Charlotte Crist, RN, managing director of clinical programs, and Guillaume Bagal, diversity & inclusion lead, Blue Cross & Blue Shield of Rhode Island

In honor of Pride month, Blue Cross & Blue Shield of Rhode Island (BCBSRI) is kicking off a three-part series covering important health topics for sexual minority women, sexual minority men and transgender individuals. Studies show that members of the LGBTQ community don’t always get the same level of healthcare as their heterosexual counterparts. This disparity is often attributed to actual or anticipated discrimination or lack of access to health coverage. We encourage you to be as open as possible with your healthcare provider(s) to ensure you get the best, most appropriate care. Below are some health concerns you may want to discuss with them.

A 2018 national study by analytics firm Gallup found the percentage of women identifying as LGBTQ has risen in the past five years. In 2012, 3.5 percent of female respondents stated they identify as LGBTQ, while in 2017, the number increased to 5.1 percent. As these numbers grow, it’s not only imperative for healthcare providers to educate themselves on how to best provide care to the LGBTQ patients they serve, but also for patients to stay informed on relevant health concerns to ensure they are staying healthy.

Sexual minority women – including lesbian, gay, bisexual, queer and other women in the LGBTQ community - face unique challenges within the healthcare system that can often lead to a decline in mental and physical health if not properly managed. Healthcare providers may lack the knowledge and training to address specific concerns from these patients, and unfortunately doctors sometimes lack the willingness to treat patients with compassion and respect, or even treat them at all. Although individual health risks are shaped by factors beyond sexual orientation — including family history, age and geography — it's important for healthcare providers to understand and screen for common issues affecting sexual minority women.

At BCBSRI, we know health needs vary from person to person and from community to community. And, we hope to bring awareness to some of the specific health concerns impacting sexual minority women to make the most of healthcare provider visits.

• Physical Health:
  • Breast and gynecological cancer – While it is common knowledge for most that breast and gynecological cancers are two of the most common cancers for all women, it is lesser known that sexual minority women are at an even higher risk. According to the American Cancer Society, studies suggest that sexual minority women are less likely to get routine care including breast and cervical cancer screenings, Pap tests and mammograms, further increasing risk of serious illness.
  • Heart disease – The number one killer of all women is heart disease. The risk for heart disease is increased by stress, smoking and obesity, which all have been shown to occur in higher rates among sexual minority women compared to heterosexual women. Getting annual screenings for high blood pressure, high cholesterol and diabetes can greatly reduce your risk.
• Mental Health:
  • Depression and anxiety – The Gay & Lesbian Medical Association reports that sexual minority women have been shown to experience chronic stress due to homophobia and biphobia. This stress, depression and anxiety may be due to social pressures, abuse and violence, unfair treatment in the legal system, or rejection by family and friends. If left untreated, depression and anxiety can lead to a severely decreased quality of life and self-destructive tendencies.
  • Domestic violence – Sexual minority women might be more likely to stay silent about this kind of violence due to gender stereotypes. Some healthcare providers may not be as likely to ask sexual minority women about intimate partner violence as often as they ask heterosexual women, but access to counseling and shelters is just as important for this group.
  • Alcohol, illicit substance and tobacco use – Substance use disorders affect 20 to 30% of the LGBTQ population, compared to 8.4% of the general population, according to the Substance Abuse and Mental Health Services Administration. Increased stress from homophobia, sexism, discrimination, depression and anxiety can lead to increased risk for alcohol, tobacco and substance abuse. One study reported that lesbian, bisexual and queer women had higher rates of substance dependence, more than three times the rate for heterosexual women.
• Sexual Health:
  • Sexually transmitted diseases – Sexual minority women can contract the same sexually transmitted diseases (STDs) as heterosexual women, but are less likely to be open about sexual history in fear of negative reactions about their sexual orientation. It is incredibly important for ALL sexually active women to be screened for STDs.
• Financial Health
  • LGBTQ people - particularly lesbian, bisexual and queer women, LGBTQ people of color and transgender people - tend to be disproportionately low-income and/or living in poverty. Women, because of fewer financial resources and the frequent added responsibility of caring for family members, suffer particularly from the lack of convenient and available forms of transportation to LGBTQ-competent and HIV-specific healthcare facilities. Access to adequate, nutritious food also remains a problem for millions of people in the U.S. Poverty is a leading cause of hunger and food insecurity, and marginalized groups experience disproportionately high poverty rates. As a consequence, households such as those headed by single parents - especially women - as well as by Latinx and black adults experience substantially higher rates of food insecurity than the average U.S. household.

Some sexual minority women struggle to find a provider knowledgeable about their specific health issues and with whom they feel comfortable discussing their needs and concerns. It’s important to find a provider who is curious, empathetic and respectful of your specific needs - which can sometimes be difficult. That’s why we created the BCBSRI Safe Zone program, which identifies healthcare practices that provide safe, affirming and inclusive care to the LGBTQ community. The list is always expanding, so please check for updates at bcbsri.com/safezones.