Addressing Orlando’s LGBT Healthcare Disparities

1. What’s a “disparity”?
2. What’s the problem? Outline LGBT disparities by the numbers with data specific to Orlando and Florida
3. What are the issues?
4. What are the compounding factors?
5. What is Orlando Immunology Center doing?
6. LGBT Healthcare Resources – National and Local
7. What can I do?

A disparity is a lack of similarity or equality. A healthcare disparity refers to differences in the health status of different groups of people. These disparities can occur across many facets including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. For example, if red cars make up 10% of all cars but yet they are involved in 80% of auto break ins, that is a disparity. More data would be needed to determine why this occurred and develop solutions. Except in healthcare, disparities impact people’s health and lives therefore it’s important to identify them and then address them.

LGBTQ+ individuals face significantly higher health disparities than their non-LGBTQ counterparts as documented through various studies. Discrimination, stigma, unsupportive laws, lack of access to culturally- and orientation-appropriate medical and support services, heightened concerns about confidentiality, fear of losing your job and fear of talking about your sexual practices or orientation are factors that can negatively impact LGBTQ health or ability to receive care. There are health conditions that deferentially impact each of the sub-populations in the ‘LGBTQ umbrella’ and these should be identified and treated accordingly. Addressing Orlando’s LGBT healthcare disparities will provide a healthier, more productive community for everyone. Major health concerns disproportionately affecting the LGBTQ+ population include:

• HIV
• Sexually Transmitted Infections (STIs)
• Preventative Medical Care for Cancer (cervical, breast, HPV, anal dysplasia)
• Mental Wellness
• Substance Use

Addressing Orlando’s healthcare disparities will require additional data but here are just a few stats:

• In Orange County, Florida there has been a 60% increase in new HIV cases since 2012 among Men that have Sex with Men (MSM) (1)
• In Orange County, Florida MSM account for 69% of new HIV cases (1)
• The prevalence of the human papillomavirus (HPV) is 47% higher in gay men than their heterosexual counterparts (7)
• Recent survey data demonstrated that 25% of those who identify as LGBT did not see a doctor when they needed to because of fear of being mistreated as a transgender person (2)
• 19% Black transgender women in Florida were living with HIV (2)
• LGB individuals are 32% more likely to smoke and transgender are 82% more likely to smoke than their heterosexual counterparts (3)
• 82% of male syphilis cases with information on the sex of the sex partner were among gay and  bisexual men (5)
• LGBTQ individuals in Florida are 50% more likely to ever be diagnosed with a depressive disorder by a health care professional (6)
• 33% of those who identify as LGBT and saw a health care provider had at least one negative experience related to being transgender (6)
• Studies show Lesbians and bisexual women have a higher prevalence of several important risk factors for breast cancer, cardiovascular disease, and poor mental health (7)

A multifaceted approach in addressing Orlando’s healthcare disparities is required because of the dynamic and sometimes fluid influences on the problem.  Here are just a few of the compounding factors:

1. LGBTQ Culture Ignorance, discrimination and stigma among the LGBTQ population regarding healthcare, disease states and each other
2. Culturally Appropriate Healthcare Many medical providers are not aware of the guidelines for medical treatment of LGBTQ individuals from the U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control (CDC) resulting in discrimination and poorer health outcomes
3. Affordable Healthcare Lack of affordable healthcare
4. Legislation Lack of laws and protections, bureaucracy for gender nonconforming individuals creating an unsupportive social environment. One example is ‘conversion therapy’ which tries to change an individual’s sexual orientation or gender identity or expression. It causes harm and is not recommended by DHHS, CDC or the Substance Abuse and Mental Health Services Administration (SAMHSA)
5. Data collection Lack of LGBTQ health related data collection – data doesn’t accurately reflect the population resulting in health disparities and an inability to develop comprehensive solutions to improve health outcomes.

Orlando Immunology Center has been at the forefront of addressing Orlando’s LGBT healthcare disparities for over 20 years. Over those 20 years, OIC has developed a unique understanding of the issues that face the LGBT community. Creating what was probably the first culturally competent clinic in Central Florida. We continuously evaluate every aspect of healthcare to provide the best medical care and patient experience to everyone we serve. We have championed the evaluation, prevention and treatment of many conditions impacting the LGBT community. Some of these conditions include cardiovascular disease in people with HIV, HIV, STIs, Pre-Exposure Prophylaxis (PrEP), HPV and Hepatitis. OIC has been recognized both locally and nationally for our clinical research in these areas. We have established procedures to address these disparities specifically with a focus on the prevention of these conditions. Educating

Our providers train other medical professionals on new medications and best practices. OIC is also the first and only private healthcare provider to align with the goals set forth in the National HIV Strategy. Collaborating with the local community planning body responsible for its implementation, the Central Florida HIV Planning Council (CFHPC). We have even been honored with WAVE Awards by Watermark readers for the last ten years culminating with a WAVE Award feature article in 2018. Watermark is the leading LGBT publication in Central Florida. OIC will continue to work with community partners towards the common goal of ending LGBT healthcare disparities in Orlando and will rise to the challenge of leading the way with an approach focused on cultural humility, and the provision of high-quality care.

