Community Health for Queer and Trans Folks
Despite the passing of the Affordable Care Act that expanded healthcare access to millions of people, one in ten Americans under age 65 are still uninsured and over half of these individuals report struggling to pay medical bills. People who struggle to cover medical expenses more likely to be poor, to be women, to be black or latinx*, to have a disability, and to be queer or trans.
‘Community’ healthcare acknowledges that even though healthcare is a necessity, not everyone has equal access to it. It also acknowledges that even though a person may have access to healthcare, they may not receive complete or high quality healthcare. To fill in the gaps, it often means having people in the community staffing clinics, receiving training and acquiring skills to provide special services, and speaking out on community needs.
For queer and trans people, the healthcare disparity does not stop at debt burden and insurance. Finding a queer- and trans- competent physician remains a task that many people in the community continue to struggle with, especially in small rural areas. Reconstruction surgery may involve flying out of state and coverage is unavailable for many.
Further, the LGBTQIA+ population is disproportionately affected by many health concerns. For example, MSM (men who have sex with men) and trans women are more likely to have HIV, lesbians have higher rates of obesity, and LGBTQIA+ folks smoke at higher rates than almost any other subpopulation. While there is a lack of adequate research on the health and healthcare access of trans and non-binary people, it is readily apparent that the healthcare profession has a long way to go. Nonetheless, like many aspects of LGBTQIA+ history, the story of our movement, both past and present, for healthcare and dignity is much more vibrant than statistics.
History of Community Healthcare in the LGBTQIA+ Community
The turning point in the history of queer and trans health is glaring: the AIDS crisis devastated an entire generation of gay men and this continues to affect those most removed from our healthcare system, including trans women, people of color, sex workers, and IV drug users.
The AIDS crisis as a historical moment redefined the meaning of theLGBTQIA+ community. Lesbian women who had grown distant from gay men on charges of sexism mobilized in large numbers to help in every way possible. They provided direct medical care, ran food banks, began and led organizations to combat the prejudice they were seeing.
Dr. Jean Carr, who dedicated much of her life to HIV research, was a graduate student at the time of the initial HIV outbreak and co-chair of an organization called the Louisiana Gay Political Action Caucus, a group of lesbians and gay men advocating to remove laws that made same-sex relationships a felony.
“When the CDC said that gay men couldn’t give blood and a lot of HIV positive men needed blood, we organized blood donations since we were safer blood donors than either straight men or straight women,” said Carr of her and her lesbian cohorts’ actions in the early HIV/AIDS movement.
The AIDS crisis also redefined who could take part in healthcare and what constitutes community health work. Many people, especially those living with the disease or watching their loved ones die of it, felt that federal organizations and health professionals were not responding fast enough. The Food and Drug Administration held back life-saving medications, physicians refused to take on HIV positive patients, the mainstream culture ostracized MSM and removed HIV/AIDS from recognition.
In 1987, the AIDS Coalition to Unleash Power (ACT UP) took the issue into their own hands by training its members directly in advanced medical research, policy law, and activism. Doing the work carried the task of becoming experts regardless of educational background or professional skills, but this did not stop them. They began a needle exchange program in 1990 despite bans on federal funding. They took over the Food and Drug Administration and forced them to implement a program called Parallel Track that brought investigational drugs to dying AIDS patients. They suffered mass arrests while putting pressure on major U.S. insurance companies.
Today, programs for the management of HIV remain community-driven: STI screening and education, drug abuse counseling, and needle exchange programs are in cities across the U.S., ran by ranks of volunteers on often unstable funding. Their need is punctuated by events such as the recent Austin, Indiana HIV outbreak following the passing of a law under Governor Mike Pence that prevented access to clean needles without a prescription.
Similar broad approach strategy brought criticisms to the medical community concerning long-held (mis)treatment of intersex people, individuals who do not fit within the biologically-defined binary of male or female. The Intersex Society of North America (INSA) founded in 1993 brought together intersex individuals from across the United States, creating support groups that were the first of their kind. Individuals who had lived their lives in secrecy suddenly found support and solidarity.
This advocacy for community permitted a more transparent discussion on healthcare and the seemingly widespread unhappiness with current protocol. Many intersex people confessed that they felt their consent was taken from them when doctors surgically reconstructed their genitals in infancy. They also reported being lied to by their doctors as well as their parents about the nature of their medical history and suffering psychological abuse at the hands of various people involved in their sometimes forced assimilation into a binary gender. As part of ISNA, people began fighting back against this normalization of this medical abuse.
Although ISNA finished their work in 1999, the seeds had been planted and today, international standard medical protocol now evokes the voices of the intersex community and activism continues to thrive in current organizations like InterAct Youth that seek to see this same standard carried out in the United States.
Community Healthcare in Pittsburgh
Community health is a point of great pride in the city of Pittsburgh. University of Pittsburgh is the birthplace of the Salk vaccine that nearly entirely eradicated Polio in the United States, free of patent rights or payment. Today, community healthcare is flourishing in our neighborhoods.
Central Outreach Resource and Referral was founded 16 years ago, responding to the need for faster and safer community-based access to rehabilitation for drug and alcohol abuse, particularly for minorities. They then expanded their services to sexually-transmitted infection (STI) screening and prevention. As of 2 years ago, they work in collaboration with the Central Outreach Wellness Center through which Dr. Stacy Lane provides supportive and competent care to a primarily LGBTQIA+ population through services including HIV treatment and hormone therapy. All over Pittsburgh’s queer and trans community, ringing endorsements can be heard for Central Outreach and Dr. Lane’s services.
Toye Starver, Public Information Supervisor for Central Outreach Resource and Referral Center, describes her motivation for community healthcare, “Because I have always had a passion for people who are perceived to be on the outside or on the fringe. And perceived is the big word here because none of us are really on the outside.”
A project ran by Albert Schweitzer Fellows and medical students, Allison Rigel and Carla Wood, called Health and Education Advocacy for LGBTQIA (H.E.A.L) is working under Starver’s mentorship this year to expand upon Central Outreach’s work in sexual wellness with a strong focus on education and advocacy, especially for youth. Next month, they will launch a help hotline for youth with questions and concerns about their sexual health as well as an education series on radical consent, queer and trans focused sexual health, and Pittsburgh resources.
When asked what our community could do to fill more gaps in queer and trans community healthcare, Starver urged people to think outside the box to make sure our resources apply to everyone in the queer and trans community, “even within the queer community, we have a diverse set of people but we would never know it in clinics that are geared towards [LGBTQIA+ people]. There are people in this community who don’t necessarily speak English or Spanish. Where do they go?”
This article originally appeared on QueerPgh.com. This article is preserved as a part of the Q Archives project. Please consider donating to help preserve Pittsburgh’s Queer history.