1. LGBT HEALTH AND
HEALTHCARE DISPARITIES
HLTH-4900-2: Capstone
2014 Winter Quarter
Presented by Brandon Gordon
Professor: Dr. Barbra Duffy
Walden University

2. LGBT STATISTICS
• In 2013, the U.S. population totaled 317,292,487 (U.S. Census Bureau, 2014)
• The National Health Interview Survey (NHIS) used a sample of 34,557 adults
aged 18 and over to provide national estimates for indicators of health-
related behaviors, health status, health care utilization, and health care
access by sexual orientation:
• 1.6% identified as gay or lesbian
• 0.7% identified as bisexual
• 1.1% identified as something else or refused to answer
(Ward, Dahlhamer, Galinsky, & Joestl, 2014)
• LGBT patients are a minority.

3. FACTS ABOUT LGBT HEALTH AND
HEALTHCARE DISPARITIES
• “LGBT people have been grouped together for the purposes of research
and advocacy, but LGBT communities are immensely diverse, comprising
individuals of every gender, race/ethnicity, age, socioeconomic class,
religion, and geographic area, just to name a few dimensions of
difference”(McKay, 2011, p. 394).
• The Institute of Medicine published a report in 2011 that declared that
lesbian, gay, and bisexual (LGB) patients are understudied (Cahill &
Makadon, 2014).

4. FACTS (CONTINUED)
• In 2013, a population-based study was conducted on health disparities
among the LGB population (Fredriksen-Goldsen, Hyun-Jun, Barkan, Muraco,
and Hoy-Ellis, 2013). Analyzing 25 years of literature, Fredriksen-Goldsen,
Hyun-Jun, Barkan, Muraco, and Hoy-Ellis determined that literature regarding
the Lesbian, Gay, and Bisexual population is scarce.

5. CHANGING DEMOGRAPHICS AND
LGBT HEALTH DISPARITIES
• Research suggests that LGBT patients face more financial barriers and have
a lower percentage of having a regular healthcare provider than that of
heterosexual patients (Ward, Dahlmer, Galinsky, & Joestl, 2014).
• The lower percentage of having a regular, or primary care, healthcare
provider could be explained by a limited number of LGBT physicians or a
lack of those that publicly identify as LGBT for fear of being discriminated
against (Eliason, Dibble, & Robertson, 2011).
• A study conducted in Virginia found that Transgender patients have been
denied medical care (Bradford, Reisner, Honnold, & Xavier, 2013).

6. CHANGING DEMOGRAPHICS AND
LGBT HEALTH DISPARITIES
• The lack of access to healthcare for the LGBT population is alarming since
research suggests that homosexual men (men who have sex with men),
have a greater need for medical services than a heterosexual men
(McKirnan, Du Bois, Alvy, & Jones, 2013). Without access to health care, HIV-
infected gay men will go undetected, thus spreading the disease to their
sexual partners.
• It is estimated that a million people are infected with HIV per year, globally,
bringing the total cost to $35 billion per year by 2031 (Hecht, Bollinger, Stover,
McGreevey, Muhib, Madavo, & de Ferranti, 2009).

7. CHANGING DEMOGRAPHICS AND
LGBT HEALTH DISPARITIES
• Within the United States, a study has shown that patients that are diagnosed
with HIV later in the disease process have increased health care
expenditures than those patients whose HIV is detected earlier.
• “Persons with HIV infection who present late to care, as defined by an initial
CD4 count <200 cells/mm3, incur higher cumulative direct HIV treatment
expenditures than those who present earlier in the disease process. Mean
medical care expenditures for late presenters were 1.5 to 3.7 times as high as
expenditures for early presenters, similar to a Canadian study” (Fleishman,
Yehia, Moore, Gebo, & HIV Research Network, 2010).

8. CHALLENGES AND OPPORTUNITIES IN
HEALTH CARE DELIVERY AND SERVICE
• Some LGBT patients will not disclose their sexual orientation to healthcare
providers or may refuse to seek medical care due to fear of being
mistreated or discriminated against.
• It is even more likely for lesbian, gay, and bisexual patients of ethnic
minorities to not disclose their sexual orientation (Durso, & Meyer, 2013).
• Non-welcoming environments, social stigma, lack of LGBT practitioners.

