Seven Ways FQHCs Can Support LGBT Health

Apicha Community Health Center Nov 25, 2015  

fqhcs can support lgbt healthApicha Community Health Center (Apicha CHC) is happy to announce that this month included National Health Center Week.

Throughout the nation, Federally Qualified Health Centers (FQHCs) are celebrating their work in the communities they serve.

This celebration is made extra special this year as Apicha CHC received a New Access Point (NAP) Award, on August 11, 2015. With this award, we can begin the process of applying for full Federal Qualified Health Center (FQHC) designation and prove how FQHCs can support LGBT health.

What is an FQHC?

FQHCs are locally-based nonprofit organizations led by a board of directors made up of area volunteers. At FQHCs, payment is based on ability to pay. Nationally, FQHCs provide more than 24 million patients with comprehensive care. The goal of all FQHCs is to enhance primary care services in underserved urban and rural communities.

Apicha CHC has long served the LGBT community, a group that has been underserved by FQHCs in the past (though, as you can see here, that is changing). Apicha CHC makes it a priority to pay attention to the needs of our patients, so we’ve learned a few things about taking care of LGBT people along the way.

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Seven Ways that FQHCs Can Support LGBT Health

The following are the health issues Apicha CHC has identified as most commonly of concern for our Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. There are many ways that FQHCs can support LGBT health, and it is our belief that these things should be incorporated into FQHCs nationwide to ensure LGBT cultural competency.

1. Create an LGBT Affirming Healthcare Environment:

An LGBT-affirming healthcare environment includes the following practices:

Board and senior management are actively engaged with LGBT issues; Key center policies include LGBT identities and families; Registration / intake forms and procedures and medical histories include LGBT identities and relationships; Sexual orientation and gender identity information is collected and entered into electronic medical records; All staff receive training on culturally affirming care for LGBT people; Services incorporate LGBT health care needs; The physical environment welcomes and includes LGBT people; LGBT staff are recruited and retained; and, Outreach and engagement efforts include LGBT people in your community.

2. Substance Misuse or Abuse:

The LGBT population demonstrates higher misuse and abuse of alcohol, drugs, and tobacco in comparison to the cis-gender, heterosexual population. In addition to the health problems traditionally associated with misusing drugs, alcohol, or tobacco, within the LGBT community these behaviors also increase sexual behaviors that increase the risk of HIV and STIs.

The stress created from the stigmatization of LGBT people in many segments of the United States’ population perpetuates the misuse and abuse of these substances. As a result, assessing substance use is recommended for all LGBT patients and providing LGBT-affirming substance abuse treatment when necessary.


In the United States, the majority of new HIV infections remain highest among gay and bisexual men and trans-women. As such, it is necessary to ask patients specific questions regarding sexual and other potential high-risk behaviors and offer HIV testing to any patient with risk of infection.

In addition, patients who are HIV-positive should be put on anti-HIV therapy to maximize HIV virus suppression, so they remain healthy and prevent further transmission. Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are biomedical advances in preventing HIV transmissions that should be familiar to all primary care providers (PCP).

PCPs should assess their patients’ potential risk for HIV infection to determine if he or she is a good candidate for PrEP and inform all patients at risk for contracting HIV about PEP with instructions of how to access it if becomes necessary.

4. Appropriate Sexually Transmitted Infection (STI) Screening:

It is necessary for PCPs to ask LGBT patients specific questions regarding the specific types and body parts of sex they are having. These answers direct PCPs in screening body parts used for sex for sexually transmitted infections (STIs) (e.g. anally or orally). Overlooking sites of potential infection may lead to false conclusions regarding the absence of STIs, which both neglects the health of the patient and may allow further STI transmission.

blacklgbt.jpg5. Access to Mental Health Services:

Rates of depression and anxiety are higher among the LGBT population in comparison to cis-gender, heterosexual populations. These contribute to high-risk sexual behaviors, substance misuse or abuse, and suicide. It is recommended that all LGBT patients be assessed for depression and anxiety and linked to mental health services with an LGBT-friendly provider when necessary.

6. Appropriate Cancer Screening:

The LGBT community requires cancer screenings as part of their primary care. It is important to screen all HIV+ people, regardless of gender identity and sexual orientation, for anal dysplasia (pre-cancer) as they are at an increased risk. While not at higher risk for cervical cancer than the general population, pelvic cancer screenings are necessary for trans*men—it is important to approach this procedure in a sensitive manner as many trans*men may be uncomfortable with vaginal procedures. Specific tips for creating a safe environment for pelvic exams will be posted in a future blog.

7. Access to Hormones:

It is common for transgender patients to take cross-gender hormone therapy as a gender-affirming procedure. Many trans people get their hormones from the black market. Hormone treatment can be associated with an increased risk for abnormal liver function, cardiovascular disease, diabetes, thromboembolism, osteoporosis, and certain cancers. For this reason, hormone treatment should be prescribed and monitored by a PCP, even if they feel uncomfortable prescribing these hormones.

These are just a few ways that FQHCs can support LGBT health. The LGBT community has traditionally been an underserved community in terms of affordable healthcare, which should be, and is, changing. The evidence of this can be seen from the recent events that Apicha CHC has been a apart of, including being Grand Marshals of the Queens Pride Parade in early June of 2015, and receiving the NAP Award as a clinic that provides healthcare for the LGBT community.

Make sure you follow our journey as we evolve into a Fully Qualified Health Center via our Facebook and Twitter feeds, and subscribe to our blog by filling out the form in the top right of this page!

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