Throughout Pride Month, I had conversations with several patients in my primary care practice who identify as gay, queer, trans and bisexual during their regular visits. They all planned to attend the Toronto Gay Pride Parade and other events. Two patients were going to New York to mark the 50th anniversary of the Stonewall riots. They spoke about how pivotal those riots were in marking the start of a major movement for gay rights and how important the apology made by the New York Police just a few weeks ago was. A similar apology was made by the Toronto Police a few years ago for the city’s history of bathhouse raids, including one as recent as 2000.
The conversations also turned to the patients’ experiences in health care. Several of them commented on the welcoming posters in our waiting room, a greater degree of knowledge about LGBTQI2S health issues and overall acceptance in their health care teams.
One HIV-positive patient marvelled at the “miracle” of his steady zero viral load (meaning there is no evidence of the HIV virus in his blood). He recounted watching many of his friends die from AIDS a couple decades ago and the fact that he assumed his own diagnosis would take him down a similar rapid path. Another patient who had come to discuss Truvada—a drug that, when taken regularly, can dramatically reduce a person’s chance of being infected with HIV if exposed—talked about the growing acceptance and role of pre-exposure prophylaxis.
Despite the generally positive nature of these conversations, they were also a sharp reminder of a difficult past. Our history in medicine and health care of the treatment of the LGBTQI2S community is often not a proud one. There was the categorization of homosexuality as a mental disorder, the practice of conversion therapy, the general lack of education in health professional education programs, and delays in broad access to effective treatments for HIV as they became available.
And, unfortunately, the challenges are not all historical. For members of the LGBTQI2S there are still broad issues of social stigma and distrust of institutions like the police force. I had a conversation with one patient about his conflicted feelings around the involvement of the police in this year’s Pride Parade.
There is good data documenting the mental health and addiction impact of these issues on members of the LGBTQI2S community. Patients often talk about the ongoing challenges of acceptance at work and from their own immediate family, and the extensive measures they have to take to accommodate others rather than being accommodated. A few have told me that they experienced derogatory comments from other patients in the waiting room of my practice. I have had patients make comments to me about “the types of people in our waiting room,” and about three years ago, one patient even chose to leave my practice because of the diversity of its patients.
The Pride theme of “love is love” is a great spirit to continue to draw on throughout the year. As health care organizations and providers, we should take collective pride in progress but continue to acknowledge our unproud past and seek to improve the parts of health care which don’t uphold our broad commitment to providing all patients with the best possible care. We need to continue, as health organizations, to create safe and welcoming spaces for our patients and staff who are members of the LGBTQI2S community. We need collectively and individually to call out intolerance, to educate ourselves on our unproud history, and to gain knowledge about the unique health needs of each of our patients.