Zakia McKensey struggled to find doctors who would treat her.
The Richmond native came out to her mother at 16 years old and was kicked out of the house. She found a family in the LGBTQIA+ community, but health care for transgender people like herself was almost nonexistant, and patients were subjected to frequent discrimination.
“There were no plastic surgeons who wanted to see me. There were no doctors who wanted to give me hormone therapy,” McKensey said. “I was buying stuff online, from people who were not doctors.”
McKensey told her story to more than 100 people from Virginia Commonwealth University and VCU Health, many of them health care providers, as well as community members, as part of the Health Equity Series at the C. Kenneth and Dianne Wright Center for Clinical and Translational Research. “Across the Rainbow: Moving from Disparities to Equity in LGBTQ+ Health” on Aug. 10 brought expert panelists and community leaders together for a conversation about health care in the LGBTQIA+ community – the ongoing challenges and what providers can do to close the gap.
McKensey is now the executive director of Nationz Foundation, which increases access to sexually transmitted infections (STIs) testing, links people to care and provides holistic services to increase wellness in the greater Richmond area – with a special focus on the LGBTQIA+ community.
Many in the transgender community, she said, see their only choice as dangerous, ‘black market’ procedures and treatments that come with serious risks and complications. And finding gender affirming treatment is only one reason that transgender people struggle with health care. They have higher rates of unemployment due to discrimination and often lack health insurance. They struggle with mental health and substance use disorders. The have higher rates STIs due to survival sex work, and more.
“The life expectancy of a black trans woman in the U.S. is around 36,” McKensey said. “I’m lucky to be celebrating 49 in September.”
Bill Harrison, president and executive director of Diversity Richmond, moderated the virtual conversation. As the leader of the Central Virginia community center, Harrison emphasized that the health disparities that transgender people experience are similar to those that the entire LGBTQIA+ community has encountered and continues to encounter.
They face health disparities linked to discrimination, social stigma and denial of their human rights. Research suggests this inequity leads to high rates of psychiatric disorders, substance abuse and suicide.
Harrison stressed that organizations like his, as well as health care institutions, can’t fail to adapt to new health research, their changing community and a dynamic understanding of gender and sexuality.
“You can’t rest on your laurels,” Harrison said. “The needs of the community change, and you have to stay in contact with your community to stay relevant.”
He cited Richmond’s Health Brigade (formerly the Fan Free Clinic) as a positive example of community leadership. Their commitment to HIV/AIDs early on, when other health organizations “ran in the other direction,” was crucial to the community.
Karen Legato, the executive director of Health Brigade, was on hand to talk about their commitment to flexibility and community engagement. Recently, they’ve seen an uptick in transgender patients and the need for substance use disorder treatments.
People often come to the clinic after seeking treatment at more established or larger providers, she added.
“I really thought the needle would have moved a bit more by now,” Legato said of health disparities for the LGBTQIA+ community. “We should not be having to fight this battle every day. It’s time to step up and learn. This is not rocket science.”
Awareness of transgender people and their health care needs have increased, but there’s still a long way to go, the panelists agreed.
“A lot of times we as trans people are teaching our health care providers about us,” said McKensey.
How can mainstream providers improve care for the LGBTQIA+ community and fight inequities? Harrison asked.
Legato cited the plethora of resources that can help health care providers overcome biases that may have been part of their medical training on sexuality and gender. Ask questions and get comfortable with topics of sexuality, she said. “Shape your environment where you can.”
McKensey said that simple steps like saying your pronouns and not assuming others,’ when you interact with a patient, would go a long way. Look at your institution’s forms to make sure they’re inclusive of all genders and sexualitues, she added. “And check your personal biases.”
“I’m hoping, from our conversation today, some light bulbs will click on and some people will reassess the way they interact with our community,” McKensey said.
When it’s available, the video for the Aug. 10 event, Across the Rainbow, will be posted on the Health Equity Series Kaltura channel.
The next Wright Center Health Equity event will be on Nov. 9 and focus on lung health disparities in the Black community. Learn more and register online.