Providing Quality Healthcare for the LGBTQIA+ Community

Pride Month is a time to celebrate the courage, resilience, and contributions of LGBTQIA+ individuals throughout history. It's also a timely reminder of the ongoing challenges this community still faces, especially in health care. As we engage with LGBTQIA+ community members, it is important to acknowledge those who are different from us and allow LGBTQIA+ community members visibility of those of similar identities. Many of us interact with LGBTQIA+ individuals daily even if we may not know the details of their identities. Despite progress toward equal rights, LGBTQIA+ individuals still endure significant health disparities that demand our attention and action.

Understanding LGBTQIA+ Health Disparities

According to Gallup , the number of individuals in the United States who identify as LGBTQIA+ has substantially increased in recent years to 7.6% of the adult population, with 1 in 5 Gen Z adults identifying as LGBTQIA+. Although this population has grown, the LGBTQIA+ community is classified as a "health disparity population" due to their complex relationship with health care and the insufficient level of medical research being conducted on LGBTQIA+ health issues.

Access to affirming care for LGBTQIA+ patients is not consistent among health care providers due to a variety of state-level policies and individual biases among health care professionals. LGBTQIA+ adults experience an increased likelihood of discrimination, refusal of care, and unnecessary or invasive procedures in health care settings based on their sexuality or gender identity which creates a lasting impact. Transgender patients experience an even higher risk of discrimination due to state-level restrictions and a lack of insurance coverage for gender-affirming health care, a critical need for transgender patients. Discrimination of LGBTQIA+ patients within a health care setting further exacerbates health disparities as patients who experience discrimination are less likely to seek routine care, often delaying medical intervention until an emergency arises.

Impact of Discrimination on LGBTQIA+ Patients

LGBTQIA+ patients face a variety of barriers when it comes to accessing health care services, including but not limited to a lack of affirming providers, inequitable treatment in comparison to cisgender heterosexual populations, insurance and resource limitations for family planning, poorer mental health outcomes, and increased risk for long-term medical issues. Many LGBTQIA+ patients are limited in their options for health care providers, making the search for an affirming and inclusive provider more difficult.

When experiencing discrimination in a health care setting, LGBTQIA+ patients struggle to find new providers due to their increased distrust of the health care system. For many LGBTQIA+ patients, simply changing providers is not easy due to environmental factors such as experiencing poverty and homelessness, which affect the LGBTQIA+ community at higher rates than their peers, limiting the geographical area where they can seek health care services. This distrust and reluctance lead many LGBTQIA+ patients to seek care largely from LGBTQIA+ community resource centers, which do not always provide full, comprehensive care and are not accessible in all states.

Despite federal protections, LGBTQIA+ patients still face challenges due to state-level regulations and insurance companies bypassing coverage for their needs. Same-sex couples often experience a lack of insurance coverage for family planning as their needs are different from those of cisgender heterosexual couples. Many insurance plans don't cover IVF, leaving lesbian couples facing significant out-of-pocket costs to build their families; the same is true for gay couples seeking surrogacy. Transgender patients experience various limitations on the type of care they can receive and where they can receive that care due to many gender-affirming care procedures being considered cosmetic or medically unnecessary. The limitations on where transgender patients can receive care will often leave them with few options for providers, causing many to endure discrimination to access gender-affirming care.

What Makes the Public Health Institute at Denver Health Different?

Everything we do at the Public Health Institute at Denver Health (PHIDH) and Denver Health Medical Center revolves around person-first health care. For LGBTQIA+ patients, we will do everything in our power to make our patients feel safe and affirmed while seeking care with us. This includes patient files and intake forms that use the patient's preferred name and pronouns, discrete post-visit summaries, equal visitation, and medical decision-making. By recognizing patients as people first, we acknowledge the importance of addressing and referring to our patients with the terminology, names, and pronouns that match their identities. Our staff is trained on the complexities of LGBTQIA+ health care, and we strive for representation within our clinics to reflect the communities that we serve.

Denver Health Medical Center is one of the 384 hospitals in the United States that received a score of 100 on HRC's Healthcare Equality Index 2024. The Healthcare Equality Index is a rigid scoring system that assesses health care facilities based on five criteria: non-discrimination and staff training, patient services and support, employee benefits and policy, patient and community engagement, and responsible citizenship. Denver Health is proud to be an LGBTQIA+ Healthcare Equality Leader, receiving a perfect score on the 2024 report.

