In 2017, a visibly bleeding Anirban Kundu was refused treatment by several hospitals in Bengal after an accident. “Is she a girl or a boy?”, the staff at one hospital had asked. At another hospital, the staff spent previous time arguing against admitting Kundu in the women’s ward because she had a ‘male name’. If there had been a further delay in treatment, she would not have survived.
Among others, the LGBTIQA+ community faces discrimination in healthcare. A 2017 survey by the College of American Pathologists found that 29% of the transgender respondents and 8% of the lesbian, gay, bisexual, and queer respondents said that they were refused to be seen by a doctor or healthcare provider as a result of their actual or perceived sexual orientation. 6% of LGBTQ respondents said that they were not given healthcare-related to their actual or perceived sexual orientation. While 23% of transgender respondents said that they were intentionally misgendered or called by the wrong name by a doctor or healthcare provider.
This issue isn’t just prevalent in the US. In India, there are approximately 2.5 million people in the LGBTIQA+ community as per the data submitted before the Supreme Court of India. However, with homosexuality being considered a disease by many, it’s not surprising there are hardly a few LGBT IQA+ clinics in India. Access to quality health care is extremely difficult for members of the LGBTIQA+ community, with many finding it distressing to explain themselves, especially to uneducated healthcare workers.
“Transgender health in India and Pakistan”, a 2016 paper by Long C Ming, Muhammad A Hadi, and Tahir M Khan, mentioned the alarming disparity in the access of quality healthcare between transgender patients and their cisgender counterparts. The paper mentions how in India there is no access to treatment of sexually transmitted diseases for almost two-thirds of the transgender people.
With physicians and healthcare workers lacking knowledge about LGBTIQA+ healthcare, they are ill-equipped to provide adequate treatment. According to a survey in the US by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, 50% of the respondents reported a lack of knowledge by the health care provider and having to teach their medical providers about transgender care.
Looking at the results of the 2006 study by Dr Bharat Reddy on “Medical Students’ Knowledge and Perception of Homosexuality in India” which showed that 55.43% of the respondents “thought homosexuality was a psychological disorder and required therapy” it is apparent we need to educate healthcare professionals on LGBTIQA+ healthcare.
Another reason for the discrimination against the LBGTQ+ community and their health is the implicit bias against the members of this community. A 2015 study, titled “Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study”, which included 4,441 heterosexual first-year medical students, showed that 45.79% expressed at least some explicit bias while 81.51% expressed at least some implicit bias against gay and lesbian people. Personal prejudices and preferences of clinicians and healthcare workers come in the way of them providing equitable care to their LGBTIQA+ patients.
The bias and discrimination against the LGBTIQA+ community in healthcare have had some very rancorous effect on them. According to the aforementioned survey done by the National Center for Transgender Equality and National Gay and Lesbian Task Force, 28% of the respondents stated that they have postponed medical care when they were sick or injured. According to “Health care use among gay, lesbian and bisexual Canadians” by Michael Tjepkema, 75% of lesbians reported delaying or avoiding healthcare, with the three main reasons for doing so being: affordability, fear of discrimination, and past experiences of discrimination.
Doctors and healthcare staff must be educated thoroughly about LGBTIQA+ healthcare and be given the cultural competency to understanding gender identity and sexual orientations. Medical schools should start devoting more time and energy to educating their students about LGBTIQA+ health. As of 2011, medical schools are only providing 5 hours in the entire curriculum to LGBTQ-specific training according to the American Medical Association.
According to a review study conducted by Matthew Morris titled “Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systemic review”, Bias-focused educational interventions, Experiential learning interventions, and intergroup contact are effective measures that can increase knowledge, comfort levels, as well as tolerance attitudes towards LGBTIQA+ patients.
Discrimination against a marginalized community is a disease, which must be eradicated, and this disease has to be fought on a war footing basis. As a first step, hospitals and medical institutions must put in place processes that discourage discrimination. Regular training of the stakeholders on bigotry and discrimination and their adverse impact must be made compulsory. Strict assessments of the processes implemented by hospitals to reduce bias against LGBTIQA+ patients must be done on a monthly basis and independent third-party audits on the processes must be conducted and the hospital’s institution found lacking must be disincentivized.
It’s a long journey to eradicate discrimination and marginalization of the LGBTIQA+ community. But the first steps have to be taken. Let’s take those steps together.