Bebashi Transition to Hope, a nonprofit that provides sexual health resources and hunger relief to communities of color and other minorities, hosted a May 25 discussion panel on LGBTQ+ access to healthcare. Community leaders discussed barriers to healthcare that queer and trans people face, how the pandemic has impacted those barriers, ways of mitigating some of the roadblocks and local assets to accessing care.
Lee Carson, director of Philadelphia Area Sexual Health Initiative, moderated the discussion, which consisted of commentary from Chris Bartlett, executive director of William Way LGBT Community Center; Jacen Bowman, vice president of Philadelphia Black Gay Pride, makeup artist and member of Philly’s ballroom scene; Bebashi board member Chris Landtroop, who serves as secretary and co-chair of the Strategic Planning Committee; and Evan Thornburg, health equity special advisor for Philadelphia’s AIDS Activities Coordinating Office and co-lead for the Health Equity Core Team of the Philadelphia Department of Public Health.
The group first addressed the largely social factors that previously and currently prevent LGBTQ folks from seeking care. Thornburg brought up the lack of culturally competent providers when it comes to avoiding HIV care or engaging in case management, especially for trans people.
She said in the panel that case studies reveal a particular type of mistreatment from providers, “and not mistreatment around a trans or queer identity, but the assumptions that come with trans or queer identity and a diagnosis.” She then added, “Hearing things like being overly asked about sex work. That’s not to demonize sex work, but it doesn’t feel good to come in and receive a diagnosis of something like HIV and then to be immediately bombarded with this assumption that you’re engaging in sex work and that you’re hiding it from a provider.”
Bartlett cited the need for more LGBTQ data collection, also known as sexual orientation and gender identity (SOGI) data, to allocate the appropriate resources to underserved areas.
“We always have to be pushing, especially for gender identity data to be collected because they’re often omitted,” he said in the discussion. “And to make sure the folks who are doing these surveys have the cultural competency to ask questions in ways that really get us the data we need. The money follows the data. This is a really crucial equity issue to be able to tell the stories of our trans, nonbinary, queer, people of color communities.”
While data identifies the inequities, it takes community engagement to help queer and trans communities to access care, including within the ballroom community, Bowman pointed out. He told the group that many people in the ballroom world also experience barriers to care, including distrust of medical providers fueled by previously negative experiences.
“We’re always seen as data, data, data, and they always look at us as numbers, numbers, numbers. They only come around when it’s Pride month, they only come around when it’s time for them to get their numbers for a ball, and they need to make what I call the HIV quota. Outside that, they don’t really care about if we have access to care.”
When it was time to talk about COVID-19’s impact on LGBTQ access care, Thornburg said that the pandemic has exposed two things, the first being widespread ableism.
“To consistently tell people with disabilities, ‘we cannot make these things more accessible, we cannot put these things on virtual platforms,’ and then to have something global affect us and then suddenly telehealth is everything — I want to highlight that,” she told the group.
Secondly, she underscored the fact that the pandemic has shone a light on inequities in the community. In the case of digital care access, some people do not have access to the internet to take advantage of those services, she pointed out.
Carson addressed how health inequities exacerbated the devastation of the pandemic.
“All of the money, the trillions of dollars that were flooded into addressing the epidemic in the country — imagine if the country cared to have invested in addressing health inequities earlier on, that the pandemic wouldn’t have hit us maybe as hard as it did,” Carson said. “It’s one of those things where it’s really helped to expose how inequitable, how unjust our government is, that they immediately were able to find these funds to help, when poor people, racial, sexual and gender minorities have needed this help for decades.”
Bowman told the panel that he has seen depression skyrocket during the pandemic, rates of new HIV infections and STIs increase, as well as instances of drug use. “I’ve seen a rise in all of those things, especially among my house alone,” he said. “I’ve helped a lot of my peers and my house children get over the hurdle of COVID-19.”
Mental health access was also a prominent topic of conversation in terms of its taboo nature, the need to foster culturally competent resources for queer communities and how it relates to the long-lasting, collective trauma that the pandemic will leave on society.
“I always feel like when it comes to HIV, drug use, certain decision-making processes, it really starts with mental health,” Bowman told his fellow panelists. “I know that in Black and Brown households, even me growing up, mental health was not something that was ever discussed.”
Thornburg and Bebashi’s Landtroop approached the mental health piece from very personal angles. They spoke about their own mental health struggles, but also the tendency for some providers to link disorders or traumas to a person’s queerness or queer experiences.
“As somebody who’s not as sexually marginalized as Bebashi clients, I still struggle to find somebody who will not think that any of my traumas or the fact that I am a queer person connects to the fact that I have mother issues,” Landtroop told the panel. “Or constantly trying to prove that all of who we are isn’t because of the things that we experience. Spending so much time around those individual pieces of our story really affects the end goal and it makes it where you don’t want to go back, but you can’t find the person that you do need. If we think about the level of [intensity] for the folks that organizations like Bebashi serve, we’ve got so many other barriers to help them get there.”
The discussion ended on the topic of LGBTQ healthcare assets that are present in Philadelphia, as well as audience questions. Panelists mentioned that Philadelphia has many LGBTQ-inclusive policies, and though there is still work to be done in terms of being inclusive and equitable outside of those policies, the community can work together to help make things better.
“I think one huge asset in the Philadelphia area is the fact that all of our nonprofit organizations that really serve these marginalized communities, work together instead of in silos,” Landtroop said.
Thornburg told the group that while Philadelphia is home to a considerable number of activists and advocates, largely Black and Brown, particularly young people, who are knowledgeable about their queer and trans peers, but “we have to put them in positions of power and we have to protect them from trauma, targeting and abuse within our own community,” she said.
When asked about what needs to change in Philadelphia to help improve access to care, especially for queer and trans people of color, Thornburg said: “Put those people in charge.”
Bowman then added, “give them the job and then pay them what they’re worth.”