Illness, Injury, and Identity: Our Health System and the LGBTQIA+ Community
Updated: Jun 6, 2020
February 25, 2020 ⋅ 3:30 P.M ⋅ Cate Schroeder ⋅ Editor: Guadalupe Sandoval
It’s sex ed class when you’re thirteen. Or it’s the hospital staff when you’re 32. Or maybe, just maybe … it’s the doctor’s office when your kid isn’t even old enough to walk yet. Maybe it’s all of the above. But chances are, if you’re a member of the LGBTQIA+ community, you’ve felt those cracks and fissures in a health system supposedly meant to flood us with relevant help, information, and treatment. Many people take information about their physical, mental, and sexual health for granted, but you cannot know what you aren’t exposed to, you cannot prepare for what you don’t expect, and you cannot entrust your health to people who don’t try to see you for you.
The Sex Ed Gap
Although there are many reasons for the health and health care disparities LGBTQ+ people face, a critical root lies in middle and high school sexual education classes. Yes, those “cringy,” monotonous, awkward lectures by PE teachers actually matter greatly in the long run. According to the National School Climate Survey conducted by the Gay, Lesbian, & Straight Education Network in 2013, under five percent of LGBT students reported having health classes that positively portrayed LGBT-relevant subjects. I’ll say it again: not even five percent. For those who received sex ed, it was generally oriented toward cisgender, heterosexual students, with the primary purpose of preventing pregnancy. And as of 2017, only 12 states mandated that school sex ed even address sexual orientation. Not many, right?
What if I told you that three of those 12 states required schools to teach harmful, false ideas about sexual orientation? Take Alabama, where educators would teach students the “unacceptability” and “criminality” of being queer (abiding by what are known as “no promo homo laws”). Exclusion becomes condemnation in schools like these, as the harm to students just piles up.
The facts are unequivocally bold and obvious: LGBTQ+ youth simply don’t see themselves reflected in sexual education. Walking into those classes, they don’t see a mirror; they hit a wall. They don’t learn about safety, protection, STIs, or healthy relationships in ways pertinent to their own lives. And that’s where the chain reaction starts. These youth may tune out of noninclusive classes and turn to the Internet or friends or their own “best judgement” for (often faulty) information. The dominoes keep tumbling from there, becoming a huge factor in the sexual (and other) health disparities LGBTQ+ individuals encounter later.
Health Risks and Disparities among the LGBTQIA+ Community
What are those health disparities? Some are known, others will come as a surprise. The LGBTQ+ population exhibits a higher likelihood of early sexual activity, multiple partners, sexual activity while under the influence, and HIV or STIs --along with a lower likelihood of using birth control or condoms. Experiencing intimate partner and dating violence is also more common among LGBTQ+ individuals, and (maybe counterintuitively), so are rates of teen pregnancy. In fact, lesbian and bisexual female teenagers have a pregnancy rate 2 to 7 times higher than that of heterosexual teens.
Didn’t expect that one, did you?
In the case of HIV and STIs--as we work dedicatedly to dismantle the stigma surrounding them--it is still crucial to note the disproportionately higher occurrence of these in the LGBTQ+ population. For instance, more than ⅔ of new HIV infections for individuals 13 to 29 years old are in men who have sex with men (this is a proper term used to include multiple possible sexual orientations!). LGBTQ+ individuals of color are especially vulnerable, as are transgender individuals, who experience four times higher HIV occurrence than the national average. Here lies an intersection of two dangers--disease and stigma--both of which we continue to battle, having made huge strides ... yet certainly not finished.
But it turns out that some of the most dangerous, unpredictable disparities are often the most invisible. Members of the LGBTQ+ community are at a heightened risk for depression, substance abuse, self-harm, PTSD, physical/sexual abuse, and suicidal thoughts or attempts. Some of this risk stems from what we call the Minority Stress Effect: the tendency of people experiencing prejudice or stigma to turn to drugs or alcohol as a coping mechanism. It’s a common theme: when people can’t get the information, comfort, or acceptance they need from one place … they turn elsewhere, and unfortunately, that detour can turn destructive.
Laying out this information is a delicate task, I’m not going to lie. For a long time, many of these health disparities--especially HIV occurrence--were wrongfully taken to justify stigmas, stereotypes, and alienation (even in medical practice). Knowledge was not so much power, but an excuse, and many of those close-minded attitudes still persist today. It is absolutely terrifying to think that as we open a dialogue about these disparities, people may co-opt these facts for their own prejudice. But right now, if we want to explore and pursue change, we do need to recognize the faults and fissures in the LGBTQ+ community’s health education and health care experience. We need to talk about these disparities not just in terms of what they are … but in the context of how our society created them. Let’s talk about the roots, the origin story, about what we did or didn’t teach, who we supported and who we left behind. Let’s talk. It’s incredible: the damage that comes from silence.
So let’s not be silent.
About the Author
Cate Schroeder is an undergraduate at University of California - Los Angeles.