9. CHALLENGES AND OPPORTUNITIES IN
HEALTHCARE DELIVER AND SERVICE
• Healthy People 2020 urges for an increase in the number of population-
based data systems used to collect and monitor standardized data on
patients that identify as lesbian, gay, bisexual, and transgender (Healthy
People 2020, 2015).
• The answer is in EHRs (this will be discussed later with technology).

10. TRANSCENDING BORDERS
• The barriers to access to healthcare, discrimination, denial of medical
treatment, etc. are present in numerous countries.
• The Pan American Health Organization and World Health Organization
already recognizes that LGBT health and healthcare disparities exist globally
(PAHO & WHO, 2013).

11. LGBT HEALTH BEHAVIORS
• The Institute of Medicine reports that LGBT individuals tend to have worse
health outcomes compared to that of heterosexual patients (Institute of
Medicine, 2011).
• High rates of STI/STD infection, with 66% of new cases of HIV in the United
States occurring in gay or bisexual men in 2010 (Cahill & Makadon, 2014, p.
34).
• “Lesbians are at higher risk than heterosexual women for obesity, breast
cancer, and polycystic ovarian syndrome, and are less likely to seek
preventative care” (Durso & Meyer, 2013, p. 35).

12. LGBT HEALTH BEHAVIORS & MODEL
• High rates of suicidal ideation, smoking, and substance abuse (Institute of
Medicine, 2011).
• Using the social-ecological behavior theory/model, programs can be
developed to help combat LGBT health and healthcare disparities.
• Focusing on the individual, intrapersonal relationships, the community, and
the society as a whole, programs can begin to break down the barriers
surrounding LGBT health and healthcare delivery disparities.

13. THE ROLE OF CULTURE
• “WHO noted in a 2011 report that longstanding evidence exists of
widespread stigma against homosexuality and ignorance about gender
identity, both within mainstream society and within health systems” (PAHO &
WHO, 2013, p. 3).
• The times are changing with the emergence of the LGBT rights era.
• More than half of states recognize same-sex marriages (CNN, Pew Forum,
Human Rights Campaign, & Marcum LLP, 2015)

14. THE ROLE OF CULTURE
• Health care providers as well as organizations can work in tandem with the
cultural changes by creating a welcoming and all-inclusive environment for
LGBT patients.
• For example, gender questions on medical forms can include the option for
transgender as well as including pamphlets on LGBT health in public waiting
areas.

15. USING TECHNOLOGY TO END
LGBT DISPARITIES IN HEALTHCARE
• “The Institute of Medicine and The Joint Commission have recommended
asking sexual orientation and gender identity (SOGI) questions in clinical
settings and including such data in Electronic Health Records (EHRs). The U.S.
government is currently considering whether to include SOGI data collection
in the Stage 3 guidelines for the incentive program promoting meaningful
use of EHR” (Cahill, Singal, Grasso, King, Mayer, Baker, & Makadon, 2014).

16. LEGAL AND ETHICAL ISSUES
• Since 1977 , the Food and Drug Administration has banned men that have sex with
men from donating blood.
• Same-sex marriage bans continue in some states.
• LGBT patients face disparities when it comes to having children or adopting children.
• “Adoption provides a pathway to child-rearing, although a few states explicitly ban
same-sex couples or gay or lesbian single individuals from becoming adoptive
parents” (The National LGBT Health Education Center, 2012, p. 5).

17. LEGAL AND ETHICAL ISSUES
• The 2010 Patient Protection and Affordable Care Act (ACA) is the first piece
of legislation to help combat LGBT health and healthcare disparities.
• Expanding data collection
• Includes nondiscrimination protections,
• provides free-of-cost prevention and wellness screenings such as HIV testing,
• reforming the health insurance market by making it illegal for health insurance
companies to deny one of insurance due to a pre-existing condition such as HIV
or Aids
• Adds new coverage options for domestic partner benefits (The National Health
Education Center, 2013, p. 4).

18. AN INTERDISCIPLINARY APPROACH TO
END LGBT HEALTH DISPARITIES
• Healthcare organizations can provide diversity training to all staff, create a
welcoming “safe place” with unisex bathrooms, display nondiscrimination
policies, adding a section to patient surveys to better understand the needs
of LGBT patients, and creating programs and strategies to address the needs
(The National Health Education Center, 2013).
• Train staff to not assume.
• Do not judge someone by their looks or the way that their voice sounds over the
phone.
• When unsure, ask the patient how they would like to be addressed.
• Apologize if you make a mistake.

