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The LGBTQ+ population includes lesbian, gay, bisexual, transgender, queer, individuals who are still questioning, and more. This population is diverse in sexual orientation as well as ethnically and racially diverse. The LGBTQ+ community is rapidly growing, and unfortunately, along with that comes discrimination, bias, and stigmatization. Although healthcare providers go through many courses and trainings to provide equitable care, there is still subconscious bias and discrimination that afflicts certain populations which makes those populations vulnerable. The LGBTQ+ community is at high risk of either not receiving healthcare at all or receiving poor quality care. According to Healthy People 2020, societal stigma, discrimination, and denial of civil and human rights make this specific population vulnerable to health disparities. Healthy People 2020 also points out that discrimination against the LGBTQ+ population has led to high rates of psychiatric disorder, substance abuse, and suicide. LGBTQ+ members have less access to care and are more likely to delay necessary medical care. Some factors that contribute to this population delaying care are prior experiences of discrimination and denial of care from health care providers. These factors put this population at a higher risk of disease and reduction of lifespan, thus, making them a vulnerable population.

Our group, The Rainbow Researchers, collectively decided to research this population because we believe in equity within healthcare. The Rainbow Researchers agree that our job as nurses is to provide safe and equitable care to every patient regardless of their life choices, beliefs, skin color, gender, ethnicity, etc. We all also know people close to us that are a part of this population and it is heartbreaking to know that the hardships they face even get carried over into the healthcare setting. We want to educate ourselves so that we are able to advocate for these patients that have become used to being stigmatized and/or discriminated against.

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Neighborhood & Built Environment-LGBTQ individuals can face a variety of difficulties in their neighborhood setting. One of these difficulties is discrimination in the housing market. Specifically, transgender and gender non-conforming individuals experience high rates of differential treatment compared to non-transgendered individuals. This treatment often looks like not being shown additional housing options, not being offered financial incentives, and being quoted higher rental prices. This means they are more likely to live in a house that has poorer quality. Housing quality includes “air quality, home safety, space per individual, and the presence of mold, asbestos, or lead” (ODPHP, n.d.). Having poor housing quality can increase people's risk for illnesses and chronic diseases. Additionally, LGBTQ individuals are highly likely to be the victims of hate crimes, both verbally and physically. They are the most likely to experience these types of crimes more than any other group in America (Cahill, 2020). Being exposed to violence can increase people's risk of mental health disorders such as depression and anxiety. Overall, both of these environmental contexts make everyday living very difficult for LGBTQ individuals, leading to complications in other areas. Ultimately this leads to economic uncertainty and poor healthcare. 

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Neighborhood & Built Environment-LGBTQ individuals can face a variety of difficulties in their neighborhood setting. One of these difficulties is discrimination in the housing market. Specifically, transgender and gender non-conforming individuals experience high rates of differential treatment compared to non-transgendered individuals. This treatment often looks like not being shown additional housing options, not being offered financial incentives, and being quoted higher rental prices. This means they are more likely to live in a house that has poorer quality. Housing quality includes “air quality, home safety, space per individual, and the presence of mold, asbestos, or lead” (ODPHP, n.d.). Having poor housing quality can increase people's risk for illnesses and chronic diseases. Additionally, LGBTQ individuals are highly likely to be the victims of hate crimes, both verbally and physically. They are the most likely to experience these types of crimes more than any other group in America (Cahill, 2020). Being exposed to violence can increase people's risk of mental health disorders such as depression and anxiety. Overall, both of these environmental contexts make everyday living very difficult for LGBTQ individuals, leading to complications in other areas. Ultimately this leads to economic uncertainty and poor healthcare. 

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Social & Community Context-Social and community support is extremely important for all groups. In recent years, the LGBTQ community has grown and provided support to many individuals. However, there still persists problems of social isolation and out casting that needs addressing. Individuals in the LGBTQ community can face social isolation in a number of ways. One of those ways is incarceration. Within the youth of this community, they are overrepresented in the juvenile justice system, while transgendered adults are overrepresented in the adult corrections facilities. Incarceration leads to a higher likelihood of a copious amount of health issues, such as an increased risk for high blood pressure, asthma, cancer, arthritis, and infectious diseases (i.e. HIV or TB) (ODPHP, n.d.). Another problem exists in the elderly population of the LGBTQ community. They are less likely to receive social services and culturally competent providers, therefore increasing the chance for isolation (ODPHP, n.d.). Social isolation can be the cause of depression and anxiety, which can ultimately lead to physical health problems. 

