Pride Month: LGBTQ Self-Advocacy In Healthcare
Navigating the healthcare system can be an extremely vulnerable and sensitive process. The LGBTQIA2S+ communities have been disproportionately affected by healthcare discrimination and have a history of health oppression. For many trans, queer, and non-conforming individuals, being educated about their healthcare needs is a necessity and self-advocacy can help us to get the care we need and deserve from a system set up against us.
Self-advocacy is when you speak for yourself, understand your rights, and ask for what you need. LGBTQ self-advocacy requires self-awareness, assertiveness, and preparation.
Basics of Queer Healthcare:
Specific Needs of the Queer Community:
Due to the chronic stressors of discrimination and oppression, the queer communities have higher rates of substance misuse, chronic illnesses, mental illnesses, and suicide. Healthcare providers, both primary care and mental health, should be aware of the risks associated with chronic anxiety, as well as specific health needs of their queer patients. Some healthcare needs that are specific to the LGBTQ community include puberty blockers, gender affirming surgeries, pelvic floor therapy, voice therapy, and hormone replacement therapy. You deserve healthcare that acknowledges and proactively protects your queer identity. You deserve healthcare that is de-gendered and culturally competent, and we want to encourage you to assert your needs.
Sex Positive Care:
Sex positive healthcare operates from an understanding that sexuality is a vital aspect of overall well-being and that the sexual spectrum is vast and complex. Sex-positive providers create a judgment-free, compassionate, professional space that acknowledges this and avoids assumptions about sexuality. Sex-positive care can be beneficial for people of all sexualities, and it can be crucial for the effective care of LGBTQ patients. The popularized medical model of healthcare skews toward STI prevention as the primary goal. Of course, STI prevention and treatment is critical care for all sexually active individuals. However, the implementation of candid and respectful conversation about sexual wellness without assumptions is one important aspect of holistic care.
Trauma Informed Care:
Trauma informed care acknowledges trauma at the individual, interpersonal, institutional, and societal levels. A trauma informed provider understands that the effects of discrimination, abuse, social instability, and medical trauma are real influencers of a person’s overall health. This understanding should be illustrated through collaboration with the patient in the form of active listening and responding transparently. Unfortunately, many providers are not aware of queer and trans micro-aggressions that are common in healthcare settings. While most do not intend harm, the effects of these micro-aggressions can be detrimental to your health. It’s not easy, but we strongly encourage you to speak up and raise your provider’s self awareness. A trauma informed provider should use non-gendered language when referring to your body and should not make any assumptions about your identity. If you are not receiving this level of attention to your needs, your healthcare may lead to the opposite effects than what was intended, increasing dysphoria and deregulating the nervous system. Your health should exist within a culture of consent. Your care is in your control, and we give you permission to say “no.”
What is LGBTQ Self-Advocacy?
Self-advocacy can be an important part of receiving care for anyone, but especially for marginalized groups. For people who are disabled, BIPOC, queer, poor, uneducated, and for people whose identities intersect in many of these communities, quality healthcare is often gate-kept and inaccessible. Members of the LGBTQ community are diverse and many experience aversion and discrimination from multiple sources, due to their intersecting identities. LGBTQ self-advocacy is the result of a valuable set of skills and self-awareness that can allow someone to fully speak for themselves.
In healthcare, self-advocacy is crucial for many in order to be heard and believed by their providers. Self-advocacy requires communication skills such as being assertive and listening closely to be sure that your needs are being met. Practical skills of self-advocacy include making phone calls, writing emails, saying “no”, and knowing when to ask for a new provider. Advocacy For Inclusion has created a Self-Advocacy Kit (intended for the disabled community, but it’s plenty relevant to people of intersectional marginalized identities, including the LGBTQ communities) that you can find linked at the bottom of this post.
Tips for LGBTQ Self-Advocacy:
Be Honest About Your Experience:
For many queer people, we have to play the roles of both the patient and the educator. Marginalized individuals have been told to keep silent about their struggles for far too long, and this silence has created a willful ignorance of our needs in the United States healthcare system. Our healthcare system was created for cisgender, heterosexual, white, educated, and relatively healthy individuals. The heteronormative standards of healthcare can directly impact the availability of important treatment for members of the queer community. Ignorance among healthcare providers is common, and false beliefs about LGBTQ+ individuals can limit access to contraception, medically necessary examinations, and screenings. Letting your provider know when you are feeling the effects of this ignorance can be an important first step. Honesty about your experience is a form of LGBTQ self-advocacy. Please tell your provider if you are feeling unsafe, unseen, or unheard.
