Sussex County is grappling with a healthcare shortage, but for people in the LGBTQ+ community, it can be even harder to find adequate care.
This week is LGBTQ+ Health Awareness week, and a recent climate survey conducted on the Eastern Shore shows many LGBTQ+ Sussex County residents are dissatisfied with the availability of services in their community and with the knowledge current providers have of LGBTQ+ health issues.
Breakout responses from Sussex County in the survey mention a lack of providers, thus long waits to see one, and discrimination, bias, and lack of knowledge about the LGBTQIA+ community from providers.
David Mariner is Executive Director of survey partner Sussex Pride.
“There are many providers who just are not knowledgeable or don’t know about LGBTQ+ health issues in the ways that we would like them to, or don’t know how to talk with LGBTQ folks about our lives,” says Mariner.
Mariner says there are also social determinants of health like housing and employment that can affect someone's health. One of the greatest factors that lead to poor overall health is minority stress.
“Some people call them microaggressions, some people call it just discrimination,” Mariner says. “You experience bias and you experience places where you are othered and don’t feel fully accepted or fully integrated into society.”
Mariner says these experiences contribute to mental health issues like depression and isolation and can lead to substance abuse or unhealthy eating habits as a coping mechanism.
On the whole, the LGBTQ+ community is at greater riskfor certain health conditions like hypertension, diabetes, and cancer, plus mental health issues like anxiety and depression, and are at a greater risk of suicide.
“And these inequities and disparities are a result of persistent discrimination and stigma,” says CAMP Rehoboth Executive Director Kim Leisey.
She says some LGBTQ+ people face discrimination when seeking health insurance too.
Leisey notes Sussex is already dealing with a general lack of healthcare as a rural area, so compounding LGBTQ+ disparities with that puts those individuals at an additional high risk.
And the fear of judgment could keep some from seeking care at all.
“Not being out means I might not even go to the doctor,” Leisey says. “Maybe I’ve been having symptoms of something but I’m afraid to go and get it checked out because I don’t know what I’m going to experience when I walk into a medical office. And so by the time it gets really bad, a stage two cancer diagnosis may be a stage four cancer diagnosis.”
Beebe Healthcare Chief Population Health Officer Dr. Bill Chasanov says the climate survey results are synonymous with what he hears from the community.
“While PrEP is for everyone who has risk factors for that, I do hear those comments quite a bit, that I’m not sure if I feel comfortable talking to my primary care physician about this,” Chasanov says.
Mariner says he also noticed a significant reduction in the access and availability of HIV prevention medications when he moved to Delaware from D.C.
“Many of the primary care providers have no hesitancy when it comes to prescribing PrEP, because they’ve taken a continuing education credit on PrEP and they know the basic guidelines and they are comfortable with it,” Mariner says. “But what was happening here in Delaware was, if you asked for PrEP they’re like ‘that’s a gay thing, you’re getting referred to a specialist.’ And there was a waiting list to get to the specialist.”
But Chasanov says the greatest need in Sussex County overall is primary care.
“And when I talk about primary care, it may not necessarily be what we think about from high blood pressure and how do I control my cholesterol, but it’s a preventative measure,” Chasanov says. “How do I feel comfortable knowing that my physician or provider understands if I am on hormone therapy or if I need to have specific types of screenings from an OBGYN standpoint, and not to be uncomfortable with that?”
But now Beebe and other community partners are making an effort to quantify that need to determine the best approach to reach the LGBTQ+ community, which could include telemedicine.
“Is there a way to connect people via telemedicine so they are getting the services that, let’s be honest, traditionally, we think of in large cities, Philadelphia, Baltimore,” Chasanov says. “Those type of larger organizations that have additional subspecialty training and physicians and providers that can provide that.”
Chasanov says Beebe is in the process of accessing those methods, noting that while Delaware has some gender-affirming healthcare options, it is not nearly enough to meet the needs of the community. Meanwhile, Chasanov says Beebe strives to be a trusted source of healthcare knowledge, so if they don’t have the ability to provide a service, they can at least discuss someone who does.
Leisey says an LGBTQ+ specific health center would go a long way to encourage that community to seek care when they need it.
She also puts a particular emphasis on protections for LGBTQ+ seniors, considering Sussex County’s growing aging population.
“How are we making sure that continuing care communities have staff that are going to be affirming?” Leisey says. “That we are going to be safe as we age in those kinds of facilities?”
Mariner says to address these disparities, they are engaging with the state health department about how to collect and analyze more data on LGBTQ health.
“We can’t eliminate health disparities that LGBTQ folks face if we are not documenting them, if we are not setting goals,” Mariner says. “And that is something I would love to see a lot more of here in Delaware.”
But having data doesn’t always result in action either, Mariner says. A 2022 survey from the Trevor Project showed that 49 percent of LGBTQ youth in Delaware who responded considered suicide and 17 percent attempted it.
“And it makes sense because they see things in the news like the stories about Nex Benedict, like experiences people have had,” Mariner says. “They see their very lives and their ability to participate in school being discussed and debated on television.”
For more information on transgender health resources from Beebe visit https://www.beebehealthcare.org/transgender-health-resources.
