As a result of the Trump Administration’s rollback of affordable healthcare and harsh cuts to affordable housing opportunities, many Americans are struggling with access to quality healthcare and stable housing. The combined toll of both of these issues, as well as pervasive and persistent discrimination, consistently put LGBTQ groups among the most affected.
For decades, homosexuality was considered a mental disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Being transgender was only declassified in May from the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Laws — some of which still exist today — such as those banning marriage and adoption — continue to enact and encourage “direct explicit discrimination” toward the LGBTQ community, said Dr. Ethan Mereish, a health researcher and assistant professor of health studies at American University.
On an individual level, hate crimes have long threatened LGBTQ people. According to Mereish, surveys show that American attitudes toward this community have become gradually more favorable, but this upward trend has plateaued in recent years. Correlating with an increase in violence and hateful speech, the National Coalition of Anti-Violence Programs’ “Crisis of Hate” report found that 2017 was the deadliest year in recent history for LGBTQ people in the United States.
Chas Moore, executive director and founder of the Austin Justice Coalition (AJC), a National Community Reinvestment Coalition member organization, has witnessed this discrimination of LGBTQ people in his home state of Texas. “We as a society have really mistreated that particular community,” he said. “I don’t think they feel safe almost anywhere.”
“When we think about discrimination we think about race, like black and Latino, but we rarely think about sexual orientation,” Moore said. “It is the same with mental health; people just think of the stereotype of the homeless person on the street that may have alcohol or substance abuse issues. We do not think of the person of a different sexuality.”
This mistreatment has resulted in poorer mental health, Mereish reports. “Over two decades of research show that sexual minorities have poorer mental health than heterosexual people … [as well as] higher rates of substance abuse and psychological distress,” Mereish said.
In addition to often-overlooked mental health issues, physical health disparities for the LGBTQ community have also been identified in the past decade. For example, lesbian and bisexual women are more likely to be overweight, and LGBTQ groups have higher rates of cancers and heart disease, Mereish said, clarifying that there is an overlap or co-morbidity between these two health issues, as struggles with mental health often translate to problems with physical health, and vice versa.
These health disparities are also predictable considering the social determinants of health, which the Centers for Disease Control and Prevention defines as conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes. Access to stable housing in a safe environment has been shown to have a dramatically positive impact on an individual’s health. Mereish emphasizes that adverse health effects are especially felt by members of the LGBTQ community, as homelessness disproportionately affects transgender adults and LGBTQ youth.
Jorge Membreño, director of housing and clinical services at Supporting and Mentoring Youth Advocates and Leaders (SMYAL), confirmed this fact. Citing a study organized in part by SMYAL, an advocacy organization in Washington, D.C., that provides housing and other services to at-risk LGBTQ youth, he said that around “38% of homeless youth in D.C. identify as LGBTQ.”
Membreño explained that this phenomenon is the result of “fear of rejection, fear of being kicked out,” and also “especially due to the high rent prices in D.C. and family history of unstable housing.” All those served at SMYAL are youth of color, and many also have a family history of incarceration or economic struggles, which Membreño refers to as an “intersection of marginalization.”
Membreño sees the health effects of this marginalization in the youth he treats at SMYAL. “A lot of what we see is a long history of trauma,” Membreño explained. Young adults seeking transitional housing “usually come to us between ages 18-24, but for most this is not the first time they’ve been homeless.”
“For many, there is a history of domestic violence or abuse,” Membreño added, and when they are on the streets “youth sometimes engage in survival sex,” which results in higher rates of HIV.
In addition to LGBTQ youth, transgender adults are also at a greater risk of housing insecurity due to higher rates of unemployment and work discrimination which translates to homelessness, Mereish said.
Lack of anti-discrimination laws for LGBTQ people, especially the transgender community, means that in more conservative states “a trans person can be fired for being trans, kicked out of their housing, a doctor can deny seeing them” — all of which are “social determinants of health that accumulate to create a toxic mix” for all LGBTQ people, Mereish said. “These are not only human issues affecting our communities, they are also expensive issues that tax our health care system,” Mereish said.
The wide array of intersecting oppressions and disadvantages faced by LGBTQ people is a drain on health and wellbeing within the community. However, LGBTQ activists for decades have found strength and solidarity in extreme adversity.
Mereish highlights the advocacy efforts behind the Equality Act — a bill that prohibits discrimination based on sex, sexual orientation and gender identity in areas including public accommodations and facilities, education, federal funding, employment, housing, credit and the jury system. Mereish calls this proposed bill “a huge victory for LGBTQ civil rights, maybe even more important than same-sex marriage,” due to its potential wide-reaching impact. The bill was passed in the House in late May, but is now facing the Senate. It has the potential to address long-term health disparities in the LGBTQ community by ending the discrimination that inevitably endangers the health of this group.
On a local level, LGBTQ leaders like Membreño support younger members of the community, creating and utilizing “safe and affirming” spaces — meaning LGBTQ youth are not only accepted but also “celebrated exactly for who [they] are” and can see their identities reflected in the staff. For LGBTQ youth who may justifiably fear general public shelters, drop-in centers like those provided by SMYAL serve not only as a place to stay, but also an opportunity for “youth to connect with each other” and for younger LGBTQ children and their parents to ask questions and find support.
Outside of the immediate LGBTQ community, the message of finding strength through intersectionality continues to spread. The AJC is a grassroots, activist-led organization addressing community needs, increasing political involvement, empowering communities and criminal justice reform at the local level. While AJC has focused primarily on minority and low-income communities since its creation in 2018, the organization plans to incorporate LGBTQ issues into its mission.
“This is something we just jumped into,” Moore admitted, “We are currently in a deep and quick phase of research and outreach.” Still, the efforts of organizations like AJC to explicitly include LGBTQ people in its goal of “making everyone’s voices heard,” speaks to the growing support of the movement for social, political and health equality.
Emily Schreer was a summer intern at NCRC