October is LGBTQ+ History Month and to celebrate, we at Access Health Louisiana want to highlight some of the history of LGBTQ+ healthcare in the United States.
The relationship between the LGBTQ+ community and the healthcare system has been a contentious one. In the 19th century, the terms homosexual and homosexuality began to appear as scientists began to research same-sex behavior, which had previously only been viewed as sinful. This research did not stray from public perception, however, and most of the medical/scientific community viewed homosexual behavior as an illness or abnormal behavior. Sigmund Freud, the father of psychoanalysis, viewed homosexuality as “development arrest” and thought heterosexuality to be the norm for adults. At the same time however, Freud believed that attempts to change homosexual sexual orientation were not likely to succeed, based on a report where he unsuccessfully attempted to change the sexual orientation of a young woman brought to him for treatment by her parents.
In 1948 and 1953, Alfred Kinsey, an American sexologist, published Sexual Behavior in the Human Male and Sexual Behavior in the Human Female respectively. These books introduced the Kinsey Scale, a tool used to demonstrate that sexual behavior in humans was not strictly heterosexual or homosexual, but more fluid. Kinsey’s reports generated controversy, as his report implied that same-sex behavior was much more common than society believed at the time. In 1952, a year before Kinsey’s second report, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (DSM), which classified homosexuality as a “sexual deviation” underneath a group of personality disorders.
The LGBTQ+ community was further stigmatized by the DSM in 1968, when the Second Edition expanded the “sexual deviation” category to include individual diagnostic codes for homosexuality and “transvestitism”. Gay rights activists, following the Stonewall Riots, worked to protest the APA’s classification of homosexuality as a mental disorder. These protests included psychiatrists such as John E. Fryer, a gay man, and groups such as the Gay Liberation Front. These activists were successful in 1973 in getting the APA to change the diagnosis to “sexual orientation disturbance,” meaning the diagnosis was only valid if a person’s sexual orientation caused them distress.
While the medical world began making changes in regard to same-sex attraction, gender identity continued to be a point of contention in the medical community. The diagnosis of gender identity disorder (GID) first appeared in the DSM-III in 1980 as a diagnosis for children, while adults who showed gender fluidity were given the diagnosis of transsexualism. This was changed again in 1987, when “Gender Identity Disorder of Adolescence and Adulthood, Non-Transsexual Type” was added. These diagnoses remained in the DSM until 2013, when they were replaced with gender dysphoria, to help mitigate the stigma of the word “disorder”.
In the middle of these debates over diagnoses and terms, the AIDS crisis broke out, creating a serious issue for LGBTQ+ healthcare. In the New York Times in 1981, the disease was labeled “gay-related immunodeficiency” (GRID), which even at the time was incorrect as the disease was affecting many non-LGBTQ+ people including people who injected drugs, hemophiliacs, and sex workers. The misinformation about HIV/AIDS and the reluctance of governmental leaders such as President Ronald Reagan to acknowledge the disease at the time reinforced prejudice against those living with HIV and created social barriers to accessing healthcare. The government’s reluctance to acknowledge and act on the epidemic led to a huge loss of life, with 83,000 cases of AIDS being confirmed during the Reagan administration, and 50,000 patients eventually passing away of AIDS.
Since the 1980s though, huge strides have been made in HIV/AIDS research. Nowadays, we have PrEP and PEP to prevent infections, and medicines such as tenofovir and other antivirals can help HIV-positive patients reach an undetectable viral load. When a patient’s viral load is undetectable, they cannot transmit the disease to others. Patients can achieve this undetectable status by taking their medication on schedule and seeing a provider regularly to check their viral loads.
These improvements in LGBTQ+ healthcare have made accessing healthcare easier for some, but the LGBTQ+ community is still affected by homophobia, transphobia, and discrimination in the healthcare setting. This creates unique health disparities for the LGBTQ+ community. For example, LGBTQ+ people are more likely to need mental health services, partially due to minority stress and persistent fear of discrimination. In addition, LGBTQ+ people are more likely to face body issues, particularly gay men and bisexual people.
Lesbians have a higher rate of breast cancer, which is believed to be due to a lower rate of mammograms and self-breast exams. They are also less likely to receive appropriate cervical cancer screenings, which can lead to later diagnoses. Gay and bisexual men are more likely to come in contact with HIV and other sexually transmitted diseases. Transgender people are much more likely to be denied care outright, regardless of the type of care they are seeking. The Trump administration told the HHS’ Office for Civil Rights to stop investigating cases of discrimination based on gender identity, opening the door for providers to deny trans and gender non-conforming patients services with little fear of repercussions.
It is important that the LGBTQ+ community is aware of its history with the healthcare systems in this country, and we at Access Health Louisiana are here to help mitigate the health disparities that affect this community in any way we can. If you are seeking healthcare, please contact our LGBTQ+ Linkage to Care Coordinator Milo Malone at (504) 226-2976 ext. 1022 or reach out at mmalone@accesshealthla.org.
References
https://www.theatlantic.com/politics/archive/2021/04/full-story-nancy-reagan-and-aids-crisis/618552/
https://www.nytimes.com/1982/06/18/us/clue-found-on-homosexuals-precancer-syndrome.html
https://www.ncbi.nlm.nih.gov/books/NBK64801/
