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Health care equity still out of reach for LGBTQ people
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Health care equity still out of reach for LGBTQ people

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The woman came by bus to Richmond from Florida with no extra clothes, no food and no shelter, Zakia McKensey recalled.

Through Nationz Foundation, McKensey’s organization, the woman, who is transgender, was able to receive resources and health care. With support, she secured a job; a victory in a world that disadvantages LGBTQ people.

“A lot of times, it doesn’t go like that,” McKensey said Tuesday during a webinar centered on LGBTQ health care inequity.

The “Across the Rainbow: Moving from Disparities to Equity in LGBTQ+ Health” webinar opened up discussions this week on adversities LGBTQ people experience in the health care system.

Many LGBTQ people, especially transgender people, experience obstacles to accessing quality heath care, including medical mistreatment, inappropriate care and refusal of care due to their gender identity, experts say. This results in health disparities, which research shows can lead to high rates of depression and anxiety, substance abuse and suicide.

The event focused conversations on how health professionals can help shape the future of health care to be an affirming space for the LGBTQ community

There are health care services in Richmond that aim to provide quality care to LGBTQ individuals. But as roughly 100 attendees — Virginia Commonwealth University Health students, employees and community members — who participated in the seminar learned, more needs to be done to increase LGBTQ care options.

Transgender people face unique barriers in the healthcare system. According to a 2020 study by the Center for American Progress, 30% of trans Americans postponed or avoided medical treatment due to discrimination.

About one in three transgender Americans said they had to teach a doctor about transgender people to get the appropriate care, according to the study, and nearly two in five said their doctors have been visibly uncomfortable with them because of their gender identity. These percentages increased among transgender people of color.

Part of the Health Equity series hosted by VCU’s C. Kenneth and Diane Wright Center for Clinical and Translational Research, the webinar on Tuesday hosted health advocates who shared their personal experiences.

McKensey is executive director of Nationz Foundation, an educational advocacy nonprofit with a focus on providing resources to LGBTQ people with an emphasis on the trans community.

Many transgender individuals face employment and housing discrimination, McKensey said. Having nowhere to live or work, she said many engage in sex work, which puts them at risk of contacting sexual transmitted infections.

McKensey, who is transgender, said it was important for her to start a clinic that provide trans-affirming services and be a safe space for transgender people seeking healthcare services.

“A lot of times we as trans people are teaching our health care providers about us,” she said. “And a lot of times there is not any access for us to health care.”

Because of limited healthcare access, McKensey said so many transgender women, including herself, sometimes would go to extremes to receive care, such as potentially dangerous silicone injections from an unlicensed person.

Before McKensey started her own organization, she worked for what was then Fan Free Clinic, a Richmond-based health clinic that provides health services to underserved residents.

Karen Legato, the executive director of the organization now known as Health Brigade, said that McKensey, among others, helped forge a path in providing more LGBTQ care.

Health Brigade was one of the few clinics at the time to provide care to trans people “with dignity,” Legato said, helping to normalize care for the LGBTQ community. But she said Health Brigade should not be the only few services to do so — diverse care needs to be mainstream.

Both Legato and McKensey emphasized the importance for health professionals to frame their services to be more inclusive of LGBTQ patients.

Simple gestures such as asking for pronouns and including inclusive language on paperwork not only shows respect for the patient’s identity, but builds trust, McKensey said.

While the needle has been moved, Legato said, Virginia health care systems and practitioners themselves can do more to approach patients with an intersectional lens — taking into account a patient’s various cultural and social belonging, such as race, gender and class.

“We have a plethora of resources out here to learn about that stuff,” Legato said. “So one of the first things that I would really say to people is, start reading, start having conversations, start learning, and then start shaping and pushing the environments where you can.”

McKensey said the world has become safer for trans people to come out within the past decade, where it has become more visible and accepting.

She hopes that can translate into the health care system, where providers can treat LGBTQ patients in a more holistic approach.

“Understand that this is not a choice for us. The choice is when we decide to live authentically and stop suffering within ourselves and really be who we are so that we can be happy,” McKensey said. “That means having access to health care.”

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