Transgender people continue to face numerous health disparities, including an increased risk for HIV infection among transgender women of color and a lower likelihood of preventative cancer screenings in transgender men. Factors such as social stigma and insufficient access to quality care prevent trans people from obtaining essential healthcare services. In addition to enduring high rates of stress due to systematic harassment, trans people and other groups within the LGBTQ community collectively face lower rates of healthcare coverage and higher rates of discrimination by healthcare providers.
Medical professionals’ lack of knowledge or understanding of diverse sexualities and gender identities combined with the intimate nature of sexual and reproductive health can lead LGBTQ people to experience increased anxiety around seeking care. This higher level of mistrust leads many patients to choose to receive the majority of their care at small community health clinics or Planned Parenthood health centers where LGBTQ identities are more acknowledged, respected, and understood.
In an effort to provide specialized care that meets the needs of their diverse patient base, Fenway Health in Boston has sought to expand programs at the Fenway Institute, an interdisciplinary research and policy development center committed to improving the health of sexual and gender minorities. The LGBT Population Health Program, for example, is focused on creating a national training program in collaboration with the Boston University School of public health to provide pre and post-doctoral students with the knowledge to address LGBTQ community health disparities.
Outside of the Fenway Institute, Fenway Health has acknowledged how racism, sexism, and homophobia in the healthcare field continue to marginalize LGBTQ people, especially LGBTQ people of color. In a statement addressed to their Black, trans, and gender diverse patients, clients, participants, and community members, Fenway Health says, “We know we must do more to dismantle the systems of racism in our community and in healthcare as a whole. Our spaces have not always been welcoming, and your voices have not always been heard. We stand in solidarity with the Black Lives Matter movement and those who are protesting against the violence and brutality perpetrated by white supremacy and systemic racism.” In recognizing their moral responsibility to address issues of healthcare discrimination, they also are connecting with community organizations around Boston to “facilitate conversations about intersectionality and racial justice, both within our organization and with our community, while continuing to listen and learn about where we need to do better.” By adopting a social justice rather than a purely medical approach to healthcare, Fenway seeks to deliver more equitable and inclusive care.
To achieve this goal of reducing LGBTQ health inequities, Fenway has collaborated with local organizations and institutions. In 2016, The National LGBT Health Education Center at the Fenway Institute partnered with Attorney General Maura Healey’s Office and the Massachusetts Hospital Association to create a training program for hospital personnel to provide high-quality, compassionate care for members of the transgender community. Through these health education programs, Fenway has improved its front-line staff competency to ensure that trans patients feel valued at each stage of their care.
Currently, in light of the heightened violence against BIPOC and trans communities, Fenway Health also recently pledged to donate funds to community organizations that provide safe spaces, leadership training and opportunities, and advocacy directly to Black trans communities. Through this distribution of resources and partnerships with LGBTQ-centered non-profit organizations around Boston, Fenway Health serves as a model for other large health institutions to utilize community spaces to listen and learn from those who have been mistreated by the healthcare system.
However, as a result of increased stress and anxiety levels due to the COVID-19 pandemic, Fenway Health has struggled to meet the increased demand for behavioral healthcare over the past year. With limited staffing capabilities, Fenway patients can expect to wait up to six months for psychotherapy services. This has forced many people to seek care elsewhere through referrals, an alternative that is inaccessible to low-income individuals and those without health insurance. While Fenway has reassured community members that this issue represents a "short-term challenge," the limited number of available services has caused people to suffer in silence for months without the critical support they need. For groups like LGBTQ youth who are already experiencing higher rates of chronic mental illness and suicide rates than their heterosexual peers, the lack of mental health services can be detrimental to their long term health and overall well-being.
While Fenway Health’s Gender Affirming Clinical Health Model serves as an example for other institutions looking to implement more inclusive health services, much more work needs to be done to ensure that this care is accessible to trans and gender-nonconforming patients during this unprecedented time.