Confronting hate and violence against the LGBT community

August 21, 2017|Internal Medicine

It may be unusual for an LGBT health columnist to mention the horrendous events that occurred in Charlottesville, Va., in August 2017. It clearly was a demonstration of hate and violence against racial and ethnic minorities. Unfortunately, the LGBT community – especially LGBT communities of color – are often a target of that kind of hate and violence. This has a detrimental effect on the health of the LGBT community, and I believe that health care providers have a responsibility to address this hate and violence to promote the well-being of this marginalized community.

It cannot be overstated that LGBT individuals frequently experience anti-gay and anti-trans violence. According to the 2015 Federal Bureau of Investigation Hate Crime Statistics, about a fifth of hate crimes reported were based on sexual orientation or gender identity.¹ In addition, LGBT youth are eight times as likely to experience bullying at school because of their sexual orientation or gender identity.² Furthermore, on many surveys on anti-LGBT violence, people of color comprise more than half of the victims.³ There is a strong association between exposure to this violence and the health outcomes of LGBT youth. A study by Russell et al. showed that LGBT youth who were victims of physical violence at school are more likely to be depressed and suicidal and more likely to be diagnosed with an STD,⁴ and another study showed that LGBT youth who experienced anti-LGBT violence are more likely to engage in substance use.⁵ The health outcomes from anti-LGBT violence are not limited to the adolescent period – adolescents who experienced this kind of violence are more likely to report higher levels of depression as adults.⁶ Although researchers still are trying to determine the exact mechanism for these relationships, the most cited (and sensible) explanation is that exposure to anti-LGBT stigma, discrimination, and violence leads to a toxic environment, which in turn increases the risk for mental health problems and maladaptive coping mechanisms (such as substance use) as a response to such an environment.⁷

Dr. Gerald Montano talks with a patient.

Although the above statistics may easily motivate some health care providers to stand up against hate and violence toward the LGBT community, others may be hesitant to do so, feeling that their realm of influence is within the confines of the clinic or hospital walls. However, health care providers should not underestimate their influence on the communities they serve. A Gallup poll has found that more than two-thirds of U.S. citizens believe that health care professionals (that is, nurses, pharmacists, and medical doctors) have very high or high ratings in honesty and ethical standards.⁸ Health care professionals in this survey ranked higher than did governors or members of Congress – the usual power brokers in this country. This means that communities view us as leaders. Many people come to us for guidance. Health care providers often are the first professional many victims of violence – whether it is from child abuse, intimate partner violence, or street violence – interact with when seeking help for problems related to their trauma. Finally, it’s our calling. The modern Hippocratic Oath states: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm,” and “I will prevent disease whenever I can, but I will always look for a path to a cure for all diseases.”⁹ The link between anti-gay and anti-trans violence and poor health among LGBT youth is clear. As an influential pillar of society, we are obligated to prevent these diseases by confronting the hate and violence that adversely affect this community.

What can we do to stand up to the hate and violence against marginalized groups, such as the LGBT community? First, make your office a safe space. With the recent brazen display of hate and violence going around, members the LGBT community are desperate to feel protected. A good place to start is a guide by Advocates for Youth. Second, educate yourself and others. The title physician means “teacher,” and I feel it is your responsibility to teach your peers, colleagues, and the public about how anti-LGBT violence affects the health of LGBT individuals. To be an effective teacher, you need to be up to date on the research on how hatred and intolerance affects the health of the LGBT community. A good place to start is the Human Rights Campaign, which has accurate statistics on anti-LGBT violence and resources to address this problem. Finally, be an advocate. You don’t need to be in the streets with picket signs, nor do you necessarily need to lead the charge against anti-LGBT hate and violence – others will be at the front lines. What you can do is to call for your local, state, and federal government to institute policies that address anti-LGBT violence. Many medical organizations have resources that help health care providers engage with policy makers (check out the American Academy of Pediatrics advocacy page for these resources). Many of our elected officials take our professional opinions seriously.

Anti-gay and anti-trans violence is all too common in the LGBT community, especially violence against LGBT people of color, and this violence can adversely affect their health. Health care providers have a responsibility and the influence to confront these nexuses of hate and intolerance. You don’t need to do something heroic to accomplish this. You are members of a privileged and respected group of professionals, so small actions can coalesce into something that has a large impact on the health and well-being of the communities you serve.