While there have been significant advances for people of color in the LGBTQ+ community, many people are still facing discrimination in healthcare settings based on race, ethnicity, sexual orientation, and gender identity.
Being able to go to the doctor when we are sick or injured is something most of us take for granted. Making routine wellness appointments for our children is no big deal for most Americans. Sadly, that’s not the case for all of us though.
In recent years, many studies, including one done by the Human Rights Campaign Foundation, have shown that people of color in the LGBTQ+ community are far less likely to get proper treatment for physical and mental health ailments than the rest of us. In The State of Mental Health in LGBTQ Communities of Color, the HRC Foundation cites a lack of trust in the medical community and lack of health insurance as just two reasons why this is so.
Photo by Aiden Craver on Unsplash
Several studies have also found that people of color in the LGBTQ+ community who do manage to see healthcare providers are often treated unfairly. And that often has serious consequences. Take one participant in a 2021 study examining how healthcare biases affect Black, Indigenous (and) People of Color (BIPOC) patients in the LGBTQ+ community. Identifying as both BIPOC and LGBTQ+, “PT11” shared how doctors dismissed complaints of chronic knee pain for years.
“I was overweight but active, I complained about knee pain all the time, and doctors always said ‘lose weight,’” PT11 recalled. “Well, one time on vacation, I got injured and had to go get X-rays done on my knee. When the X-rays came back, the doctor was like ‘you have arthritis and also your kneecap is misaligned.’ My first reaction was ‘I’m not even 30 and I have arthritis?’ and then it was anger because I have been dismissed for like a decade.”
In this article, the legal team from Dansker & Aspromonte Associates LLP takes a comprehensive look at how healthcare biases can lead to personal injury for LGBTQ+ people of color.
What Is Intersectionality in Healthcare?
To fully understand how this happens, one must first understand an overarching concept, namely “intersectionality.”
The first use of this term is largely attributed to law professor Kimberlé Crenshaw, who described it as a way of examining how various identities and methods of oppression — such as racism, sexism, and homophobia — operate as a whole. In other words, it helps us understand that a woman of color may face discrimination due not only to her race but also because of her gender. On a similar note, a transgender man of color may face discrimination based not only on his race but also on his gender identity.
Intersectional injustices occur in healthcare settings when providers don’t acknowledge that certain biases and/or systems of oppression are preventing them from delivering the best possible healthcare services to people of color in the LGBTQ+ community. Their failure to do so causes them to perpetuate the problem by continuing to engage in the same behavior.
Accordingly, the HRC Foundation’s Healthcare Equality Index for 2024 reports that more than half of transgender or non-binary respondents experienced at least one type of mistreatment or other negative experiences with healthcare providers.
How Biases Affecting LGBTQ+ People of Color Are Manifested In Healthcare Settings
The 2021 study referenced above identified six different ways in which biases affecting LGBTQ+ people of color are manifested in U.S. healthcare settings. These are:
- Transactional care — this refers to an interaction in which the patient feels the healthcare provider is not invested in their well-being but strictly views the encounter as a job. Patients feel rushed, unseen, and unheard because the healthcare provider isn’t thorough; doesn’t address all of their medical concerns; and fails to fully inform the patient about diagnoses, treatments, or alternatives.
- Power imbalances — this pertains to interactions in which the patient felt unwelcome or intimidated based on the provider’s judgment that they were incapable of understanding medical information, identifying real medical concerns, or making the best medical decisions. This often leads to exclusion from the relevant decision-making process, the lack of any meaningful relationship between the provider and the patient, and dismissal of patients without any explanation about their condition or treatment.
- Improper communication — occurrences include verbal or non-verbal signals that the patient felt were uncomfortable, awkward, or inappropriate. These included but were not limited to negative comments or scolding, lack of eye contact, trying to leave while the patient was speaking, or using a judgmental tone.
- Unfair treatment — these are cases in which patients felt they were stereotyped and treated unjustly based on certain traits such as age, weight, gender, gender identity, sexual preference, and so on. Patients claimed this led to difficulty accessing tests, treatment, getting a diagnosis, or getting pain medication.
