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Effects of Discrimination and Refusals : Anti-LGBT Discrimination in US Health Care

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Effects of Discrimination and Refusals

In interviews, LGBT people and medical practitioners voiced concerns about the practical and symbolic effects of discrimination and refusals by healthcare providers.

Some LGBT individuals circumvented medical guidance because of such discrimination. When transgender individuals were unable to obtain hormones or other medical care, for example, they at times bought them through alternative channels and administered them without medical supervision.

Others sought to compartmentalize their care or withhold information from providers they did not trust. Charlie O., a gay man in Mississippi, said: “I’ve basically bifurcated health care. I go to Open Arms to have discussions about blood tests and Truvada, PrEP, and then have my regular doctor for health screenings, cancer screenings. I’ve self segregated…. And it’s hard to figure out where to look here. I’m lucky—I know doctors, so I can work behind the scenes to find who to go to. But a lot of people don’t have contact with doctors til they need one.” Carla B., the mother of a transgender teenager, observed: “You’re going to withhold information, you’re going to lie… You can’t treat someone and treat them properly if you don’t give them the right information. And it does affect people’s health and well-being.” As Shane Bierma observed, this can itself be damaging:

In rural communities, a lot of times LGBT individuals, they’re not disclosing right away that they are part of the community, and then they’ve already gained an attachment to a provider and they disclose that, and then the provider rejects them, it further fuels this attachment rupture they’ve experienced time and time again. It feels like a weapon to me.

Other LGBT people continued to access health care, but had anxiety about facing discrimination. Jami Contreras, whose daughter was refused service by a pediatrician because she had same-sex parents, said: “It wasn’t violent, they didn’t attack us, but your sense of security is gone. Is it going to be violence next time? You just don’t know. And it’s on all levels—health care, signing [our daughter] up for soccer, you make sure the coach and parents are okay. It’s just sad that in 2018 we have to think about those things.” Gail Stratton, a lesbian woman who co-leads a PFLAG chapter in Oxford, Mississippi, said: “I would say the most direct harm I see is that it increases the anxiety of LGBT people. It puts you on shaky ground where you’re not sure that it’s safe—not that you ever knew, but it’s one more signal that you don’t really belong here.”

Still others were unable to obtain care, and struggled with the toll it took on them. Sandra R., a transgender woman in Flint, Michigan, who had been unable to obtain gender-affirming surgery, explained:

Having gender dysphoria, the only way that a lot of it can be corrected for somebody in my situation, to be healthy and to be able to survive, is surgery. The surgery is the main issue as far as gender dysphoria. I’ve been diagnosed with severe depression, suicidal tendencies, severe anxiety. And I haven’t been in the psych ward for two years now. And all they’re treating is my symptoms, and not my gender dysphoria, which is the root of all the issues and would be resolved with surgery…. I have days where I just get tired of fighting. And I do shut down. I don’t want anyone around. It’s a constant battle.

LGBT people also expressed concern about the discriminatory message that sweeping religious refusals send. Persephone Webb, a trans activist in Knoxville, Tennessee, said that “t tells people who are prone to being bigoted to be a little braver, and a little braver. And we see through this—we know this is an attack on LGBT people.” Petra E., a transgender woman in Mississippi, had a similar assessment of HB 1523, the exemption law there. “1523 for me means that my safety is put at even more risk—that right now, I have my safe spaces because people know they’re not supposed to discriminate. With 1523 going into effect it’s going to empower people to not do their job, and to discriminate.” Sarah H., the mother of a transgender girl in Tennessee, said “We know it’s difficult to find a doctor who’s going to be able to help us with our needs and be friendly and professional towards us. These laws, they’re really more symbolic than anything else. It’s really more of a, we don’t like queer people, and we’re allowed not to like you.”

hrw.org

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