Black LGBTQ adults face disparities in income security, affordable housing, employment and upward mobility. In Charlotte, a Black child growing up in a low-income home can expect a household income as low as $21,599 a year by the time they reach age 34. The outcome for those in the Black queer community is often far worse. Data points to access to quality healthcare as having an overwhelming impact on these issues, especially for Black transgender women.

According to a new study by the Williams Institute, more Black LGBTQ adults than Black non-LGBTQ adults were uninsured (25 percent versus 17 percent) and fewer Black LGBTQ adults had a personal doctor compared to their straight counterparts (64 percent versus 76 percent), specifically in the South. 

“You’re dealing with the macroaggressions and microaggressions of just being an ethnic and racial minority,” says Dr. Benjamin Simmons, a family physician at Atrium Health, “Then you add on if I disclose that I am of the LGBT community, not only am I being discriminated against based on my race and ethnicity, but also my gender and sexual orientation. You have these multiple components.”

Simmons explained that those stressors can be an added distraction keeping people from getting the care they need until it is too late. It also carries with it an added burden in the daily lives of LGBTQ individuals.

“How am I able to focus on the things that need to get done if I’m always distracted by some of those pressures?” he says.

A study from Wake Forest School of Medicine in Winston-Salem interviewed 30 Black and Latinx transgender women living in North Carolina between May and July 2019. Numerous themes emerged around social determinants to health, healthcare experiences and health-related priorities, showing the direct connection between economic security and overall health. 

Black transgender people are three times more likely than the overall United States population to be living in poverty. Those in the study reported higher rates of physical and emotional abuse and identified barriers including limited health insurance coverage, high costs associated with care and a lack of gender-affirming providers. 

All of these things tied together paint a dire picture. “If you’re not getting the kind of medical care that you need, you cannot be productive in the workspace,” says Simmons, “You’re taking days off from work. You take too many days off from work, now you’re unemployed. Or, how do you get promoted within your organization if you’re not present?”

Hope and Training

Across the country, individuals and programs are working to address the problem. 

The American Medical Association (AMA) launched its National LGBTQ+ Fellowship Program in February. The institutional grant of up to $750,000 will be to plan and implement three consecutive, one-year medical fellowships in LGBTQ+ health. This coincided with its release of an “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.” 

According to a press release, fulfilling the mission of the nation’s largest professional association of physicians “requires an unwavering commitment to equity and a comprehensive strategy for embedding racial and social justice within our organization and domains of influence.” 

One of the LGBTQ fellowships is at Mount Sinai Health System in New York. It is a program focusing on creating a new model for primary care that combines medical disciplines and holistic care to the LGBTQ community. 

The AMA will also fund 10 new fellowships in 2022, with many in the south, where LGBTQ patients have a higher rate of limited access to high-quality health care. 

Here in Charlotte, Atrium Health’s Levine Children’s Center for Gender Health is one of only a handful of such clinics in the region. Dr. Simmons has launched a virtual consultation program for transgender patients no matter where they are in the healthcare system. 

It’s not all happening in medical centers, however. Diverse & Resilient in Milwaukee, Wis., is an LGBTQ public health agency and its SHEBA (Sisters Helping Each Other Battle Adversity) program defines itself as “a group of powerful Black women.” The transgender-serving program provides leadership development, HIV prevention, healing alternatives and community support. Diverse & Resilient just received a $55,802 grant from the state’s Department of Health Services to provide training and advising on how to work with the LGBTQ community. 

Diverse & Resilient reported reaching over 7,000 people through direct health outreach in 2017, and 3,455 youth and adults completed evidence-based interventions that year to reduce health disparities. 

Elle Halo is a health navigator at Health Connections, Inc., a health clinic serving transgender clients, and a board member at Diverse & Resilient. In an interview with WUWM, Milwaukee’s NPR station, Halo noted the importance of helping others understand how to navigate the healthcare system. “It’s most important to have people that are providing services to look like the people that they’re providing them to. And I think that it has to be actionable and not just a concept,” said Halo. While the city ranks at the bottom of the largest United States metropolitan areas for well-being among its Black residents, Halo’s work and advocacy is providing hope and inspiration for others in the community. 

Further west, Black LGBTQ residents in Nevada may experience more protections in healthcare facilities, but poverty rates are still high. According to the Williams Institute, the poverty rate was higher for transgender people than for cisgender men. Poverty rates among people of color and among all LGBTQ people are higher than that of white straight individuals. 

Says Dr. Ray Macfarlane, who works with Leaders in Training, an organization that promotes diversity in leadership positions: “Nevada was fortunate to get, on the ground, largely a lot of work done by gender justice organizations.” 

The state has a perfect score for Gender Identity Nondiscrimination Policies, according to the Transgender Law Center. 

When asked about barriers to care for the Black LGBTQ community, Macfarlane says “at the root of it is economic stability.” Programs in the area are making a difference, Macfarlane confirms. 

At Fabulous Life Skills, founder Jazmena Jameson is “dedicated to helping trans women of color get gaps filled where they might have had their lives derailed by discrimination.” Another program they mention is Northern Nevada HOPES, an inclusive healthcare center. “There are a lot of organizers who do things between and independently of groups.” 

The state’s Medicaid system includes coverage for transgender-related surgeries and hormones associated with transitioning. While legislation provides a lot of needed protections, Macfarlane warns that people still don’t know how to always navigate the systems, and there is a lack of healthcare providers to meet the medical needs of the population. “Even the providers that we do have are so few that it’s difficult to find one that is a fit for you.” 

While wraparound health programs are increasing the opportunity to better serve the Black LGBTQ community and have positive impact on their health and economic outcomes, Simmons pointed out that the missing piece is a need for national standards outlining education requirements in LGBTQ care for medical providers. 

“It can be very difficult for a patient who lives in the [LGBTQ] community,” says Simmons, “How do I engage with the healthcare system with fears of political policies out there that are discriminatory? I may not want to mention too much about myself when I engage with the hospital system.” 

Simmons indicates the average number of hours for LGBTQ curriculum is less than five in most programs, and transgender care is even less. 

According to a report from the National LGBT Health Education Center, the health care system must include increasing awareness of the lived experience of Black LGBTQ people. That means examining and changing our personal views and behaviors, critically assessing and challenging institutional cultures and providing resources and mechanisms to empower Black LGBTQ people to be resilient in the context of oppression.

Research assistance provided by Pallavi Patil. 

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