- Hidden or disguised bigotry — this occurs in cases where people of color in the LGBTQ+ community felt that healthcare providers had inherent biases against them based on certain conduct or behavior. This includes a lack of knowledge or awareness about how to talk or care for gender-diverse patients, and/or a lack of awareness about medical needs specific to people of color.
How U.S. Healthcare Biases Affect People Of Color In The LGBTQ+ Community
Ongoing subjection to these healthcare biases often causes people of color in the LGBTQ+ community to mistrust the healthcare system, and refrain from or put off seeking medical treatment. The HRC Foundation’s Healthcare Equality Index for 2024 reports that 1 in 5 LGBTQI+ adults postponed healthcare treatment due to disrespect or discrimination by healthcare providers.
This, in turn, may result in worsening ailments and self-medication. In some cases, patients will simply search for medical providers who will treat them better, even if they have to change their physical appearance as part of that process.
Vita, who identifies as Black, trans, nonbinary, mentally disabled, pansexual, demisexual, and femme, shared her thoughts in the 2021 article Improving Care of LGBTQ People of Color: Lessons from the Voices of Patients.
“One of the ways I think being a Black pansexual trans woman affects my hypertension directly is stress… I hadn’t had super high blood pressure until I came out….” Vita said. “It’s a mental exercise to leave the house now, you know, and to feel confident enough that you would get from point A to point B and back to point A safely… On a racial level, there’s a societal stigma that Black people aren’t intelligent… I’ve noticed a very real sense of entitlement in medical health professionals and mental health professionals around hypertension around STI [sexually transmitted infection] prevention…. ‘I’m a doctor. I know more than you, period. So, here’s what you’re going to take.’”
Reyna, who identifies as Latina and transsexual, also shared her thoughts in a sidebar accompanying the article published by AFT Health Care.
“I had a terrible accident, and I was just traumatized…. The [healthcare provider’s] receptionist looked at me and said, ‘How can I help you, sir?’ The pain went away, and the only thing that I had was anger. I was furious that this person decided to be so blatantly disrespectful to me in a time of need…. Some trans women don’t see a doctor until they’re practically dying,” Reyna said.”
A transgender woman quoted in an infographic accompanying the Executive Summary of the HRC Foundation’s Healthcare Equality Index for 2024 shared a similar experience. In her case, she had gone to the doctor for “her first physical in years” when the incident occurred.
“When I walked toward the women’s bathroom in the waiting area, the receptionist jumped up and told me to use a McDonald’s restroom down the street,” she said. “I felt like leaving and never going back.”
Photo by Terry Hamlett on Unsplash
Self-Advocacy and Options For Legal Recourse
The key to self-advocacy in a healthcare setting is knowing your legal rights. These vary based on the circumstances.
Sponsored by the HRC and LGBT Healthlink, among others, the Healthcare Bill of Rights details basic rights that should be afforded to everyone in the LGBTQ+ community. These are:
- The right to be treated with respect and made to feel welcome no matter who you are.
- The right to not be denied service or given inferior service.
- The right to be called by your chosen name and gender pronoun and to include these preferences in your advance directive.
- The right to use the gender-based facilities of your choice.
- The right upon admission to certain medical facilities to be told how to create an advance directive – and the right to pick whoever you want to be your decision-maker.
- The right to be visited by anyone you choose (regardless of your legal or biological relationship) at any reasonable time.
- The right to ask the facility to show you the rule that prohibits that visitor if visitation is denied.
- The right to the privacy of your medical records and care under a law known as HIPAA – the Healthcare Insurance Portability and Accountability Act.
- The right to protest being discharged from a hospital rehabilitation facility, assisted living facility, or nursing home.
- The right to information concerning how you can appeal the discharge or transfer and to have time to figure out where you will go when you are discharged.
According to the HRC, federal regulations mandate that hospitals participating in the Medicare and Medicaid programs (which is most of them) have written policies and procedures regarding patients’ right to designate the visitors of their choice. Any such policies and procedures should include language barring discrimination in visitation based on sexual orientation and gender identity.