Do not be silent. Get educated. We all have a role in addressing Orlando’s LGBT healthcare disparities. If you are a member of the LGBT community, get educated about health issues and link others to verified information.  Work with others to create an open and affirming environment to others in the LGBT community. Don’t use derogatory language towards other groups. Do you have a bias against a certain group in the LGBT community? Are you aware of it? Be honest with your provider about issues affecting you. Become familiar with the CDC guidelines for Lesbian, Gay, Bisexual, and Transgender Health. Get educated and become your best advocate. If you are an ally, don’t be silent. Ask your doctor if they have an antidiscrimination policy, and if they don’t, encourage them to initiate one. Share this article with your friends and on social media. Join a local organization that promotes LGBT health issues. Utilize the resources below to connect to local and national LGBT health resources.

• National-
  • CDC guidelines for Lesbian, Gay, Bisexual, and Transgender Health
  • Lesbian and Bisexual Health
  • Gay and Bisexual Health
  • Transgender Health
  • LGBT Youth
  • Center of Excellence for Transgender Health
  • Fenway Institute
• Local-
  • Orlando Immunology Center – OIC has created our Community Relations Manager position to make sure that everyone gets linked to the resources they need. Our website has received the WAVE Award from Watermark readers for several years.
  • Ryan White – Provides HIV care to the underinsured or uninsured
  • Central Florida HIV Planning Council – Is a community planning body responsible for planning HIV prevention and care.
  • Talk, Test Treat – Offers HIV prevention and testing resources
  • Covering Central Florida – Provides culturally appropriate assistance with navigating healthcare and getting insurance
  • Libby’s Legacy Breast Cancer Foundation –  Provides comprehensive services to the underserved through education, mammograms, and patient navigation
  • Equality Florida’s TransAction Florida – Resource guide including providers
  • Zebra Coalition – A network of organizations which provide services to lesbian, gay, bisexual, transgender and all youth (LGBTQ+) ages 13 – 24
  • Mental Health Association of Central Florida – Provides mental health services, support and information to Central Florida
  • Orlando United Assistance Center – Offers support and resources to those impacted by the Pulse tragedy

We are here to help. If there is a resource you need but can’t find it, please email our Community Relations Manager, Sam Graper at sgraper@oicorlando.com.

Sam Graper
Orlando Immunology Center
Community Relations Manager

Get connected and stay up to date on Addressing Orlando’s LGBT Healthcare Disparities on Facebook, Intsagram and Twitter.

Special thank you to Yasmin Flasterstein of Mental Health Associates and Gabriella Rodriguez of Orlando United Assistance Center for their contributions in writing and compiling information for this article.

References:

1. FLHealthCharts.com is provided by the Florida Department of Health, Division of Public Health Statistics & Performance Management. Data Source: Florida Department of Health, HIV/AIDS Section

2. U.S. Transgender Survey (USTS), Florida State Report, National Center for Transgender Equality (NCTE)

3. Tobacco Free Florida, Smoking Impact on the LGBT Community Report

4. de Voux A, Kidd S, Grey JA, et al. State-specific rates of primary and secondary syphilis among men who have sex with men — United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66(13):349–354. https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6613a1.pdf7. Case P, Austin B, Hunter DJ, Manson JE, Malspeis S, Willett WC, Spiegelman D. (2004)Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. Journal of Women’s Health. 13, 1033-1047.

5. Williams Institute; The Impact of Stigma and Discrimination against LGBT People in Florida 

6. Pragna Patel, Tim Bush, Erna Milunka Kojic, Lois Conley, Elizabeth R Unger, Teresa M Darragh, Keith Henry, John Hammer, Gerome Escota, Joel M Palefsky, John T Brooks. Prevalence, Incidence, and Clearance of Anal High-Risk Human Papillomavirus Infection Among HIV-Infected Men in the SUN Study. The Journal of Infectious Diseases, Volume 217, Issue 6, 5 March 2018; Pages 953–963.