Tackling LGBTQ stigma What like its hard

human beings

start putting each other into boxes the

second that they see each other

are they attractive are they a potential

mate

can i network with this person are they

dangerous

we do a mini investigation when we meet

people to make a mental note which helps

us decide

how to interact with them

i get it though our brains are hardwired

to immediately judge people

and that’s not always a bad thing we

begin formulating beliefs

from a very young age with our family as

a guide

but as we grow our beliefs continue to

be shaped with every interaction that we

have

we start making associations women named

karen

abrasive fashionable man gay

italian family loud you get the idea

what ends up happening when we are asked

the question

what’s your story or who are you it can

feel like somebody’s opening a tiny box

and asking you to squeeze yourself

inside of it

but the boxes are sometimes too narrow

and this can be really challenging

when i was young i didn’t want to stand

out in the crowd so

i let myself be placed into whatever box

people put me in and i just didn’t

correct them

female caucasian athletic jewish

great family unruly hair characteristics

that you’ve probably picked up on

already

and you wouldn’t be wrong to take those

observations

and put them in a box labeled kimberly

and call it a day

but you’d be missing the most important

thing about me

if you stop right there this is me now

a proud member of the lgbtq community

the process of coming out is unique for

every individual

and the news is received by those around

them in various different ways

for me i noticed that some people were

looking at me a little bit differently

people on the street my family friends

even my doctor easily started making

assumptions about me

and i’m not alone as assumptions can be

made because of the way you dress

your profile picture on facebook your

political views

your hobbies your interests or the fact

that you really really love the rainbow

flag

but society will make assumptions often

and assumptions can have a negative

impact on someone’s life

there is a relationship between

assumptions and stigma

assumptions lead to a form of stigma but

we all know what people say

if we assume things you make an ass out

of you

and me but what i’m saying to you

is not new

gay teenager was attacked forced to

strip

in video posted online

man was killed for being gay

as discrimination debates rage on lgbtq

youth

face ongoing challenges in schools

gay man shot dead after leaving

nightclub

lgbtq youth disproportionately

experienced homelessness and the list

goes on

as you can see stigma is still very much

present

and dangerous as these are news

headlines from the last few months

and years being a member of the lgbtq

community means having to constantly

evaluate the space you are in to see if

it’s safe to be queer to be affectionate

with your partner

and this can be both be both challenging

and exhausting

several years ago proposition 8 the

great marriage equality debate

was raising a lot of dust around this

country

i was struck by the fact that america a

country with such

a tarnished civil rights record could be

repeating its mistakes so blatantly

needing a supreme court decision to

legalize my right to marry who i love

made me feel so stigmatized

each time i hear about another law or

lack of protection for the lgbtq

community

i feel it as well and it feels like you

don’t belong

and though marriage equality is now

recognized federally

it doesn’t mean that society has changed

completely overnight

when i meet new people saying i’m

married usually brings with it

a lot of questions like what does your

husband do

or how did you and your husband meet

they have assumed that if i’m married or

wearing a ring

it must be to a man and that puts me in

a really awkward position

because now i have to quickly decide if

i’m going to correct them

and say actually my wife or

let them put me in an incorrect

heterosexual box

with every new person i meet i have to

decide whether or not to

lie to them or come out to them and

coming out is not a one-time thing

i feel like i need to make 100 extra

decisions every day

to make sure everyone else around me is

comfortable

which sometimes means i’m omitting a

part of myself

and that’s a lot of a lot of extra

energy right

over time there’s going to be an effect

and i

argue that effect is most pronounced

on your health whether that means your

mental health

physical spiritual emotional health or

some combination of all these

so how do we as soon to be health care

professionals

do something about this issue

when people enter the doctor’s office

they are required to check off

boxes and i’m not talking about tiny

boxes that we fall

into based on our internal individual

characteristics

i’m talking about literal boxes

on a patient form sex orientation

marital status for most people paperwork

is paperwork

but i want to walk you through things

from the perspective of a gay woman

this woman is worried that the

receptionist looking at the form

will judge her if she decides to check

off homosexual on her box

in truth the receptionist does give her

a look when the forms are returned but

doesn’t say anything

the nurse calls her in and asks some

standardized questions

including being sexually active the

woman says yes which leads the nurse to

say

that they’ll need to do a pregnancy test

and the woman knows that this is

completely unnecessary

but doesn’t feel comfortable

explaining why that is so she just says

okay

the provider reading the intake form was

aware of the patient’s sexual

orientation

the doctor tells her that since she’s

not sexually active with a male partner

that hpv testing an important indicator

for cervical cancer and a sexually

transmitted virus is not needed

the visit made the patient feel like she

was treated differently

because she’s gay so she never went back

to that provider again

the experience made her wary of doctors

in general

and avoided them if possible so she

wouldn’t feel so uncomfortable again

fast forward a few years later and this

same woman now has cervical cancer

requiring

an invasive surgery and chemo

you might be thinking that this example

is unrealistic

because most patients would go to

another provider but the assumption

would be unfortunately wrong

the lgbtq stigma is so prevalent and

widespread amongst providers that

patients are more likely to experiences

experience these type of interactions

than a welcoming affirming environment

in fact because of this gay women are 10

times less likely to have had cervical

screening tests in the past three years

compared to their heterosexual

counterparts

and therefore at a much higher risk for

developing cervical cancer

and having it progress

even small slights leave a lasting

impression

the woman in that situation went from

experiencing no stigma when she walked

into the doctor’s office to feeling

different judged and uncomfortable

and experiencing stigma like this is

associated with a range of negative

health outcomes

like higher risk of mental health issues

substance use

physical abuse hiv obesity and suicide

now i’m proposing this

that there is ultimately a stigma

spectrum that easily unfolds when

someone makes assumptions about you

or your lifestyle it can go from

experiencing no stigma to dealing with

different types of

microaggressions and in worse cases

being discriminated against

refused treatment or falling victim to

violence

the extremes of the spectrum are obvious

so i want you to focus on things in the

middle

that are arguably more common and easier

to counteract

micro insults like not using preferred

pronouns or preferred names

micro assaults intentionally isolating

someone because of their orientation

or micro invalidation saying i would

never have known you used to be female

these examples are not exhaustive and if

you have

if you haven’t already i guarantee that

you will find yourself witnessing some

form of stigma towards an lgbtq patient

when a patient experiences

microaggressions or is not met with an

affirming environment this leads to

missed opportunities for proper care

so what can we do we need to strive for

a greater understanding of lgbtq health

seek out training opportunities

encourage colleagues

have a sign or poster in your office

that signifies inclusivity

it doesn’t need to be a rainbow but make

sure language on forms is up to date

with all pronoun options and if you say

something

wrong just apologize and move on and if

you don’t know

just ask and most importantly leave

all those figurative boxes unchecked

so what like it’s hard you know what

it is hard it’s hard not to make

assumptions

it is important to make efforts to

reduce microaggressions but

we all make mistakes we may not always

say the right things

and when this occurs it’s important to

acknowledge our own limitations

or where we may have additional

questions

becoming more culturally competent takes

time

we must all start somewhere but the

important thing is to keep moving

forward

with inclusivity