PHIDH’s LGBTQIA+ Inclusive Services

At PHIDH, we understand that furthering equity for the LGBTQIA+ community includes work within our clinics and directly with the community. Alongside many initiatives that overlap with the LGBTQIA+ community, PHIDH provides direct patient care and community impact work via the Denver Sexual Health Clinic, Outreach, Linkage to Care, and the Youth PRIDE Coalition.

Denver Sexual Health Clinic (DSHC)

The Denver Sexual Health Clinic (DSHC) stands as a beacon of inclusive health care, dedicated to breaking down barriers for LGBTQIA+ individuals. Since its inception, DSHC has been unwavering in its commitment to providing person-first care, ensuring every patient feels seen, respected, and understood. DSHC has been purposeful in designing an environment that is inclusive and reflective of the communities in which we serve. From the moment a patient comes to the clinic and steps through the doors of DSHC, inclusivity is tangible. The clinic's design, educational materials, artwork, and even room layouts are carefully planned to foster a sense of belonging for all individuals, regardless of sexual orientation or gender identity.

DSHC recognizes that providing truly inclusive care requires continuous learning. That's why the staff undergoes rigorous training on patient-first practices, implicit biases, and culture-affirming care. This commitment to education ensures that every interaction is infused with empathy and understanding.

In 2022, DSHC took a significant step forward by expanding its services to better serve the LGBTQIA+ community. Recognizing the disproportionate impact of certain health issues, such as mpox, on the community, DSHC introduced comprehensive testing and treatment options. Additionally, DSHC responded to community requests by strengthening our PrEP and nPEP services, providing crucial support to those in need.

DSHC at Denver Health understands that trust is the cornerstone of effective health care delivery. Over the years, DSHC, the DSHC Outreach Team, and Linkage to Care have forged deep connections with the LGBTQIA+ community, demonstrating a commitment to mutual respect and inclusivity. By bringing services directly to the community, DSHC ensures accessibility and fosters a sense of partnership in care. As part of this trust, we want to ensure that we gather community input. At DSHC, community feedback is essential. The clinic actively seeks input from LGBTQIA+ individuals to ensure that its services remain inclusive and patient-centered. Moreover, DSHC prioritizes hiring staff members who reflect the diverse communities we serve, further strengthening the bond of trust between staff and patients.

Youth PRIDE Coalition

The Youth PRIDE Coalition is a coalition made up of youth and adults working towards improving the lives of queer youth. We hire youth leaders ages 15-24 to help us in leading the work and along with youth, we have adult volunteers who are community members and representatives from organizations across the Denver metro area. The Youth PRIDE Coalition uses the Communities that Care model, which guides communities through a proven five-phase change process to promote healthy youth development and improve outcomes while reducing problem behaviors.

Part of YPC also includes professional development and skill building for our members and youth leaders. This professional development can look like topics not learned or touched on at school, public speaking, affirming care, etc. In the past, we have hosted workshops on financial literacy, medical history and where to access services, deep dives into active LGBTQIA+ organizations, insurance options, transgender health care, and more.

In addition to this, we constantly work to elevate the work that already exists instead of recreating the wheel. YPC created the PRIDE Toolkit as a resource toolkit to share information about active organizations and educational information for adults working with queer youth. Youth can even access it and find resources for themselves. Currently, we are working on developing an interactive calendar that will support sharing queer events happening throughout the Denver Metro area. Stay tuned for more!

Our Continued Commitment to LGBTQIA+ Health Equity

By continually seeking community feedback and expanding our services, the Public Health Institute at Denver Health remains at the forefront of LGBTQIA+ health care equity. We recognize that trust and inclusivity are fundamental to effective health care, and we will continue to work tirelessly to provide the highest quality care for all our patients.

If you are interested in connecting with us for testing at community events, tabling, or education opportunities, please reach out to Jesse Chavez at 303-602-3631 or via email at Jesse.Chavez@dhha.org.

Together, we can make a difference and ensure that the health care needs of the LGBTQIA+ community are met with compassion, competence, and respect. Thank you for joining us in this vital work.