LGBT Q&A Session with Marwan Haddad, MD, MPH

1. How do we improve care to members of the LGBT community?

We improve care to members of the LGBT community by first making them feel welcome and respected. If we don’t create an environment that is accepting and affirming, LGBT individuals will not share with us who they are and they will not engage in ongoing care with us. We will miss opportunities to screen, identify, and manage numerous medical conditions and psychosocial circumstances that are specific to the LGBT community

2. What are the biggest challenges you foresee?

I think the biggest challenge will be the education and training of all staff around cultural humility and ensuring clinical staff remain aware of the many biopsychosocial issues faced by the various members of the LGBT community, both specifically and disproportionately. We need to change an entire culture to be more open and understanding of issues. If we do run into any concerns with or about staff, it will be crucial to make sure they are addressed and resolved in a timely manner.

Changing our electronic health records (EHR) to better reflect the needs of the LGBT community will also be a challenge we have to face. Until such time that the electronic health record vendors update their systems to be inclusive of LGBT patients and their needs, we are going to need to find workarounds within the current EHR to properly reflect the community and their needs.

3. How do you make health centers more welcoming to LGBT people?

To make a health center more welcoming, there are things that we can do in addition to ensuring that all staff approach ALL patients in a respectful and affirming manner , We need to make the physical environment inclusive of all patients, including LGBT. That may mean changes in signage, photos, and language to better represent the LGBT Community. It is so important to make them feel like they belong. They’re a population that has been marginalized for so long it’s critical we make them feel as comfortable as possible.

4. What are special challenges providers need to be aware of as they deal with LGBT patients?

Providers need to make sure they treat LGBT patients with the same compassion, care, and respect as they would any other patient. It is also essential that providers understand that the LGBT community is varied and complex and that the L, the G, the B, and the T will have similar but also very different issues and needs. While there will be medical needs that will be specific to this population, we cannot forget that this community also has the same concerns that many of the non-LGBT patients have.

5. Are there special considerations for LGBT patients with HIV, Hep C, and STI’s?

Certain members of the LGBT community definitely will be at higher risk of HIV, Hepatitis C and sexually transmitted infections and so identifying those with higher risks will make it easier to target prevention, screening, and treatment efforts. Many members of the LGBT community suffer higher rates of depression and substance and alcohol use; for those who are also chronically infected with HIV and HCV, the risk of not engaging in care or adhering to treatment becomes very high.  We need to create an environment that is nonjudgmental and respectful and open so as to allow our patients to share their lives and behaviors with us. Only then would we be able to begin effective, informed treatment and hopefully see improvements in treatment outcomes.

6. How would PrEP play a role in this?

For the first time in HIV prevention strategy, we have an effective tool that doesn’t involve a barrier method i.e. condoms. We continue to witness about 50,000 new cases of HIV each year in the U.S., the overwhelming majority being among men who have sex with men. If we can identify those individuals at the highest risk, we can offer them pre-exposure prophylaxis (PrEP)—a combination HIV medication taken as one pill once a day– to reduce their chance of becoming HIV infected by 92%.

7. What roles does stigma play in LGBT health and how can we better address stigma around LGBT issues?

Stigma and discrimination have been major barriers for the LGBT community in seeking healthcare. We know that many LGBT individuals are at much higher risk of depression, substance and alcohol use, and suicide than the general population. We know men who have sex with men and transgender women are at much higher risk of acquiring HIV. The statistics are clear.

The LGBT community experiences enough stigma in society. We need to make sure that when they walk through our doors, they are welcomed and accepted with openness and respect. Our patients need to know that they will receive respectful and complete healthcare at CHC and as an agency, I am proud to say that we are committed to leading the way in Connecticut in becoming a beacon of LGBT health.

Dr. Haddad (right)pictured with members of the Project ECHO team.