Central Indiana LGBTQ community faces critical health care gaps, study finds

The results of a study released this month assessing the needs of Central Indiana’s LGBTQ population illustrates critical gaps in availability and accessibility to culturally competent mental health and health care providers.

The survey, released June 17, was developed and distributed by the Damien Center, Indiana Youth Group, Indy Pride, GenderNexus, Indy Rainbow Chamber, OutCare Health and the IUPUI LGBTQ+ Center. It explored needs in the five social determinants of overall health: health and health care, economic stability, social and community context, neighborhood and built environment and education.

While leaders whose organizations were involved in developing the survey told IndyStar the results come with some caveats — namely, a lack of diversity among respondents — the data points to clear areas of need in health care and mental health.

Alan Witchey, president and CEO of the Damien Center, the state’s largest and oldest HIV/AIDS service organization, said although the respondents were relatively well-off — 84% reported being employed; many report an annual household income of $60,000 or more each year — struggles to afford or access health care and unstable housing were still prevalent.

If the results are surprising to see in this population, he said, they’re likely to be moreso for under-resourced and disenfranchised communities.

“I knew we would see a lot of these disparities,” Witchey said. “I didn’t think it was going to be so high in some of them.”

Critical needs of LGBT Hoosiers

Among the major takeaways from the survey:

  • 17% of respondents said they have experienced homelessness at some point.
  • 30% said they struggle to pay for a doctor or medical care, while 27% said they struggle to pay for medications.
  • 21% of respondents said they have acted on thoughts of suicide — seven times higher than public health data collected among the U.S. general population. 
  • 17% said they have acted on thoughts of suicide in the past year.
  • 44% said they have been harassed, threatened or attacked in the last year for being LGBTQ+.
  • Only 38% said they felt connected to Central Indiana’s LGBTQ+ community.
  • One-third of respondents rated their overall health as fair or poor. Of those who identified as transgender, half consider their health fair or poor.

When asked which areas of need were of importance, 96% of respondents identified access to LGBTQ-sensitive health care and mental health care.

Dr. Dustin Nowaskie, founder and president of OutCare, which provides information and education on LGBTQ health care, said nationally, over 20% of LGBTQ individuals have experienced some kind of health care discrimination, ranging from microaggressions to physical assaults or violence.

Studies have documented a critical lack of cultural competency among providers across the country that contributes to stigmatization and discrimination against LGBTQ individuals. When patients are uncomfortable or do not feel safe talking to medical providers, they are less likely to seek health care, which can exacerbate pre-existing conditions or allow developing issues to take hold.

“What we see is this starts very early,” he said. “We see that a good proportion of students and providers have biases, both implicit and explicit biases about the LGBTQ population.”

A handful of hours out of four years of medical school spent focusing on LGBTQ-specific issues simply isn’t enough, he said. 

“It doesn’t matter what kind of health care provider you are, because LGBTQ people span all different conditions, they’re across all different organ systems,” he said. “Every provider is interacting with 4-10% of their patients as LGBTQ, so this applies to everyone. Everyone should have this knowledge.”

‘Within this data, there are stories’

Moving forward, Witchey said, he and other community leaders share a goal of establishing an LGBTQ community center that would provide health and social services, networking and job readiness opportunities to address some of the needs outlined by respondents.

“There is a need for having social support and building up social income of your own that you can connect with people and build job opportunities,” he said. “But, really, the human capital piece of how do we build skills and find people jobs and employment to create stability during this time has to go hand in hand.”

The survey’s distribution, Witchey said, was interrupted by the novel coronavirus outbreak, which may account for some of the lack of diversity among respondents. Another factor, the study notes, is that the survey was distributed primarily via email and social media, limiting responses to those who had internet access.

Of the 682 respondents, most lived in Marion County, were between the ages of 25 and 44 and were predominantly white. Furthermore, 37% identified as cisgender women and 44% identified as cisgender men, meaning their gender identities matched the sex they were assigned at birth.

With those demographics in mind, it’s important to recognize that these issues disproportionately affect minority groups, particularly transgender women of color. The next step, Nowaskie said, is to make the process as inclusive as possible.

“We know, unfortunately, that these populations are the ones who have the most struggle, who have lower incomes, who have lower rates of health care insurance,” he said. “These are the populations that are most affected and burdened by things like stigma and discrimination at the societal level, at the political level and at the health care level.” 

The community center, Nowaskie said, would also provide a safe environment that will uplift and empower residents.

“As a state that prides itself on humility and hospitality, I think that Indiana as a whole does a huge disservice to LGBTQ Hoosiers,” Nowaskie said. “I think that the center would be a physical space and a physical representation that LGBTQ Hoosiers are heard and that they’re respected.”

Responses indicated a disconnect between individuals and the overall LGBTQ community, which undoubtedly contributes to a person’s struggle with mental health, Nowaskie said. A lack of support — from difficult coming-out experiences to feeling it’s unsafe to be open about their sexuality at work or in public — can leave LGBTQ Hoosiers feeling particularly vulnerable and isolated.

“What is really upsetting to me is that (in) the LGBTQ community, those stories are enriched within the community, but even the community is not interconnected and is not accepting of other LGBTQ members,” he said. “I have a lot of patients who feel so isolated that they don’t even want to connect with LGBTQ members within the community.”

The community center, Nowaskie said, should serve as a one-stop-shop for care and outreach, serving all of Central Indiana’s LGBTQ community.

“Within this data, there are stories,” he said. “There’s a lot of stories, there’s a lot of perspectives that we’re missing. And we want to be able to tell that in a center.”

Call IndyStar reporter Holly Hays at 317-444-6156. Follow her on Twitter: @hollyvhays.