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Social & Community Context-Social and community support is extremely important for all groups. In recent years, the LGBTQ community has grown and provided support to many individuals. However, there still persists problems of social isolation and out casting that needs addressing. Individuals in the LGBTQ community can face social isolation in a number of ways. One of those ways is incarceration. Within the youth of this community, they are overrepresented in the juvenile justice system, while transgendered adults are overrepresented in the adult corrections facilities. Incarceration leads to a higher likelihood of a copious amount of health issues, such as an increased risk for high blood pressure, asthma, cancer, arthritis, and infectious diseases (i.e. HIV or TB) (ODPHP, n.d.). Another problem exists in the elderly population of the LGBTQ community. They are less likely to receive social services and culturally competent providers, therefore increasing the chance for isolation (ODPHP, n.d.). Social isolation can be the cause of depression and anxiety, which can ultimately lead to physical health problems. 

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Education Access & Quality-LGBTQ individuals are at a higher risk of facing bullying and harassment while in school. Research has shown that LGBTQ individuals are more likely to face discrimination from peers and teachers in the school system (Roberts, 2020). This has many implications on their development and even life after high school. These implications can include being less likely to graduate high school, go to college, and get a well paying job. This ultimately can cause this population to not be able to afford health services, causing them to have poorer health outcomes.

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Education Access & Quality-LGBTQ individuals are at a higher risk of facing bullying and harassment while in school. Research has shown that LGBTQ individuals are more likely to face discrimination from peers and teachers in the school system (Roberts, 2020). This has many implications on their development and even life after high school. These implications can include being less likely to graduate high school, go to college, and get a well paying job. This ultimately can cause this population to not be able to afford health services, causing them to have poorer health outcomes.

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Healthcare Access & Quality-LGBTQ individuals are at a high risk for a number of diseases and illnesses. For example, “lesbians are less likely to get preventative services for cancer, gay men are at high risk of HIV and other STDs, and LGBT population have the highest rates of tobacco, alcohol, and other drug uses” (Office of Disease Prevention and Health Promotion, n.d.). Despite the fact that these individuals are at a high risk for these health problems, they are less likely to seek medical attention due to fear of discrimination from healthcare providers. They are more likely to struggle finding a non-judgmental provider who can provide the services they need. This prohibits them from receiving any needed treatment or any possible preventative care. In addition, they are also more likely to be uninsured due to increased poverty and unemployment rates (Kastanis & Gates, 2019). This is also another barrier that stops LGBTQ individuals from receiving needed medical attention or any preventative care. 

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Healthcare Access & Quality-LGBTQ individuals are at a high risk for a number of diseases and illnesses. For example, “lesbians are less likely to get preventative services for cancer, gay men are at high risk of HIV and other STDs, and LGBT population have the highest rates of tobacco, alcohol, and other drug uses” (Office of Disease Prevention and Health Promotion, n.d.). Despite the fact that these individuals are at a high risk for these health problems, they are less likely to seek medical attention due to fear of discrimination from healthcare providers. They are more likely to struggle finding a non-judgmental provider who can provide the services they need. This prohibits them from receiving any needed treatment or any possible preventative care. In addition, they are also more likely to be uninsured due to increased poverty and unemployment rates (Kastanis & Gates, 2019). This is also another barrier that stops LGBTQ individuals from receiving needed medical attention or any preventative care. 

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Economic Stability-One of the main causes for poor health care is economic instability. With LGBTQ community there is an overwhelming amount of evidence and research that shows they are more likely to experience poverty. Consequently, the rates of homelessness are very high within this community, especially among LGBTQ youths (ODPHP, n.d.). They are also more likely to experience unemployment, food insecurity, and not have insurance. Individuals who are unemployed are more likely to suffer from stress-related illnesses such as high blood pressure. Economic instability overall can increase a person’s risk for having stress-related illnesses but also decreases a person’s chances for receiving treatment due to being unable to afford healthcare services. 

