The Orlando Shootings and Homophobia in Healthcare

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After the horrific shooting in in Orlando, the conversation has turned to homophobia—specifically, the homophobia of a man who sees two men kissing, buys an AR-15, goes to a gay nightclub, and killed 49 individuals.  But homophobia does not always come with a high capacity rifle—sometimes it comes with lab coats and syringes.  As the 53 individuals who were critically injured in the shooting receive medical care, we must come to terms with the anti-gay discrimination that pervades our medical system.

Take blood donation for example.  Orlando residents have provided blood with such generosity that local blood centers have reached capacity.  Donors explained that they were giving blood to show solidarity with the victims of the shooting, even if they knew none of them.  They wanted to do something to help.

But some of the closest friends of the victims of the shooting—other gay men—were left feeling powerless, because rules set by the U.S. Food and Drug Administration prohibit them from donating blood.  The rules are a legacy of the early days of the AIDS epidemic: gay men were among the hardest hit by the epidemic, and HIV testing was unreliable.  But today, testing has improved to the point that the American Red Cross, America’s Blood Centers, and the American Medical Association have all declared the ban unnecessary.  Straight individuals from groups with similar risk profiles can continue to give blood.

Yet, instead of abolishing the ban, the FDA has merely ‘relaxed’ it:   men who have sex with men can only donate blood 12 months after their last sexual encounter with another man.  In other words, an HIV negative gay man in a monogamous marriage cannot give blood—unless he stops having sex with his husband for a full year.

Gay people also routinely face discrimination from their medical providers.  Patients, advocacy groups, and even doctors have reported incidents where medical staff condemn their gay patients on religious grounds, or refuse care altogether.

A few years ago, a Florida hospital reportedly informed a woman whose partner had collapsed that she was in an “antigay city and state.”  Accordingly, they would not recognize the same-sex relationship or permit visits.  After she was admitted, the patient died without seeing either her partner or their children.

The discrimination sometimes comes from ignorance rather than malice.  Fewer than half of medical schools and few hospitals  train their students or staff on LGBT issues.  One doctor tells us how a colleague simply assumed that his gay patient’s medical condition was HIV related, and ordered HIV test upon HIV test, all of which turned out negative.  Only when the patient went to a different doctor was the real cause of his complaint uncovered—hypothyroidism.  In a survey, the Centers for Disease Control found that 34% of primary care doctors and nurses had never heard of a drug that, when taken regularly, can prevent HIV transmission.  Because of the substandard care they often receive, many LGBT patients simply stop going to the doctor altogether, or lack a regular provider.

Perhaps most troubling is that the law denies gay individuals in most states—including Florida—the ability to fight anti-gay discrimination.  If the victims of the Orlando shooting suffer discrimination because of their race, sex, national origin, or religion, they can file suit under the antidiscrimination provision of the Affordable Care Act.  But if they suffer anti-gay discrimination, their hands are likely tied.   As the Department of Health and Human Services explained just last month,  the ACA does not conclusively prohibit sexual orientation discrimination in healthcare.

There are signs of change.  Marriage equality addresses many of the problems surrounding spousal visitation.  In 2014, the Association of American Medical Colleges issued recommendations for curricular change so that future doctors are more competent to address LGBT issues.  Providers and the federal government have begun major efforts to collect data about LGBT individuals (over the protest of many providers) so that they can address their unique healthcare needs.

But there is a long way to go.  Acts of discrimination, harassment, or sub-standard care will continue to pervade the healthcare system until providers receive appropriate training in hospitals, and anti-gay discrimination is prohibited. Gay men will still feel like second class citizens until they can provide blood and organs for their loved ones, or even to complete strangers, should they choose to.  As our medical system experiences an influx of queer individuals, it is time to take step back to consider how to extend to them the protections that we provide other vulnerable populations so that the homophobia that brought them there is not perpetuated.

–Craig Konnoth is a Sharswood Fellow and Lecturer at Penn Law School and a Rudin Fellow in the Division of Medical Ethics at NYU Langone Medical Center.  He writes on LGBT health law and health information policy.

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