Ask for What You Need:
When you make the choice to receive care from a healthcare provider, you are choosing to trust someone with vulnerable parts of yourself. If there is something that will make this process more comfortable for you, you are allowed to ask for that. For example, many people benefit from bringing a friend or other companion along to their appointment, or to have a nurse of a certain gender. Some people use certain words that feel more safe to them to describe their body parts, and need their providers to use the correct terms when referring to their body. If this type of support would be helpful for you during your appointment, please speak up.
Know Your Rights:
Part of LGBTQ self-advocacy is understanding and asserting your rights. There has been a history of leaders before you that have fought for these rights, and you deserve the safety of these rights being respected. The Affordable Care Act, section 1557, is a nondiscrimination provision prohibiting discrimination based on race, color, national origin, sex, age, or disability in federally-funded health programs or activities. The 14th Amendment includes an equal protection clause requiring both state and federal governments to treat people equally. You have the right to create an advanced directive, and this can include your chosen name and gender identity as well as the individual that you trust to make decisions for your care if you are no longer able to.
Seek Care Without Your Parent’s Support:
An important aspect of healthcare for queer, and especially trans youth is parental support of choices that you make about your body. However, for many, this parental support is not possible. We want to affirm that you know what your body needs. In Washington state, as well as others, the age of informed consent for mental and sexual health is 13, which means you can make decision independently of your parents.
Find Safe Providers:
When it comes to choosing providers, you deserve to see someone who can make you feel safe and cared for. It can be risky for a queer individual to enter into a healthcare setting without doing some research ahead of time. A 2017 survey from the Center for American Progress found that 8% of queer people were refused care by a healthcare provider due to their actual or perceived sexual orientation. This number is a staggering 29% for trans patients that were surveyed. This creates a reasonable culture of fear and avoidance for the LGBTQ community when it comes to pursuing healthcare.
Some things to look for when choosing a healthcare provider are a nondiscrimination statement on their website that specifically mentions sexual and gender identity, as well as queer-affirming language throughout the site. Before seeing a new provider, you can send them a message and ask them some questions to get a sense of their level of preparedness to see a queer patient. Some questions you can ask are:
“Are you trauma informed?”
“Are you queer-friendly?”
“Are you sex positive?”
“Are you affirming of non-monogamous relationships?”
“Are you gender-affirming?”
It’s important to know that you have the right to terminate care with a certain provider at any point in time for any reason. You are in charge of your appointment. The GLMA Heath Professionals Advancing LGBTQ Equality has a director of queer affirming providers across the US, and there are many local resource lists with a similar purpose. An important part of LGBTQ self-advocacy is taking steps to ensure that the people you see are safe for you.
Conclusion:
Marginalized groups have a history, both past and present, of discrimination in healthcare. Access to care that affirms your identity is critical to your health. LGBTQ self-advocacy is a set of skills and mindsets that can help you speak up and get the care that you deserve. With some focused attention and courage, you can take your healthcare into your hands and feel safe and healthy in your own body. You deserve respect, compassion, and to be seen as fully yourself.
Ready to take your healthcare into your own hands?
Download a copy of our FREE self-advocacy workbook and learn the skills you need to get the care you deserve.
RESOURCES:
https://qspaces.org/- coming soon, find LGBTQIA2S+ safe providers
https://www.outcarehealth.org/- “the nation’s first comprehensive resource for LGBTQ+ healthcare offering provider and healthcare resource directories, mentorship, medical education reform, and cultural competency training. OutCare’s most notable endeavor, the OutList, is an online, nationwide directory of healthcare providers who identify as culturally competent in the care of the LGBTQ+ community.”
https://www.lgbthealthlink.org/News- Queer health related news
PELVIC FLOOR SPECIALISTS:
LETTER FOR SURGERY:
SOURCES:
Written by Sien Mendez
