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