San Antonio Express-News (Sunday)
At this clinic, the doctor is in for LGBTQ patients
Discrimination, lack of insurance make their health care a struggle
Joshua Solis showed up for his medical appointment, but no one was there — that’s how he learned his nurse practitioner had abruptly closed shop.
Solis was left scrambling. Finding a doctor is challenging for anyone. But for Solis, it’s especially difficult — he’s a transgender person with no health insurance.
The 25-year-old searched for months for a new medical provider to prescribe the hormone therapy he needs to transition from a woman to a man, a treatment he’s been on for seven years.
Some people in that position turn to the black market or cross the Texas-Mexico border for the medication. But without medical supervision, it’s a dangerous route.
“It was always at the back of my mind — where will I get my hormone shots?” he said.
The lesbian, gay, bisexual, transgender and queer communities face serious challenges in accessing health care, according to a survey conducted last year by a trio of researchers in San Antonio.
The results from the Strengthening Colors of Pride survey show LGBTQ patients in San Antonio frequently face discrimination and substandard care during medical visits. About 42 percent of the respondents also said they had problems finding a
competent provider.
And 1 in 4 transgender people struggle to access basic health care.
Dr. Amy Stone, a sociology and anthropology professor at Trinity University, said the reasons trans people often have difficulty getting in to see a doctor include lack of insurance; limited or no insurance coverage for procedures such as hormone therapy; and a dearth of health care providers who can competently treat trans patients.
Stone’s research partners are Phillip Schnarrs, a professor at University of Texas at Austin, and Robert Salcido, chair of Pride Center San Antonio. They are in the second phase of a three-year study funded by the Robert Wood Johnson Foundation, a New Jerseybased nonprofit dedicated to health.
The researchers are now looking for LGBTQ residents living in Central Texas, South Texas and the Rio Grande Valley to participate in a second survey, which runs through the fall.
The group hosted a Pride Month discussion on health care access at San Antonio College during which LGBTQ people spoke about their experiences finding doctors or clinicians who understood their medical needs.
A man who attended the event said some free health clinics affiliated with religious organizations either shun homosexuals or promote conversion therapy, a discredited practice of attempting to change a person’s sexual orientation, gender identity or expression.
Ashley Smith, an advocate for transgender equality, told of trying to put together an online listing of LGBTQ-friendly medical practices — however, not all providers wanted their names on the list.
Several attendees also said that even if they found a doctor who welcomed LGBTQ patients, the receptionist or support staff often weren’t as accepting.
Dr. Peter Guarnero, a psychiatric nurse and professor at UT Health San Antonio, told the group that he and several colleagues “had to challenge the system” when they sought to open an LGBTQ-friendly clinic for underserved patients in the city.
Guarnero said it took more than two years to get UT Health’s approval and funding to open the student-run clinic. The Pride Community Clinic opened in fall 2017.
The clinic — inside the office of social service organization Alamo Area Resource Center, known as the AARC, at 303 N. Frio St. — is open two nights a month. AARC also operates a health clinic at that location for people who are homeless, disabled or face life-threatening illnesses such as HIV and AIDS.
For two years, patients have been signing up for appointments at the Pride clinic for primary care, mental health, sexual health and substance abuse services. They’re seen by nursing and medical students under the supervision of faculty advisers.
Some patients drive from 60 miles outside of the city, Guarnero said.
On the night of July 24, 10 patients showed up at the clinic, but sometimes as many as 20 seek care there. A university security guard was parked in front of the clinic.
Solis, who came in for a checkup, said he was relieved to finally find a free clinic where everyone was nice to him. The staff even helped him get the monthly cost of his hormone therapy down from $71 to $25.
The all-volunteer staff undergoes what Guarnero calls “safe space” training, which is an hourlong course where students and clinicians learn about about different gender and sexual identities. Participants, he said, are asked to examine their own prejudices and assumptions. Unlike many clinics, the patient intake form asks patients to write in their preferred name, the personal pronouns they use, gender identity, sex assigned at birth and sexual orientation.
“You want to make sure you respect every aspect of their identity,” said Lindsey Gendron, a UT Health nursing student clinic leader who wears a 1-inch rainbow button on her scrubs.
Gendron, who is a lesbian, said she first experienced discrimination while attending a Catholic university in Dallas — she and friends of hers were blocked from starting an LGBT student organization on campus.
She was one of several students volunteering that night who said the Pride clinic was one of the main reasons they applied to UT Health San Antonio.
Ravyn Middleton, a secondyear medical student, said she considers working in the clinic an opportunity to learn about treating the LGBTQ population so she’s better prepared when she becomes a doctor.
Some of the students help with grant-writing, trying to find additional funds to support the clinic.
Dr. Ruth Berggren, director of the Center for Medical Humanities and Ethics at UT Health San Antonio, said most of the funding for the clinic’s $40,000 annual budget comes from philanthropic groups, but students and AARC also pitch in.
“We don’t charge patients a penny and the doctors provide their services for free,” said Berggren, who is an infectious disease specialist.
She recalls treating a young gay man with an advanced HIV infection in 2016. It was too late. He died in an ICU room in a San Antonio hospital. The patient’s parents sent her a message: She was the only doctor who had ever looked him in the eye.
The fear of being treated differently by medical professionals kept him from seeking care earlier, when his infection could have been brought under control, she said.
“My patient really died from shame,” she said.