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Fair Treatment: LHI Houston staff (from left) Cathy McMillan, RN, Jenna Miller, LPN, Ann Pinchak and Iris Rodriquez at a recent health fair. courtesy LHI Houston

However, a group of volunteers, nurses, physicians and non-healthcare professionals in Texas are trying to change this situation. They started the Lesbian Health Initiative of Houston Inc.  (LHI Houston) 17 years ago to help bridge the gap between the LGBT community and the healthcare services they were going without.

Women With a Mission
In an effort to bring necessary information and preventive screenings to the LGBT community, LHI Houston hosts two health fairs each year (June and November). The events provide an opportunity for attendees to receive mammograms, Pap tests, pelvic exams, blood glucose and cholesterol screenings at no cost to attendees. LHI provides these services through grant funding and financial support from community organizations and businesses, and an annual Valentine Gala, said Ann Pinchak of LHI Houston.

And, just as the population at large is being affected by the recent economic downtown, there is an increased need for these services in the LGBT community, Pinchak said.

"We take calls a month and a half ahead of time to reserve spots for the well-woman exams, and in November, we filled the spots faster than ever before," she said.

While preventive screenings are a large part of the health fairs and purpose of LHI, there's also a greater mission.

"There are several reasons for our existence," Pinchak said. "One of them is that we wanted to create a safe non-homophobic environment. A lot of times when LGBT women go to receive medical treatment they experience hostility, inappropriate interventions or violations of confidentiality."

Pinchak shared the experience of a woman who was going into the hospital and wanted her partner to be able to visit her there. Instead of assistance, the physician told her that being a lesbian "was wrong."

During a regular checkup, lesbians may also need to navigate uncomfortable conversations about birth control, since it's the main reason many heterosexual women visit the gynecologist in the first place.

"Experiences like these are really a barrier to early detection," Pinchak explained. "When a woman has had a negative encounter in a healthcare setting, she's not as likely to seek treatment."

Additionally, Pinchak mentioned many lesbians don't realize they need preventive health screenings and visit a doctor less frequently than their heterosexual counterparts. So another large part of the organization's mission is to promote health education.

"Our ultimate goal is to provide preventive healthcare in a safe environment," she said. "If a woman has a suspicious mammography or problems with a Pap [that they received at one of our health fairs], we connect them with providers who will carry them through the follow-up process. It's our hope that once you've gone to the doctor and have a positive experience, maybe you'll go back."

Just the Facts
LHI volunteers aren't only dedicated to provide education for the LGBT community but also for healthcare providers. For instance, Pinchak noted whereas 80 percent to 90 percent of heterosexual women give birth, about 20 percent to 30 percent of lesbians do. She added that since having children reduces a woman's risk of ovarian and breast cancer, lesbians are in a higher risk group by default.

LHI board member Jenna Miller, LVN, said some healthcare providers have their own misunderstandings about the preventive screening needs of lesbians. 

"There are a lot of misconceptions that just because women are partnering with women, they've never been exposed to HPV and, therefore, do not need Pap smears because they are at a lower risk for transmission of HPV and cervical cancer," Miller explained. "That is completely not true. It's more than likely that most lesbians have partnered with men and women." 

Miller recommends an educational tool developed through the Mautner Project, a national lesbian health advocacy organization based in Washington, DC.

"Mautner has a training program called "Removing the Barriers" that helps educate healthcare professionals and offers CEUs in a class designed to raise awareness about the healthcare needs of lesbians," she said.

Raise Your LGBT IQ
While LHI Houston has made great strides in promoting the healthcare needs of the population it serves, the organization continues to battle prejudice and hostility. Lucy Watson, BSN, RN (retired), has served the organization as a volunteer, past president and consultant for more than 11 years. She thinks the issue may sometimes be one of ignorance as opposed to malice.

"I think some people have no experience with the LGBT population," Watson said. "[Before my work with LHI Houston] I had never met a lesbian that I knew of; it simply wasn't something I was exposed to. "

So, if a patient mentions that she's a lesbian, how should a healthcare professional respond?

The answer: treat her like she's any other patient, Watson said.

"Just show them they are people, and don't act like you're afraid of them," she explained. "I mean, they're just women. Don't judge them, or treat them like they just got off a spaceship."

Sensitivity and respect go a long way to earning the trust of this patient population, Pinchak added.

"I think the healthcare provider can be sensitive to the person," she said. "If the patient says, 'I don't need birth control,' then respect that. If the patient needs to make arrangements for her partner to visit her in the hospital, assist her in doing whatever is necessary."

Overall, Miller noted providers need to understand how difficult it is for a woman to "out" herself to a care provider.

"Nurses need to remain sensitive to that and speak to our mission as nurses," she said. "Our charge is to advocate for our patients no matter what color they are or who they choose to partner with. If a patient wants information or needs direction, there are a lot of available services in the community; it's just a matter of being open to seeking them out."

Barbara Mercer is senior associate editor at ADVANCE.