The HRC also notes that all hospitals with Joint Commission accreditation (which is most of them) are legally barred from discriminating against patients based on sexual orientation and gender identity. There is a significant catch, however. The Joint Commission does not mandate that these hospitals have a written patient non-discrimination policy outlining their non-discrimination standards. Furthermore, The Joint Commission “does not have any specific requirements about the training of hospital staff regarding these policies or LGBTQ+ cultural competency.”
On April 26, 2024, several federal agencies issued a final rule under Section 1557 of the Affordable Care Act (ACA), furthering protections against discrimination in healthcare. Of particular relevance here is that the final rule protects people of color in the LGBTQ+ community from discrimination. It does so by codifying that Section 1557’s prohibition against discrimination based on sex includes LGTBQI+ patients.
Options For Legal Recourse
If you are a person of color, identify as LGBTQ+, and believe a healthcare provider discriminated against you, you may be able to pursue legal recourse. The specific legal remedies available to you will depend upon the circumstances of your unique case.
For example, the HRC recommends following the hospital’s grievance procedure if discrimination occurred at a hospital. You can also file a complaint directly with The Joint Commission.
In some circumstances, you may also be able to file a civil rights complaint with the Department of Health and Human Services’ Office for Civil Rights (OCR). This is the federal law enforcement agency tasked with ensuring that certain healthcare and human services don’t discriminate against anyone based on their:
- Race
- Color
- National origin (including primary language)
- Disability
- Age
- Religion
- Sex (including pregnancy, sexual orientation, and gender identity)
The New York State Long Term Care Ombudsman Program may also be able to help if the discrimination you experienced occurred at a nursing home or long-term care facility.
Helping Healthcare Providers Recognize Intersectional Injustices
The 2021 AFT Health Care article includes several recommendations aimed at helping healthcare providers recognize and combat intersectional injustices affecting LGBTQ+ people of color. These include but are not limited to:
- Promoting compassion and understanding – specifically an understanding that your patient’s past experiences influence their current fears, concerns, and expectations.
- Recognizing intersecting identities — acknowledging that people of color in the LGBTQ+ community have likely faced discrimination based on multiple identities (i.e., race/ethnicity, sexual orientation/gender identity) and acting accordingly.
- Identifying individual and team biases — creating and engaging in activities with patients from the LGBTQ+ BIPOC community to promote a better understanding of how to deliver effective healthcare services.
- Learning and using effective communication techniques — this includes the use of neutral language and proper terminology.
According to a recent article published on the-hospitalist.org, several doctors have teamed up to create a “Gender Inclusive Care Toolkit for Hospitals.” This includes several resources and guidelines designed to facilitate the recognition of inherent biases in healthcare settings. Its creators say it can be used in healthcare settings ranging from large hospitals to local practices.
Groups that also promote healthcare equity include the Alliance for Positive Health, the GLMA in partnership with the Tegan and Sara Foundation, and the National LGBTQ Task Force. Boston-based Fenway Health caters to LGBTQ+ patients, including people of color, from Massachusetts and other states. In addition to serving patients directly, Fenway Health also does research and provides education and training to improve the care of LGBTQ people.
The Bottom Line
Those of us who have never experienced discrimination in healthcare probably don’t think about those who do. If we did give it some thought, we would quickly realize how lucky we are. Because the bottom line is that intersectional injustices in healthcare happen way too often in the United States. When they do, people of color in the LGBTQ+ population are frequently victims.
As these patients attest, they face discrimination in healthcare settings based not only on their race or ethnicity but also on their sexual orientation or gender identity. This results in greater mistrust of the medical community, avoidance, and/or delayed treatment. In worst-case scenarios, this, in turn, leads to worsening health conditions and poor outcomes.
The good news is that many efforts to promote equity in healthcare are ongoing. Let’s just hope there will soon be a time when they are no longer needed.
Additional Resources
Inclusive Healthcare=
Advocacy
Resources Specific To Communities Of Color
Featured image: by: Harry Quan/ Unsplash