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Treatment, Not Judgment

A Gay-Specific Medical Group Has Opened for Those Who Fear Discrimination


When Tom Clyde gets sick, he hesitates before seeing a doctor. Insurance is not the problem--Clyde has coverage through his employer, L.A. County, where he works in the epidemiology department as an HIV counselor and phlebotomist. The issue is his sexual orientation.

"A lot of times I avoid going to a doctor because I feel judged," says Clyde, who is gay. "It's scary enough going to the doctor without having to worry about feeling uncomfortable."

Clyde's experience is a common one for gays and lesbians in Los Angeles and throughout the country. The result, say gay leaders and health professionals, is that many in the gay community fail to get the health care they need.

But the launch last week of Lambda Medical Group by the Los Angeles Gay and Lesbian Center may change that. Located in the Miracle Mile district, the facility offers full health care to the gay and lesbian community. It is the first gay health center in L.A. to provide the full spectrum of primary care and the only one in the country designed to accept private as well as government insurance, the center says.

The move represents a significant expansion for L.A.'s largest gay and lesbian organization, which already runs numerous health-care programs out of its Hollywood headquarters. It also signals a new direction for the gay health care community, which for nearly two decades has been concentrated almost solely on the AIDS crisis.

"We can't afford to lessen our focus on AIDS," says Lori Jean, the center's executive director. "But we can expand it. We've set up this infrastructure. We have a responsibility to let others in."

Lambda's goal is to offer an alternative to what many gays and lesbians consider a pervasive problem: unequal treatment by the medical profession.

"The perception that you might get bad treatment is almost universal," says Michele Eliason, author of "Who Cares? Institutional Barriers to Health Care for Lesbian, Gay and Bisexual Persons" (NLN Press, 1996) and associate professor at the University of Iowa's College of Nursing. "Most gays and lesbians have fear and trepidation about entering the health care system. It comes from personal experiences and what friends have told them."

In her book, Eliason cites numerous studies documenting negative attitudes toward gays and lesbians among doctors, nurses and other practitioners. Patient studies have also revealed a pattern of bias. Mistreatment runs the gamut, from inappropriate questioning based on the assumption of heterosexuality to overt discrimination following disclosure of sexual orientation.

"We've been doing openly gay and lesbian health care for years, and we've had a lot of people share horror stories with us," says Suzann Gage, executive director of Progressive Health Services in West Hollywood. She recalls one patient who went for a routine gynecological examination and, after revealing that she was a lesbian, found herself being referred for psychological evaluation. In another instance, a lesbian was repeatedly told to avoid intercourse following a surgical procedure. When she divulged her sexual orientation, the doctor noted it in her charts, prompting nurses to regard her differently.

One of the most common problems faced by gays and lesbians is how the medical system deals with their partners.

"I've found it's pretty hard when you go to a doctor to talk about your partner," Clyde says. "They just assume it's a woman right away. It's uncomfortable to tell someone what's going on."

When gay people do disclose, they often find that their partners are not afforded the same access and decision-making rights as spouses (a policy that also affects many unmarried heterosexuals).

Avoiding Routine Care

Fearing insensitive or discriminatory treatment, gay people often avoid or delay seeking health care.

"Many gays and lesbians don't get routine care because they don't want to go into the health care system, so they don't get the screenings they need," says Eliason, citing mammograms and Pap smears as two examples.

This can be especially dangerous in cases of breast cancer and cervical cancer because they can be more effectively treated if they're detected earlier. Others don't say they're gay, which can also affect the quality of care they receive by preventing practitioners from addressing specific health needs.

While homophobia is often a factor in treatment, another obstacle that gays and lesbians face is the dearth of specialized training received by providers.

"There's no medical school curriculum that includes alternative lifestyle health factors," says Ricardo Hahn, chairman of USC's Department of Family Medicine, which provides staff for the LAGLC's health-care facilities, including Lambda Medical Group.

As a result, says Hahn, "There's not just an insensitivity, but a nonawareness of the medical issues that affect gays and lesbians." Matters of particular concern to gays and lesbians range from safe sex to psycho-sexual health to employment and insurance issues, he says.

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