terminology/

Challenge: Health Insurance Denying Coverage for LGBTQIA+ Issues

While the Affordable Care Act in the U.S. has provided millions of individuals with health insurance coverage, not all populations receive the same level of benefits. Health insurance companies often deny coverage for LGBTQIA+ health-related issues. For example, patients who receive a “gender dysphoria” diagnosis, which is widely used to refer to the emotional stress experienced by transgender people, often do not receive the necessary medical coverage to see a therapist or counselor. Hormonal therapy drugs are also typically not covered by insurance plans. To pay for medical treatment without sufficient coverage usually means incurring exorbitant expenses. Almost half of transgender individuals in the U.S. postpone or forego medical treatment because they cannot afford it.

Solution: Doctors Fighting for Coverage

One of the ways that doctors can fight for LGBTQIA+ equality and advocate for their coverage by health insurance companies is to closely follow professional organizations such as the American Medical Association (AMA) and advocacy groups like the National Center for Transgender Equality. By staying up-to-date on current insurance policies and federal and state laws, doctors can ensure that insurance companies do not place limits on medical coverage if those limits are discriminatory.

Challenge: Underrepresentation in Schools

Some colleges and universities make a more significant, concerted effort to enroll LGBTQIA+ students than others. Many institutions offer a resource center on campus with counseling services, special mentoring, and supportive events. In some cases, colleges and universities will offer gender-neutral housing options. These types of resource centers, institutional policies, and student activity groups contribute to a campus climate that is supportive of all students. Schools with these characteristics also offer a more welcoming community for staff, faculty, and alumni. These schools are also more likely to attract a more diverse student population over colleges with no recruitment and retention initiatives.

Solution: Recruitment and Retention Efforts for LGBTQIA+ Students

One example of a school striving to retain and recruit LGBTQIA+ students is the Massachusetts Institute of Technology. MIT is a top-tier institution with resident life and healthcare services available to all students regardless of their sexual orientation, gender identities, or expressions. The school also features single-occupancy restrooms and showers in residence halls. MIT’s student health insurance also covers hormone replacement therapy and counseling services.

Challenge: Lack of LGBTQIA+ Curricular Content

In many cases, the LGBTQIA+ community receive inadequate healthcare or are entirely denied treatment because medical students are unprepared or unwilling to handle medical examinations and procedures outside of the narrow, heteronormative expectations. Some faculty, students, and staff at various colleges and universities across the U.S. are working to ensure that medical students gain a more comprehensive education and enforce equal LGBTQIA+ inclusive policies for all patients.

Solution: Curriculum Reform

For students, faculty, and administrators who wish to instill more inclusive and holistic training in medical school curricula, it is not necessarily a matter of adding a plethora of new material. Rather, these individuals striving for an overhaul of curricular content suggest rewriting incorrect or antiquated medical information, updating language use and medical terms, and including better explanations of how sex and gender operate in today’s cultural and medical climates.

Challenge: Teachers Lacking the Proper Training

Educators at all levels, including elementary, middle, and high schools need to be informed in order to teach their students properly about LGBTQIA+ health issues. Today, there are many online resources for educators to learn how to become supportive allies of LGBTQIA+ youth. Educators are also in unique positions to discuss bullying, family diversity, and gender roles with their students. Teachers can learn how to incorporate positive representations of LGBTQIA+ people in their curricula and they can ensure that students obtain more inclusive sex education and at least a general understanding of issues faced by the LGBTQIA+ community today. By raising awareness of violence and harassment, students are more likely to identify these situations and seek out administrators or authorities when they witness acts of discrimination.

Solution: Teaching the Teachers

Schools need to put in place initiatives that provide regular training for their teachers and faculty on LGBTQIA+ health and discrimination in educational settings. Administrators, school counselors, teachers, and more can directly contact organization such as the Gay, Lesbian, & Straight Education Network (GLSEN) to obtain access to additional resources and learning materials for their schools. Ideally, school administrators create mandatory annual training sessions or workshops for teachers and faculty to receive up-to-date information on LGBTQIA+ health.

Challenge: Harassment & Discrimination from Students

From verbal taunting and bullying to physical abuse and even sexual assault, LGTBQIA+ students are at a higher risk for all types of harassment when they enter college. Some schools have taken active measures to handle these LGBTQIA+ motivated offenses, have created specific on-campus policies, and provided special training to their campus police.

Discrimination from other students, teachers, and faculty greatly impact the quality of education that LGBTQIA+ learners receive. Students who feel uncomfortable in educational settings because of their gender identity, sexual orientation, or other personal factors cannot learn to the best of their abilities. Even LGBTQIA+ students pursuing degrees in medical schools, a field where many would expect to find understanding faculty, colleagues, and allies, cannot live their fullest lives and be themselves while enrolled out of fear of discrimination. A recent study published in the Stanford Medicine Online News Center shows that 30% of medical students who identify as sexual minorities hide their sexual and gender identities while working toward their degrees.

While many colleges across the country provide LGBTQIA+ support centers and services, students’ experiences with harassment before applying to higher education institutions affects college enrollment rates. Studies by the Postsecondary National Policy Institute show that 13.4% of LGBTQIA+ high school students who experienced bullying and other types of abuse do not plan on attending college upon graduation.

