The Assistant Professor of Nursing shares insights on the realities of healthcare for the LGBTQIA+ community

To celebrate Pride Month, we sat down with Dr. Bradley White, an Assistant Professor of Nursing, to discuss the intersection of LGBTQIA+ community and healthcare – specifically, mental health and sexual health. He shares his findings, musings, and suggestions as to how we can best advocate for gender equality and change. 

The conversation between Bradley White and OSC’s Kate Chaney has been edited for brevity and clarity.  

Much of your research focuses on the ways in which members of the LGBTQIA+ community are at a disadvantage when seeking healthcare. Can you give a few examples as to how this can play out? 

When members of the LGBTQIA+ community seek healthcare, they are ultimately seeking support from a system that wasn’t built for them and one that can be uncomfortable for them to navigate. 

When I was a newer nurse, I started working in the infectious diseases clinic at Mass General where people received their HIV care, and anecdotally, I saw that there was an unmet need in that population for welcoming services. Patients often reported that our clinic at MGH was the only provider’s office in which they felt comfortable talking about their lives, behaviors, choices, and partners. 

In some research I’ve conducted, the relationships that LGBTQIA+ individuals have with their healthcare providers, and how comfortable they are discussing their sexual activity,  directly impacts the health of patients. For example, in studying the factors necessary for sexually active young men to feel comfortable disclosing their sexual behaviors to their providers, we found that comfort levels varied depending on where the individual lived, what types of supports they had in their lives, and on the beliefs of their provider.

Explicitly, we looked at what it takes for them to feel comfortable to ask for HIV pre-exposure prophylaxis. We know that pre-exposure prophylaxis significantly reduces the risk for HIV, and some would say that when taken correctly, it can eliminate the risk of HIV. But receiving this treatment requires a patient to feel comfortable enough to have a discussion about their sexual history and preferences. If they do not feel comfortable having the conversation, they will not ask their providers, won’t receive the service and, in turn, are at a higher risk of contracting HIV. 

Furthermore, there's so much in the media and in scholarship on climate change and mitigation, yet little is known about how this crisis affects gender-diverse people. For example, if you live in an area that experienced a climate disaster and you're advised or required to go to an emergency shelter, you are usually cohorted by cisgender norms like men and women. Yet what is a trans person to do in a climate crisis? Are they meant to disclose their gender identity? It is safe to disclose gender identity in some places globally but certainly not everywhere. A recent research paper raised the question, in a climate crisis, does a trans person conceal their identity, or do they put themselves at higher risk by opting not to seek emergency shelter?

Questions like these have yet to be answered in our society today.

You mention that today you are primarily interested in psychiatric nursing. What have you experienced in this role as it pertains to the LGBTQIA+ community?

I’ve been working in psychiatric settings since 2014, and I can't tell you how many predominantly young LGBTQIA+ identifying people have been admitted for suicide attempts, overdoses, and other self-injurious behaviors. When I am talking to these patients, almost always the story is that they don’t feel accepted by their family, and that at school they were never allowed to express themselves. This story is often true for many queer people, and almost always true for trans people.

I still work clinically MGH’s inpatient psych unit where we have 24 beds. Just a few weeks ago, I noticed that there were four trans patients who were admitted after a suicide attempt. That's one out of six beds and trans people only account for about 1% of the population.

Recent research has highlighted the mental health and substance abuse struggles faced by LGBTQIA+ identifying individuals. Can you elaborate on this?

My research has covered a number of different topics relevant to the LGBTQIA+ community, from the health impacts of climate change on vulnerable populations, to mental health and risk behaviors among the community, to HPV vaccination and preventative services for men who have sex with men. 

In the U.S., a recent study showed the correlation between self-reported mental health incidents of LGBTQIA+ individuals and the level of discrimination in states based on Human Rights Campaign scoring. Our analysis found that queer people in conservative, restrictive states with low Human Rights Campaign scores reported more incidents of poor mental health days that include heavier drinking or smoking. 

This research underscores the issue at hand – that individuals identifying as LGBTQIA+ are at a higher risk for mental health challenges and substance abuse. 

Much of this is driven by Minority Stress Theory, which suggests that if people face external stigmatizing stressors, they're going to have poorer health overall. This particular research looked at mental health indicators and definitely showed a correlation between a state’s level of inclusivity and mental health outcomes. People who live in more liberal, inclusive states reported that they had better mental health days and reported less smoking and binge drinking. 

From all of that, it’s clear that LGBTQIA+ identifying individuals in our country face exponentially more challenges when seeking healthcare, particularly in the areas of sexual health and mental health. What can we do to support this community?

I think there's a big role and, I would argue, a necessary role for straight or cisgender allies to be informed and take a stand on what's happening in our country right now. I think it's simply not an excuse to say, “I'm not gay, I'm not trans, it's not my fight”. We know that argument doesn't really hold water. When persecution happens, we all have to be outraged and take action. 

I would compare and draw a parallel to what's happening now with race in America. Yes, I'm white, but it angers me and I need to make efforts to stand with BIPOC people and support Black Lives Matter.  

All change is impacted by local efforts. The little things, like having the courage in a family conversation or at an event with friends to verbalize and speak up when conversations on the topic are brought up, to educate our friends and family about what’s happening. While it can be uncomfortable, it’s critical to do so.

We can also protest discriminative efforts against the LGBTQIA+ community by writing letters to our government officials, joining protests, and donating to the cause. There are organizations leading the fight right now like the Human Rights Campaign and ACLU. The ACLU actually has a specific project right now to protect the art of drag. I think that donating money to these advocacy organizations is always helpful. 

How do you feel the IHP is doing its part to address these issues?

At the IHP, we have a very progressive vision about what it means to educate our future healthcare leaders. We’ve really expanded our curriculum related to justice, equity, diversity, and inclusion. We confront the implicit bias that occurs in healthcare situations. We have conversations in class on a weekly basis about healthcare issues that affect the marginalized. 

When I have conversations with students in class about marginalization and discrimination, I try to do as much listening as I do talking; I know that I certainly don't have all the answers. 

What makes you hopeful about the status of LGBTQIA+ rights and healthcare? 

I think that younger people see what's correct and needs to be done. There has never been a generation of individuals who in their teens and twenties were so inclusive and aware of social justice. I think that really needs to be nurtured and encouraged, which we do really well at the IHP. My hope is that it will bear fruit in our larger society at some point. 

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