Responding to the health needs of LGBT communities

Neil Fishman, associate professor of medicine at the Hospital of the University of Pennsylvania (HUP), has experienced his share of uphill battles when it comes to creating imperative health initiatives. Arriving at Penn in 1988 as an infectious disease fellow, Fishman witnessed medical colleagues encounter significant barriers in developing an HIV/AIDS program that was crucial at a time when health professionals knew very little about the disease.

Fast forward to 2012, when Fishman’s colleague Baligh Yehia, an assistant professor of medicine at HUP, spearheaded the first-of-its-kind Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program at Penn. As faculty adviser for the program, Fishman can now attest: The climate for responding to the needs of underserved communities is thriving at Penn.

“It’s such a stark contrast to 25 years ago. There has been an overwhelming response and recognition of the need for the LGBT Health Program,” says Fishman. “I think it’s really a testimony to the people here at Penn, and also to the changing times and attitudes.”

But establishing the program, which launched in July 2013, has just been the first step on the road to provide comprehensive, inclusive health care for members of the LGBT community. The program is comprised of five core focus areas: institutional climate, patient care, community outreach, health education, and research.

“LGBT health is increasingly being recognized as an important component of health care as we realize that LGBT individuals have increased disparities in care. Certain health conditions are more common in this population, such as HIV, colorectal cancers, and breast cancer in lesbians,” says Yehia, the program’s director. “We also know they face a lot of discrimination and stigma. Those feelings—as well as unfair or inequitable health care policies—have exaggerated these health disparities.”

Coupled with those known disparities, which also include higher incidences of depression and alcohol and tobacco abuse, is the fact that very little data exists on LGBT populations.

Yehia says by actively gathering more health data about the LGBT community, Penn can promote both inclusivity and better individualized care.

“This is not about creating completely brand-new enterprises, but rather, about building on the strengths of research already at Penn,” he says. “It’s about looking at the questions researchers ask and prompting them to investigate through an additional lens.”

Part of the vision Yehia has for the program is to foster a health care environment where patients not only feel comfortable disclosing their sexual orientation and gender identity statuses, but one where health care providers know how to properly collect that information. To do so, the program provides mentorships, workshops, and an increase in LGBT-issues training in medical school, where the average stands at only five hours.

“When we talk about improving the climate, we want to really make sure people feel comfortable being who they are, whether they’re patients, students, faculty, or staff,” Yehia says. “We want the program to help create a welcoming environment by eliminating any sort of barriers [LGBT people] might face.”

One way to do so is by providing accessible information to the community, which the program plans to do by building a list of Penn medical providers who have strengths in LGBT health care.

“We have great specialty care here at Penn, and so we want to be able to identify who our specialists are in different areas to serve as a resource for the community,” Yehia says.

The program also promotes LGBT health and wellness in the City of Philadelphia through organizations such as the Mazzoni Center, the William Way LGBT Community Center, the Attic Youth Center, and the LGBT Elder Initiative.

“Our obligation to the LGBT community aligns with our mission at Penn as a health system,” Fishman says.

Yehia says the program is both unique and valuable for its interdisciplinary nature, drawing on strengths from the Perelman School of Medicine, the School of Nursing, the School of Dental Medicine, and health systems including the Children’s Hospital of Philadelphia and the Philadelphia Veterans Affairs Medical Center.

“There aren’t many LGBT health programs around the country. And programs that do exist are limited to hospitals or medical schools,” Fishman adds. “The difference in this program is its scope, both in terms of participants and strategic planning. This is the only program that involves all of the health professional schools in the University, as well as a children’s hospital, and also includes community work.”

Fishman says program leaders have already received inquiries from peer institutions interested in using Penn’s LGBT Health Program as a model.

“Obviously it takes a lot of time to change a culture, which is really what we’re talking about with this program,” Yehia says. “How do we create a more inclusive and equitable culture where people are more sensitive to those around them, and where folks don’t feel that they have to hide who they are or get treated differently? We are hoping that the steps we’re taking over the next few years will get us closer to that goal while providing excellent patient care.”

LGBT Health Program