The Gay, Lesbian, and Straight Education Network (GLSEN) argues that effective anti-bullying school policies need to include specific protections for all individuals (regardless of race, ethnicity, gender, actual or perceived sexual orientation, and gender identity or expression), strong accountability provision, and professional development services for school faculty and staff. As of 2015, GLSEN’s study found that only 3% of anti-bullying school policies in the U.S. include all three of these components.

When students choose not to pursue higher education out of fear of bullying, mistreatment, and violence, anti-bullying and inclusive policies need to be in place at all public and private educational institutions, including elementary, middle, and high schools, as well as college and universities themselves.

Solution: Anti-bullying & Inclusion Policies

An increasing number of campuses are advancing their diversity initiatives to help students who are part of the LGBTQIA+ community. Inclusion and anti-discrimination policies with explicit references to students signal the administration’s commitment to supporting and welcoming these students into their institution.

Solution: Anti-Discrimination Policy & Implementation

It is essential for colleges and universities to incorporate in their anti-discrimination policies and laws explicit language that protects students against violence and harassment based on sexual orientation, gender expression, and gender identity. Vanderbilt University, for example, implements a LGBTQIA+ inclusive anti-harassment policy. Violators of these policies can be expelled or lose their jobs and are considered to be in violation of federal law.

Challenge: Social Isolation in Schools

Loneliness is a common issue faced by LGBTQIA+ students who attend a college without a strong, like-minded community present. Enrolling at a school with a robust LGBTQIA+ support system, including LGBTQIA+ resources centers, student organizations, and student activities, can help combat these feelings of isolation.

According to Dr. Michael Johnson, a writer for the Lavender Health LGBTQ Resource Center, isolation and loneliness crop up in our lives in various ways. Cited in an article, “Tacking Lonliness in the LGBTQ+ Community,” Johnson identifies five phases of isolation commonly experienced in the LGBTQIA+ community: social isolation, emotional isolation, cognitive isolation, concealment of identity, and recognition that one is different from a heteronormative society. To remedy these feelings, resources at Maryville University suggest that students develop a regular exercise routine, maintain a balanced diet, and get enough sleep on a nightly basis. Additionally, students can overcome isolation by taking advantage of available social opportunities such as on-campus mentors and LGBTQIA+ advising programs, friendships, study groups, and even teachers.

Solution: LGBTQIA+ Mentor Programs

Mentorship programs on campuses are invaluable resources for students of all walks of life. Mentoring relationships between students and faculty help provide regular support and guidance through college life. These services for the LGBTQIA+ community help increase the visibility of LGBTQIA+ professionals on campus, connect students to the larger LGBTQIA+ study body, and, most importantly, help students feel supported, affirmed, and in-touch with people who understand them.

Solution: Campus Events

Whether they are student-led or created by faculty, special events give LGBTQIA+ students the opportunity to explore their interests alongside other members of their community. Checking out your potential college’s event calendar can give you an idea of their level of commitment to hosting LGBTQIA+ friendly events. The campus calendar and types of student-led interest groups or clubs can be a strong indication of the size of its LGBTQIA+ student population. Here are some of the major events to look for on your college’s events calendars:

• Celebration of LGBTQ History Month
• National Coming Out Week
• National Transgender Day
• LGBTQ leadership events
• AIDS/HIV walks and runs
• Concerts and events that benefit LGBTQIA+ organizations

Challenge: Stress, Depression, & Anxiety

When you are in a constant state of worry over potential discrimination, harassment, oppression, being outed, and all the other stressors that come along with being an LGBTQIA+ student, the anxiety can be overwhelming. On top of that, feelings of isolation and loneliness can easily lead to serious depression problems. According to the National Alliance on Mental Illness, a member of the LGBTQIA+ community is three times more likely to suffer from anxiety and depression. To address these increased health risks, many colleges have specially trained counselors on-site to handle LGBTQIA+ related issues.

Solution: Health & Counseling Services

Affirmative therapy groups both on and off campus can provide the necessary mental health support and serve as a safe place for LGBTQIA+ students suffering from anxiety and depression. While not all college campuses will have a dedicated mental health professional in its LGBTQIA+ support center or comparable office, they can direct students to appropriate health and counseling services on campus or nearby.

Challenge: Campus Safety

A study by The National LGBTQ Task Force found that almost 20% of students who identify as LGBTQIA+ have feared for their safety on campus due to their sexual orientation or gender identity. It is essential for LGBTQIA+ students to choose a college with policies, procedures, and special training programs in place when it comes to the safety of all faculty, staff, and students.

Colleges and universities can improve students’ educational experiences and overall health by making students feel safer on campus. As noted by Campus Pride, a recent study conducted by the Gay, Lesbian, and Straight Education Network (GLSEN) found that 57% of harassment issues go unreported. Of that sample set, 27% of the LGBTQIA+ victims stated that they did not report their incidents of harassment because they believed the faculty, staff, and administrators would do nothing to help them.

Solution: Stronger Safety Policies

Colleges and universities can take action to support the LGBTQIA+ community with stronger safety policies and dedicated safety services. A dedicated LGBTQIA+ liaison officer increases the likelihood that students will report harassment and violence. Additionally, colleges can provide highly visible safety officers at LGBTQIA+ events and actively strive to employ officers who identify as part of the LGBTQIA+ community.