What’s making the LGBTQ community sick? To start, discrimination and trauma

I recently partook in a panel discussion on peacebuilding. One of the panelists, an alleged proponent of religious freedom, asserted that the words “discrimination” and “trauma” are overused.

As someone who has spent three decades studying how discrimination and trauma impact health, I’m confident that any person in the United States — who is a member of a racial, ethnic, sexual or gender, or myriad of other minority groups — would beg to differ. Particularly when it comes to our health outcomes.  

For those of us who are LGBTQ+, discrimination and trauma have defined our lives across generations, through the lived experiences within our families, communities, cultures and religions. Experiences of discrimination — that range from an appointment at the doctor’s office to how we are treated just going about our days — continue throughout our lives and fuel our trauma, which in turn undermines our physical, social and mental health. For those who also are members of Black and Brown populations, the synergies of multiple minority identities create even worse health outcomes. It is not coincidental that Black gay and bisexual men are most at risk for acquiring HIV, accounting for more than 1 in 4 infections in our country. 

The health of LGBTQ+ people and populations has been under attack for centuries. Our existence has been denied since time immemorial; care professionals have been ill-prepared to address our health challenges; and when AIDS undercut our population, we were cast aside as lepers. To this day, many of us receive care in the shadows, fearing to share who we are — our whole selves — with healthcare providers lest we be dismissed, judged, or harassed because of our sexual and/or gender identities..

A recent editorial in the New England Journal of Medicine advocates for routine collection of sexual orientation, gender identity and intersex status data in health care settings and on the census — a critical step in challenging LGBTQ+ discrimination and normalizing our lives. Yet only a handful of health providers and municipalities collect this information.

Unfortunately last week, a new low was also reached when Arkansas became the first state outlawing gender affirming treatment and care for trans youth under HB1570, the insidiously named Save Adolescents from Experimentation (SAFE) Act. In tandem, states like Georgia, Texas and too many others continue to introduce and pass restrictive voting provisions that create obstacles for people of color to vote. 

These legislative maneuvers are flip sides of the same racist, homo- and transphobic coin, controlled by people who want an America in which anyone who does not fit into their narrative to be cast aside. The result of these conscious acts of discrimination is the perpetuation of trauma in our lives.

So, the words “discrimination” and “trauma” are not overused — not now, not ever. 

Any one of us whose health is challenged by inadequate care, or by laws that deny us care (or by efforts to suppress our votes), experience discrimination as a daily reality.

Quite simply, all hateful acts experienced by LGBTQ+ people, whether such attacks are personal or political, subtle or overt, emotional or physical, fuel the ongoing trauma in our lives and make us sick. These are the very conditions that fuel the health challenges faced in our population, including but not limited to HIV/AIDS, HPV, depression, suicide and drug addiction. We experience more chronic conditions than our heterosexual peers and are more likely to avoid health care in fear of how we will be treated. In the last year, my own center’s work has shown the susceptibility of LGBTQ+ to physical and economic health deterioration due to COVID-19, with LGBTQ+ people of color much more likely to be infected with SARS-CoV-2 than white heterosexual peers.

To eliminate these health burdens and disparities in the lives of sexual and gender minority individuals, we must enact structural change that includes:

1. Normalizing LGBTQ+ lives in health care delivery, in part through the collection of sexual orientation and gender identity data.
2. Eradicating and preventing the passing of draconian laws meant to appease the small handful of homo- and trans- phobic Americans whose hate is legitimized by these laws.
3. Urging the U.S. Senate to pass the Equality Act so that protecting LGTBQ+ people (and in turn our health) becomes law of the land; and
4. Calling out those whose words are an expression of their desperation to hold on to the power and privilege they have held for too long. 

Only then will we begin to feel better. 

Perry N. Halkitis is dean, professor and the director of the Center for Health, Identity Behavior & Prevention Studies (CHIBPS) at the Rutgers School of Public Health. His book, “Out in Time: From Stonewall to Queer, How Gay Men Came of Age Across the Generations,” was published by Oxford University Press in June 2019.