19. HEALTH CARE ADMINISTRATOR’S ROLE
• As a leader, I will need to incorporate a systemic interdisciplinary approach
in addressing these disparities.
• When looking at strategic planning, it will be important that the healthcare
organization review the programs that are in place that address LGBT health
disparities.
• Influence influence Human Resources to develop a benefits package to
attract LGBT healthcare professionals such as paying for In Vitro Fertilization
(IFV) or adoption fees, and including domestic partnership health insurance
coverage for states that do not legally recognize same-sex marriages.

20. REFERENCES• Bradford, J., Reisner, S. L., Honnold, J. A., & Xavier, J. (2013). Experiences of transgender-related discrimination and implications for health: results from
the Virginia transgender health initiative study. American Journal Of Public Health, 103(10), 1820-1829. doi:10.2105/AJPH.2012.300796
• Cahill, S., & Makadon, H. (2014). Sexual orientation and gender identity data collection in clinical settings and in electronic health records: A key to
ending LGBT health disparities. LGBT Health, 1(1), 34-41.
• Cahill, S., Singal, R., Grasso, C., King, D., Mayer, K., Baker, K., & Makadon, H. (2014). Do ask, do tell: high levels of acceptability by patients of routine
collection of sexual orientation and gender identity data in four diverse American community health centers. PloS one, 9(9), e107104.
• CNN, Pew Forum, Human Rights Campaign, & Marcum LLP. (2015, February 9). Same-sex marriage in the United States. CNN. Retrieved from
http://edition.cnn.com/interactive/us/map-same-sex-marriage/
• Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and
bisexuals. Sexuality Research & Social Policy, 10(1), 35-42. doi:http://dx.doi.org/10.1007/s13178-012-0105-2
• Eliason, M. J., Dibble, S. L., & Robertson, P. A. (2011). Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace. Journal
of homosexuality, 58(10), 1355-1371
• Fleishman, J. A., Yehia, B. R., Moore, R. D., Gebo, K. A., & HIV Research Network. (2010). The economic burden of late entry into medical care for
patients with HIV infection. Medical care, 48(12), 1071.
• Fredriksen-Goldsen, K. I., Kim, H., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults:
results from a population-based study. American Journal Of Public Health, 103(10), 1802-1809. doi:10.2105/AJPH.2012.301110
• Healthy People 2020. (2015). Lesbian, gay, bisexual, and transgender health: objectives. Retrieved from
http://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/objectives

21. REFERENCES
• Hecht, R., Bollinger, L., Stover, J., McGreevey, W., Muhib, F., Madavo, C. E., & de Ferranti, D. (2009). Critical choices in financing the response to the global HIV/AIDS
pandemic. Health affairs, 28(6), 1591-1605.
• Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Retrieved from
http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx
• McKay, B. (2011). Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. Medical reference services quarterly, 30(4), 393-401.
• McKirnan, D. J., Du Bois, S. N., Alvy, L. M., & Jones, K. (2013). Health Care Access and Health Behaviors Among Men Who Have Sex With Men The Cost of Health Disparities.
Health Education & Behavior, 40(1), 32-41.
• Pan American Health Organization & World Health Organization. (2013). Addressing the causes of disparities in health service access and utilization for lesbian, gay, bisexual
and trans (LGBT) persons. Retrieved from http://www.who.int/hiv/pub/populations/lgbt_paper/en/
• The National LGBT Health Education Center. (2012). Improving the health care of lesbian, gay, bisexual and transgender people: understanding and eliminating health
disparities. Retrieved from http://www.lgbthealtheducation.org/wp-content/uploads/12-054_LGBTHealtharticle_v3_07-09-12.pdf
• The National LGBT Health Education Center. (2013). Optimizing LGBT health under the affordable care act: strategies for health centers. Retrieved from
http://www.lgbthealtheducation.org/wp-content/uploads/Brief-Optimizing-LGBT-Health-Under-ACA-FINAL-12-06-2013.pdf
• U.S. Census Bureau. (2014). U.S. and world population clock. Retrieved from http://www.census.gov/popclock/
• U.S. Department of Health and Human Services. (2015). The affordable care act is working. Retrieved from
http://www.hhs.gov/healthcare/facts/factsheets/2014/10/affordable-care-act-is-working.html
• U.S. Food and Drug Administration. (2014). Blood donations from men who have sex with other men questions and answers. Retrieved from
http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/QuestionsaboutBlood/ucm108186.htm
• Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among us Adults: national health interview survey, 2013. National health
statistics reports, (77), 1