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Economic Stability-One of the main causes for poor health care is economic instability. With LGBTQ community there is an overwhelming amount of evidence and research that shows they are more likely to experience poverty. Consequently, the rates of homelessness are very high within this community, especially among LGBTQ youths (ODPHP, n.d.). They are also more likely to experience unemployment, food insecurity, and not have insurance. Individuals who are unemployed are more likely to suffer from stress-related illnesses such as high blood pressure. Economic instability overall can increase a person’s risk for having stress-related illnesses but also decreases a person’s chances for receiving treatment due to being unable to afford healthcare services. 

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There are various health disparities that the LGBTQ+ community face. One of the main health disparities is associated with mental health. Mental health problems have been shown to be almost 2 times more prevalent within the LGBTQ+ community. This increased prevalence comes with not being able to seek help within the healthcare community due to continued biases of healthcare members and/or the fear of openly talking about their lifestyle. Even with many advances for the community over the years, the LGBTQ+ individuals are still highly stigmatized. Many individuals within this community have greater occurrences of depression, anxiety, and suicide attempts that they have to face on their own without help. Which can open up the door to various other realms such as the increase in drug or alcohol abuse and eating disorders. This is an example of only one health disparity, although this community faces so much more.

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There are various health disparities that the LGBTQ+ community face. One of the main health disparities is associated with mental health. Mental health problems have been shown to be almost 2 times more prevalent within the LGBTQ+ community. This increased prevalence comes with not being able to seek help within the healthcare community due to continued biases of healthcare members and/or the fear of openly talking about their lifestyle. Even with many advances for the community over the years, the LGBTQ+ individuals are still highly stigmatized. Many individuals within this community have greater occurrences of depression, anxiety, and suicide attempts that they have to face on their own without help. Which can open up the door to various other realms such as the increase in drug or alcohol abuse and eating disorders. This is an example of only one health disparity, although this community faces so much more.

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Capezuti, E. (2018). PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER ADULTS. The Encyclopedia of Elder Care (4th ed.). Springer Publishing Company. https://www-r2library-com.ezproxy.cpcc.edu/Resource/Title/0826140521/ch0015s1378

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Capezuti, E. (2018). PHYSICAL AND MENTAL HEALTH NEEDS OF OLDER LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER ADULTS. The Encyclopedia of Elder Care (4th ed.). Springer Publishing Company. https://www-r2library-com.ezproxy.cpcc.edu/Resource/Title/0826140521/ch0015s1378

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Dustin Z. Nowaskie & John S. Sowinski (2019) Primary Care Providers’ Attitudes, Practices, and Knowledge in Treating LGBTQ Communities, Journal of Homosexuality, 66:13, 1927-1947, DOI: 10.1080/00918369.2018.1519304

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Dustin Z. Nowaskie & John S. Sowinski (2019) Primary Care Providers’ Attitudes, Practices, and Knowledge in Treating LGBTQ Communities, Journal of Homosexuality, 66:13, 1927-1947, DOI: 10.1080/00918369.2018.1519304

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False Assumption: Homosexuality is an illness, or a health issue.

Truth: Homosexuality is not a disorder or a disease. Homosexuality is a natural and non-pathological variation of human sexuality. Being LGBTQ+ is not a choice or a phase. Most of the LGBTQ+ community will agree that there was no sense of choice regarding their sexual orientation. It is simply the way that they feel.

False Assumption: All LGBTQ people have HIV/AIDS.

Truth: People of all sexual orientations are at risk for contracting HIV/AIDS. In various areas of the world, HIV/AIDS is mainly an issue among the heterosexual population. Stigma, discrimination, and exclusion of LGBTQ+ people contributes to the lack of access to accurate information regarding HIV and safe sex practices, prevention, testing, treatment, care, and support. Because of this lack of information, LGBTQ+ people are at greater risk of becoming infected with HIV/AIDS.

False Assumption: LGBTQ+ individuals do not experience discrimination in accessing health care.

Truth: There are many documented instances detailing LGBTQ+ discrimination in health care. One case of discrimination involved an HIV patient who was denied his HIV medication due to telling the hospital staff that his partner was male. One study reported that 29 percent of transgender people said that a health care provider denied them care because of their gender identity (Crossway et al., 2019). Twelve percent said a doctor denied them health care pertaining to gender transition. Another study found that one in seven LGBTQ+ people have avoided treatment for fear of discrimination because they are LGBTQ+.

False Assumption: Health care providers receive formal training on the specific needs of LGBTQ+ individuals.

