LGBT healthcare in the United States military

As of 2014, the United States Veterans Health Administration (VHA) provides healthcare services for approximately one million gay and lesbian veterans. With the repeal of the Don’t Ask, Don’t Tell policy, there will be more gay and lesbian veterans. Hence, there will be an increase in the number of gay and lesbian seeking for medical care. However, as noted by Sherman and her coauthors, there are many concerns regarding the healthcare needs of the gay and lesbian veterans, and many veterans do not feel that they have adequate and equitable healthcare services from the VHA. The researchers assert that veterans who are missing quality healthcare are less likely to maintain good health and positive well-being in life

Concerns from Gay and Lesbian Veterans

In their article, Sherman and her coauthors explain that in the past, most of the gay and lesbian veterans were uncomfortable in disclosing their sexual orientations or identities because they were afraid that this information could lead to their discharge from the military. With the repeal of the Don’t Ask, Don’t Tell policy, gays and lesbians were assured that their sexual orientations would not be used against them. Nonetheless, many gay and lesbian veterans are still hesitant about full disclosure. They are worried about confidentiality issues and that this information may jeopardize their future careers and prospects. For some veterans, because of their previous experience while serving in the military, they are apprehensive of disclosing their sexual identities and orientations. Because of societal stereotypes and stigmas, they are concerned that it can instigate discrimination and social repercussions. Specifically, they are worried that they may be denied medical service, lose their benefits, or receive inferior services

Recently, Sherman and her coauthors conducted a study on the communications between the gay and lesbian veterans with their VHA providers and the experiences regarding their healthcare services. Most of them report that their healthcare providers have never specifically asked about their sexual orientation. They also claim that the healthcare providers are not receptive to their medical needs, and they do not receive the necessary support from VHA medical providers. Many of them also express their dissatisfaction with their medical treatment. The results of their study show an inherent problem since some gay and lesbian veterans are disinclined to seek preventive care and even medical treatment from the VHA. Their study also reveals that some gay and lesbian veterans are having trouble in finding adequate and equitable healthcare services, leading to a healthcare disparity

According to statistics, lesbians often decline routine medical tests. Likewise, gay men are not as likely to seek medical treatment when compared with heterosexual men. Hence, some medical conditions and disorders may not be intervened in a timely manner.

However, Sherman and her co-authors point out that the missing cultural relevant patient-centered communication can affect the quality of medical treatment. Sexual orientation and identity can have implications for the physical and mental health of the patient. But, currently, many gay and lesbian veterans do not feel at ease and comfortable with their healthcare providers.

According to Sherman and her colleagues, since sexual identity and orientation is a contentious issue, many healthcare workers are not comfortable in approaching this topic. But if the physicians initiate the conversation, it is more likely for the veterans to provide this information. According to their data, if the gay and lesbian veterans can divulge information about their personal medical history, values, and preferences, they may experience higher levels of patient satisfaction. It is also more likely for them to receive better medical treatments and appropriate diagnostic screenings for their unique health risks, such as for sexually transmitted diseases. Since these tests are often instrumental in providing valuable information for the healthcare professionals to implement proactive measures, potential health concerns can be prevented and minimized, and the patients will have better outcomes. Moreover, comprehensive medical records can provide a multitude of information useful not only for medical treatments but also for evaluations, such as the fitness of the veterans for duty

Responses from Veterans' Health Administration

To alleviate the concerns from the gay and lesbian veterans about discrimination and inequitable healthcare, the VHA has recently introduced some policy changes. For instance, the VHA has established the Office of Health Equity to oversee the gay and lesbian healthcare needs and to reduce the disparities in their healthcare provisions.

These new developments mark a milestone in expanding the role of the government in improving healthcare provisions for the gay and lesbian veterans. To avoid any discriminatory practices, the VHA is instituting policies that require healthcare providers to care for gay and lesbian patients in the same respectful and sensitive manner as other patients. There is a focus on more individual care and personal attention. Another policy is to redefine the meaning of “family” and allow the gay and lesbian veterans to decide who is regarded as part of their family. Currently, there are many discrepancies regarding this information. The information found on medical records is often inaccurate and incomplete and may not clearly indicate the choice of the veteran. The VHA also has launched educational and training programs to help healthcare providers become more knowledgeable about the psychological and social distresses of the gay and lesbian veterans as well as issues specifically related to their care. Sharpe and Uchendu maintain that a better understanding of the healthcare needs for the veterans can contribute to building a better rapport with the veterans. It also can prevent discrimination and reduce stigmas.

Currently, the gay and lesbian veterans are not asked to disclose information about their sexual orientation on medical forms. Consequently, the healthcare providers are often unaware of this information when they consider medical treatment options. In response to these concerns, the Institute of Medicine suggested that patients disclose such information on medical records. The information will be confidential and only be used to assess health. To ease the worries of the gay and lesbian veterans, the VHA is striving to prevent this information from being shared with other organizations. Sharpe and Uchendu suggest the option of incorporating more open-ended questions to encourage the veterans to supply additional written information.

According to Sharpe and Uchendu, creating a cordial culture and a welcoming environment for the gay and lesbian veterans can fix the poor rapport with the patients and make them feel more comfortable with their sexual identities or orientations. It will encourage the veterans to inform their providers about pertinent health issues. Recently, the VHA is participating in the Gay Pride events and hosting conferences regarding healthcare of gay and lesbian veterans.

The current healthcare services for the gay and lesbian veterans are not adequate. There is a healthcare disparity. The main purpose of the first steps of the VHA is to improve the levels of medical care and patients’ satisfaction for the gay and lesbian veterans by fostering a sense of trust, openness, and rapport among the patients, their healthcare providers, and the VHA.