From 1987 to roughly 1995, the mostly white gay community united through ACT UP and other HIV/AIDS organizations to sear the idea into the public consciousness that health care is a right, not a privilege. With the advent of lifesaving HIV medications, that unity of purpose dissolved, and health care once again became an issue of individual “personal responsibility.”
Fifteen years later, when a spate of gay teen suicides shook the conscience of society, people of compassion rallied around the simple positive notion that “It Gets Better.” The cultural tables were turned, and bullying, once considered a teenage rite of passage, came to be considered shameful behavior. Issues of mental health, such as depression and substance abuse, started to be seriously integrated into health care conversations. More recently, the new focus on marriage equality has raised issues that underscore LGBT second-class citizenship—issues such as health care benefits, hospital visitation rights and the legal status of surviving spouses, partners and children. Now the majority of Americans seem to agree that the so-called Defense of Marriage Act is unfair and same-sex couples should have the same rights as opposite-sex couples.
But on the ground, especially in communities of color where anti-gay churches still hold sway as the primary source of community, homophobia and varying degrees of LGBT-bashing are often given a pass. Some still consider gays inherently evil, as the Catholic Church once decreed, and therefore bring any harm they incur upon themselves. Others are more accepting, allowing gays to live in the community under a kind of “Don’t Ask, Don’t Tell” code of silence. But for many LGBT people of color, living an inauthentic or double life hurts less than the prospect of forfeiting the love and respect of family and community, regardless of the cost to their physical, mental, emotional or spiritual health.
On April 6, the Latino Equality Alliance, in conjunction with the California Endowment’s Building Healthy Communities Boyle Heights site and more than 50 community-based organizations, held an event with the intention of once again uniting around health care inequality. Although the California Endowment has worked before with HIV/AIDS groups such as The Wall Las Memorias, the LGBTQ Forum for Youth, Families and Community Services was the first-ever gay-health-specific public event held in Boyle Heights, bringing together non-gay service providers and those who feel too afraid and marginalized to seek their services. Over 100 LGBTQ youth, families, local service providers and faith leaders came together at Mariachi Plaza to start transforming the community into one where LGBT youth and their families can feel safe to be themselves. The event included workshops where community and faith leaders and local service providers learned how to be culturally competent in responding to and providing resources for the LGBT community in their midst.
“Today and this event is special for many reasons,” Latino Equality Alliance Co-Chair Ari Gutierrez told the crowd. “It is the first time an openly gay public event is held in Boyle Heights! The first time that we are able to bring our community together to discuss the safety and health of our lesbian, gay, bisexual, transgender and queer identified youth. The first time that we can stand in our own community, in the public plaza and say to the world that ‘tolerance’ is not enough! And when it comes to discussing LGBTQ issues, we say that maintaining our family relationships with love, compassion, communication and understanding of our shared values is key to a whole and well society!”
LAPD Assistant Chief Sandy Jo MacArthur also addressed the crowd. The LAPD recently became one of the few law enforcement organizations in the nation to create a set of guidelines for how officers must deal with the transgender population. “Safety is a major component of health,” MacArthur said. “At the LAPD, we strive to ensure the safety of all communities and individuals. We are taking steps not only to address safety issues in real time, but also prevent crime from happening in the first place.”
White House LGBTQ Liaison Gautam Raghavan also attended the event as part of the Obama administration’s ongoing efforts to raise awareness about LGBT health issues.
“Policy improvements either at the local or national level cannot happen without the active support of the community. Events such as this one are a shining example of how communities across America can come together and unite service providers, families and individuals to seek solutions to the unique issues facing LGBTQ youth,” said Raghavan.
Later Raghavan told Frontiers, “I was inspired by the coalition of local organizations, advocates and service providers—from legal advocates to HIV prevention services to faith organizations—that came together to organize and support the event. I also felt a real interest and energy among participants for common sense immigration reform that will keep families together and provide an earned pathway to citizenship.”
In fact, the event fell just two weeks after National LGBT Health Awareness Week, which this year focused on enrolling LGBT people into the Affordable Care Act, which starts January 2014.
“LGBT Americans have experienced—and continue to experience—health disparities and are more likely than other Americans to be uninsured or underinsured. Now, because of the Affordable Care Act, our major national health surveys are beginning to include data on LGBT populations. This will give us the information we need to target and reduce disparities among this group going forward. We have also formed an internal working group to ensure we’re developing and coordinating policies targeted at increasing access to care for LGBT Americans and addressing their special health care needs,” Health and Human Services Secretary Kathleen Sebelius said in a March 25 press release.
But those health disparities multiply in communities of color. “Discrimination limits opportunity and choice. As a result, LGBT people of color may be more likely than either white LGBT people or straight and non-transgender people of color to be less healthy and experience greater disparities in health care access. They are more likely to live in poverty, to have trouble seeing a doctor when they need to, and to live in environments where the surgeon general’s goal of making the healthy choice the easy choice remains an unfulfilled promise. For too many Americans, each additional ‘disparity factor,’ from having a disability to being a woman to living in a rural area, magnifies the health gap,” writes Kellan Baker of the Center for American Progress on the Think Progress blog.
“An important step in breaking the cycle of disparities breeding disparities is changing our lens from health disparities—a focus on what has gone wrong—to health equity—a focus on where we want to be. The U.S. Office of Minority Health defines health equity as the attainment of the highest level of health for all people. Achieving it requires not only valuing everyone equally but also taking concrete steps to address inequality, close disparities and build a healthier society.”
“Inclusiveness, acceptance and respect are essential elements of a healthy community,” said Beatriz Solís, Director of Healthy Communities, South Region, for The California Endowment. “The California Endowment is proud to sponsor this important forum that will ‘lift up’ the profile and strengths of Boyle Heights’ LGBTQ community.”
The California Endowment’s Building Healthy Communities Boyle Heights site is one of 14 sites selected for the foundation’s 10-year “place-based” initiative committed to making these communities more healthy. In a lengthy phone interview with Frontiers, Solis (who is the sister of former Labor Secretary Hilda Solis) said the foundations’ approach to this initiative “has been to really listen to issues and concerns on the ground in each of these communities … rather than having a top-down approach.”
That enables the local communities to come up with local solutions aimed at public health outcomes. But it also exposes the difficulties of old issues of homophobia. As a result of their top-down approach, “we have 20,000 people from across the state from these 14 communities [voting] with their feet on what they thought was an important priority. And that, I believe, set the tone for a new partnership with communities,” said Solis. “On one hand, we gained the respect and willingness to be that partner on the ground, to help deal with some of those hard issues. And one of those hard issues is the issue of structural racism and legacy there and also LGBTQ issues in certain communities of color and how inclusive or non-inclusive communities can be to multiple voices in these places.”
Solis is keenly aware of the difficulties faced by marginalized LGBT people of color, including having to leave one’s own community to get access to health care services. But she hopes the Endowment’s initiative will help unify all communities in conceiving better solutions to disparities in health care. “How do you create a welcoming environment in a community that they’re familiar with? So this forum, in that sense, kind of lifts the profile for people in the community of why it’s important to be inclusive,” Solis said. “The endowment really applauds the local groups coming together to really lift up the profile of health issues that are impacting LGBTQ in Boyle Heights. As part of our Building Healthy Communities Initiative, the endowment sees that all communities, all members of the community should be at the table. We’re excited to hear what emerging issues need to be addressed.”