Truth: A study collected by the Journal of the American Medical Association reported that the average amount of time spent learning about LGBTQ content was approximately five hours during a four-year medical program (Crossway et al., 2019).

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Crossway, A., & Edgerton, G. (2019). LGBTQ+ Myths and Misconceptions Within the Health Care Community. NATAnews, 30–32.

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LGBTI myths vs. reality. Parliamentarians for Global Action - Mobilizing Legislators as Champions for Human Rights, Democracy and Peace. (n.d.). https://www.pgaction.org/inclusion/practical-tools/myths-and-reality.html.

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Time Out Youth Center offers support, advocacy, and opportunities for personal development and social interaction to LGBTQ youth.

https://www.timeoutyouth.org/

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Equality North Carolina is dedicated to securing rights and protections for the LGBTQ community.

https://equalitync.org/

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Equality North Carolina is the oldest statewide organization in the country dedicated to securing rights and protections for the LGBTQ community. We're invested in ensuring that every North Carolinian can see themselves in this movement and helping create a safer, more equitable world for all marginalized folks. Together we can build a better North Carolina.

Victorious 2020 Endorsed Candidates

Equality North Carolina is the oldest statewide organization in the country dedicated to securing rights and protections for the LGBTQ community. We're invested in ensuring that every North Carolinian can see themselves in this movement and helping create a safer, more equitable world for all marginalized folks. Together we can build a better North Carolina.

Victorious 2020 Candidates

With the sunset of HB142, NC is ready for nondiscrimination protections. We've launched a new digital portal with Campaign For Southern Equality to help connect you with your local elected officials and easily voice your support!

Get insider access to the work of Equality North Carolina and the communities we serve all across this state.

ENC has five regional chapter groups spread out across the state. We meet once a month and would love to have you get involved at the local level.

We envision a thriving, liberated North Carolina with a powerful LGBTQ+ community united in service of racial and social justice.

Equality North Carolina builds LGBTQ+ power through advocacy, education, and uplifting the stories of queer and trans North Carolinians in pursuit of racial and social justice.

We hold people at the center of all that we do: we see, hear, respect, and value each other.

We honor and build power on the margins until the margins are the center.

We know all oppression is interconnected. None of us are free until all of us are free.

We work strategically and sustainably: our work holds the realities of the need for both long- and short-term progress.

Y'all means all. We believe in the inherent dignity and worth of all, including people who are LGBTQ+, Black, Brown, Indigenous, Workers, Women, Resource Poor, Incarcerated, Immigrants, Undocumented, Rural.

The long-term goal of Equality NC is to enact statewide nondiscrimination on the basis of sexual orientation, gender identity & expression in housing, employment, public accommodations, credit, insurance, and education without exemptions that treat LGBTQ people differently from other protected groups. We provide training and education to individuals, institutions, businesses and the government on how to provide diverse, inclusive, and equitable environments. Additionally, we work to mobilize our communities and partners to advocate and take action against discriminatory practices. ENC achieves these goals through the core strategies of Advocacy, Training and Education, Leadership Development, and Base-building.

Recent News

The ruling importantly does not recognize a general constitutional right to discriminate based on religious beliefs.

From all of us at Equality North Carolina, Happy Juneteenth! Today, we join you in uplifting, celebrating, and reflecting on the end of slavery in the United States.

Use this tool to urge your state Representatives and Senator in North Carolina to prioritize passage of common sense policies protecting LGBTQ people from discrimination, violence, and harassment.

Updates

Stay In Touch

Want to stay updated on the work of Equality North Carolina and the happenings in our state that affect the most vulnerable North Carolinians? Sign up for our updates.

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Equality North Carolina is the oldest statewide organization in the country dedicated to securing rights and protections for the LGBTQ community. We're invested in ensuring that every North Carolinian can see themselves in this movement and helping create a safer, more equitable world for all marginalized folks.

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The American Civil Liberties Union (ACLU) of North Carolina works to protect and advance civil rights and civil liberties for all North Carolinians.

acluofnorthcarolina.org

https://action.aclu.org/legal-intake/nc

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If you are seeking legal assistance, please fill out this form as completely as possible. If we need information in addition to what is on this form, we will contact you.

You can also submit your request through the mail by sending a letter to PO Box 28004, Raleigh, NC 27611. All requests for legal help must be submitted in writing and will receive a response (typically within 4 to 6 weeks). We do not review requests for legal assistance in person or over the phone.

