For the LGBTQ+ community, marginalization is deterring some from accessing medical care. Nearly one in five avoid seeking care due to fear of discrimination, and studies show disparities can lead to poor health outcomes. For one gay man in Northern Nevada, navigating the health system has been a daunting experience. KUNR’s Anh Gray has his story.
As a warning, this story might not be suitable for all listeners as it discusses the topic of sexual assault.
Like many new working professionals, Robert leads a busy life. He asked to be identified only by his first name to protect his privacy. Along with working full-time, managing volunteers for a nonprofit, he also has another part-time job. That’s why on weekends, he enjoys leaving his hectic schedule behind for hikes around the Reno-Tahoe area. Sometimes he hits the trail when it’s most quiet— before the sun is even up and the stars still light the sky.
As Robert heads out on the cold and dark trail, he says the outdoors have been an escape, a place to process a sexual trauma from two years ago. He had gone out with a male acquaintance, who wanted to have sex at the end of the night. Robert refused several times.
“And then he just did it anyways. That’s really what happened,” Robert explained. “There was no dramatic, like, violence involved. But it was interesting just because I have always read about things in terms of people freezing or not fighting back when these things are happening. And I was like, ‘Oh, that’s ridiculous.’ ”
But he did freeze and was raped. Robert managed to get away after the attack.
“So, I went back to my car, and then that was when I immediately went to the ER though ‘cause it was dark," Robert said, "and I didn’t quite see if the sex was protected at all.”
Robert was scared and decided against pressing charges, but he was worried about possible STD infections, especially HIV, since he has friends in the gay community battling it. That’s why he sought immediate medical attention at Northern Nevada Medical Center.
“I had known about post-exposure prophylaxis, or PEP,” Robert said. “And that was what I was hoping to seek out immediately after that had happened.”
PEP is an antiretroviral medication that must be administered within 72 hours after a possible exposure to HIV to prevent infection.
Gay and bisexual men are disproportionately affected by HIV compared to other groups in the US. About 70% of the nearly 40,000 new HIV diagnoses in 2017 were from adult and adolescent gay and bisexual men, according to the Centers for Disease Control and Prevention.
During his ER visit, Robert says he asked for the HIV prophylaxis, and had to insist, which prompted the doctor to call a national hotline.
“She did finally call the PEP Hotline and they told her that, ‘Yes, it is definitely a high-risk exposure,’” Robert said.
Robert says some of the questions that came up in the ER were based on assumptions about him because of his sexual orientation.
“They tested me for many other STDs and the implication the whole time was that one of them was going to come back positive,” Robert explained. “ ‘It’s very likely that you have an STD based on what you’re telling us.’ 'I didn’t tell you anything except the fact that I’m gay, and that I was sexually assaulted, and that I’m sexually active.' ”
Since PEP is a 28-day regimen, Robert needed to schedule a follow-up with another primary care doctor.
“I remember the first thing that she said to me was, 'Well, don’t put yourself in situations where this is going to happen again,' ” Robert said. “I was like, 'How could you even say that?' I thought that we had moved past that sort of thing, like, 'Well, what was she wearing when this happened?' or anything like that.”
This experience, he said, further alienated him from the medical community.
Tracy Hood is the director of education and patient experience at Northern Nevada Medical Center, where Robert sought emergency care after the assault. She said the hospital can’t comment directly on his case due to patient privacy protections, but she did agree to speak more broadly.
“Currently, we don’t address just specifically the LGBTQ community health care,” Hood explained. “We address it, we treat all patients, whether they’re from a different culture, different race, different sexual orientation. We treat everybody the same, so we haven’t specifically addressed that population.”
Hood added that the facility is in the process of developing training for its providers that will be implemented in early 2020.
“Well, that’s a big part of this big push for this education because the unknown is what can cause fear, I guess in some people, and just not understanding how to treat these patients," Hood said. "And so that's why we want to get this information to our staff from very differnt directions."
Dr. Alex Keuroghlian heads up the National LGBT Health Education Center at The Fenway Institute in Massachusetts, and is an Assistant Professor of Psychiatry at Harvard Medical School. He says what Robert experienced isn’t uncommon.
“LGBTQ+ people avoid seeking health care services,” Keuroghlian explained, “even urgent and preventative health care, due to fear of being mistreated by health care staff as a result of their sexual orientation or gender identity. And we hear this from our patients all the time."
Some health facilities around the country are beginning to address this issue.
“That means training all staff, clinical and non-clinical staff, in basic concepts and terminology related to sexual orientation and gender identity, how to think through stigma and its relationship to basic health disparities," Keuroghlian said.
Even though some institutions are implementing ongoing professional development for providers, Keuroghlian said that education should be taking place much sooner, when students are in medical school.
“We as people and clinicians are no exception, are really uncomfortable a lot of times talking about sexual health, talking about sexual orientation, talking about gender identity,” Keuroghlian explained, “and it’s something that receives minimal attention in our training.”
Right now, there’s limited data on what medical students are learning when it comes to the health needs of the LGBTQ+ community. What a 2011 study found was they received about five hours of instruction at med school, and a third of the programs provided none at all.
For Robert, even though he has sought counseling for the trauma he endured, he’s hesitant about finding a new doctor.
“It's weird when you go to see them to receive the help that they're supposed to be giving you, and they do it in such a way that is not sensitive to the person that you are,” Robert said. “It was pretty traumatizing honestly, because it's, it's like, 'Well, if I can't talk to you about this, the people who are supposed to be helping me at this moment, who do I, who do I talk to?' ”