The ACLU of North Carolina works on cases that involve violations of civil liberties and civil rights guaranteed by the Constitution and related laws, such as your rights to due process, equal protection, religious freedom, privacy, speech, association, and your rights to be free from unreasonable searches and seizures and from cruel and unusual punishment.

We receive hundreds of requests for assistance each month. Because we are a nonprofit organization with limited resources, we are able to provide assistance in only a small number of cases. Unless and until the ACLU agrees to take your case, you are solely responsible for any and all statutes of limitations or other deadlines which might apply to your specific situation. If you have concerns about statutes of limitations or if you feel your case demands immediate attention, you may wish to seek advice from an attorney.

SPANISH BELOW:

Si está buscando asistencia legal, por favor complete este formulario tanto como le sea posible. Si necesitamos información adicional a lo que está en este formulario, nos comunicaremos con usted. Usted también puede enviar su solicitud por correo enviando una carta a PO Box 28004, Raleigh, NC 27611. Todas las solicitudes de ayuda legal deben hacerse por escrito y recibirán una respuesta (generalmente en 4 a 6 semanas). No revisamos las solicitudes de asistencia legal en persona o por teléfono.

La Unión Americana de Libertades Civiles (ACLU) de Carolina del Norte trabaja en casos relacionados con violaciones de libertades y derechos civiles garantizados por la Constitución y las leyes relacionadas, tales como sus derechos al debido proceso, a igualdad ante la ley, a la libertad de culto, a la privacidad, a la libertad de expresión, a la libre asociación, y sus derechos a permanecer a salvo de inspecciones e incautaciones infundadas y de castigos crueles e inusuales.

Cada mes recibimos cientos de solicitudes de asistencia. Dado que somos una organización sin fines de lucro con recursos limitados, podemos proporcionar asistencia sólo en un pequeño número de casos. A menos que y hasta que ACLU acepte tomar su caso, usted es totalmente responsable de cualquier prescripción extintiva u otras fechas límite que puedan aplicarse a su situación específica. Si le preocupan las prescripciones extintivas o si siente que su caso requiere de atención inmediata, podría considerar consultar con un abogado.

* indica los campos obligatorios

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If you are seeking legal assistance, please fill out this form as completely as possible. If we need information in addition to what is on this form, we will contact you. You can also submit your request through the mail by sending a letter to PO Box 28004, Raleigh, NC 27611.

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National Center for Transgender Equality represents a powerful transgender advocacy presence in Washington, DC.

https://transequality.org/health-coverage-guide

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National Center for Transgender Equality

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Getting Your Health Care Covered: a Guide for Transgender People

Getting your insurance to cover the health care you need can be difficult. The good news is that it should be getting easier. Many insurance plans have gotten rid of exclusions that single out transgender people, and trans people are protected from public and private insurance discrimination under federal law and state laws, including in Medicaid and Medicare.

But some insurance plans still make it hard to get coverage for transition-related health care, especially surgical care.

The most important thing to remember is that your insurance should cover transition-related care. However, you may need to show your insurance company why the treatment you need is medically necessary for you, with letters from your health care providers.

If you are denied coverage or if your plan has an exclusion, you may also need to explain to your insurance company or employer why it is illegal discrimination to exclude medically necessary transition-related care.

Use this guide to help you navigate the coverage process.

This guide will be especially useful for people who have Medicaid or private insurance.

If you are on Medicare, in the military, or a veteran who receives services through the VA, make sure to check out NCTE's specific resources for these plans:

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Getting Your Health Care Covered: a Guide for Transgender PeopleGetting your insurance to cover the health care you need can be difficult. The good news is that it should be getting easier.

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Bucholtz, K. (2021, March 1). 5.6 Percent of U.S. Adults Identify as LGBT.

https://www.statista.com/chart/18228/share-of-americans-identifying-as-lgbt/

Healthy People. (n.d.). Lesbian, Gay, Bisexual, and Transgender Health. Retrieved September 2,

2021, from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Morris, M., Cooper, R. L., Ramesh, A., Tabatabai, M., Arcury, T. A., Shinn, M., Im, W., Juarez, P., Matthews-Juarez, P. (2019). Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review. BMC Medical Education, 19, 1-13. http://dx.doi.org.ezproxy.cpcc.edu/10.1186/s12909-019-1727-3