LGBT people are at greater risk for mental and behavioral health challenges and for diseases such as cancer, heart disease, and HIV/AIDS. They are more likely than their straight people to lack health insurance, and they face other barriers to accessing healthcare – especially among those who are transgender, people of color, undocumented, or low-income.
In short, LGBT people are more likely to need healthcare and are less likely to get the care they need. Like other marginalized populations, LGBT people face significant health disparities:
- Cancer: Due to higher rates of smoking, alcohol consumption, and delayed engagement in preventative health care, LGBT people are at increased risk for developing various types of cancer.
- Mental Health: LGBT people are more likely to report feelings of depression and anxiety, and they have higher rates of suicide and attempts, especially among transgender people – 41 percent of whom report having attempted suicide (compared to 1.6 percent of the general population).
- Substance Abuse: Disparities in cancer, cardiovascular disease, HIV/AIDS, and other conditions can be attributed in part to risk factors such as substance abuse and addiction. These challenges are tied to the wider experiences of discrimination and stigma that LGBT people face, which unfortunately lead some to turn to alcohol and other substances as a coping mechanism.
- HIV/AIDS: Gay and bisexual men account for 64 percent of new HIV infections, even though they make up only about two percent of the population. These rates of new infection are particularly alarming in the South, where there is an especially high prevalence among youth, Black men, and Latino men. Transgender women are nearly twice as likely as gay and bisexual men to contract HIV.
In addition to the above disparities, LGBT people are less likely to have access to health care. Eighteen percent of LGBT adults have no health insurance, while 13 percent of non-LGBT adults lack health insurance. When LGBT people do access health care, they often encounter providers that lack the expertise to provide effective care. Four in ten physicians receive no LGBT-related training in medical school, residency, or continuing education. Half of transgender people report having to teach their own medical providers about appropriate health care for transgender people.
In 2014, foundations awarded $24.7 million to address the health and well-being of LGBTQ communities in the United States. This is a 37-percent increase from 2013, when LGBTQ health received $18.0 million. Nearly all of that increase was for HIV/AIDS, much of it focused on raising awareness of new prevention tools such as pre-exposure prophylaxis (PrEP) among gay and bisexual men and transgender people.
Looking at specific health issues that receive funding, the largest amount ($14.9 million) is devoted to HIV/AIDS prevention and treatment. Several other health issues received $1 million or more in 2014: general health services, primary care, mental and behavioral health, and insurance access. Smaller amounts of funding were devoted to address cancer, cultural competence, and sexual and reproductive health in LGBTQ communities.
Funding for LGBTQ Health, by Specific Health Issue Funded (2014)
An in-depth analysis of foundation funding for LGBTQ health may be found in Vital Funding: Investing in LGBTQ Health, a report released by Funders for LGBTQ Issues in January 2015.
In 2014, the top 10 funders for LGBTQ health in the U.S. awarded about $14.5 million, more than half of all LGBTQ health funding that year. Five of the top ten funders are HIV-focused funders, and four others are funders addressing a range of health issues. None are LGBTQ-specific funders.
Top Ten Grant Funders of LGBTQ Health (2014)
|1. Gilead Sciences — Foster City, CA||$5,886,447|
|2. Elton John AIDS Foundation — New York, NY||$1,980,656|
|3. AIDS United — Washington, DC||$1,636,019|
|4. The California Endowment — Los Angeles, CA||$1,135,065|
|5. Robert Wood Johnson Foundation — Princeton, NJ||$806,625|
|6. M.A.C. AIDS Fund — New York, NY||$734,621|
|7. Ford Foundation — New York, NY||$600,000|
|8. Kaiser Permanente — Oakland, CA||$593,000|
|9. Broadway Cares/Equity Fights AIDS — New York, NY||$568,278|
|10. Susan G. Komen Foundation — Dallas, TX||$532,391|
In 2014, the top ten grant recipients of funding for LGBTQ health received $7.3 million, or nearly 30 percent of all LGBTQ health funding that year. Five of the top ten recipients were HIV/AIDS service providers, and seven of the top ten were located in California or New York.
Top Ten Grant Recipients for LGBTQ Health (2014)
|1. San Francisco AIDS Foundation — San Francisco, CA||$2,522,898|
|2. GMHC — New York, NY||$1,168,516|
|3. AIDS Foundation of Chicago — Chicago, IL||$580,749|
|4. AIDS Project Los Angeles (APLA) — Los Angeles, CA||$494,185|
|5. Trevor Project — Palm Springs, CA||$459,400|
|6. NEO Philanthropy – Out to Enroll — New York, NY||$452,200|
|7. Human Rights Campaign (HRC) Foundation — Washington, DC||$450,000|
|8. Transgender Law Center — Oakland, CA||$422,665|
|9. Howard Brown Health Center — Chicago, IL||$393,000|
|10. Los Angeles LGBT Center — Los Angeles, CA||$391,750|
For funders seeking to advance the health and wellbeing of LGBTQ communities, there are a number of community assets to build on:
- There are hundreds of LGBT community centers around the country, which provide physical health services for more than 277,500 people and mental health services for more than 42,000 people annually. These community centers are connected through the national network of community centers, CenterLink.
- There are hundreds of HIV/AIDS service organizations around the country, many of which offer programming targeting the unique needs of gay and bisexual men and transgender people.
- Several LGBTQ health centers providing wraparound comprehensive health care services, offering best practices for culturally competent care in LGBTQ communities.
- More than 200 organizations have received training through the Out2Enroll, a nationwide initiative to expand health insurance coverage in LGBTQ communities by taking advantage of the provisions of the Affordable Care Act.
- There is a growing set of resources and training programs for providers seeking to increase their cultural competence in LGBTQ communities, including programs provided by the American Association of Medical Colleges, Fenway Health, GLMA, the Health Resources and Services Administration (HRSA), LGBT HealthLink, the National LGBT Cancer Network, and the Rainbow Heights Club.
Building on these assets, funders have several opportunities to improve LGBTQ health:
- Increase Access to Insurance Coverage for LGBTQ People: The Affordable Care Act is rapidly shifting the health policy landscape and increasing access to health insurance. Funders have an opportunity to assure that coverage outreach efforts reach LGBTQ populations, and that insurance providers do not discriminate against LGBTQ people—especially when it comes to medical care for transgender people.
- Build Capacity of the HIV/AIDS and LGBTQ Health Services Sector: LGBTQ community organizations have unparalleled cultural competence when it comes to serving LGBTQ communities but often lack the resources to meet the full range of needs of their communities or are heavily reliant on one or a handful of government contracts. Particularly given the current shifting health policy climate, funders have an opportunity to build the capacity of these agencies, to expand the scope of their work and to develop sustainable revenue strategies.
- Increase LGBTQ Cultural and Clinical Competence of Health Service Providers and Systems: Many LGBTQ people may never be able to take advantage of LGBTQ-focused service providers, particularly in rural and less densely populated areas. Funders have an opportunity to support training, curriculum development, and other efforts to increase the cultural competence of hospitals, health centers, and other mainstream health care providers, so as to maximize their ability to effectively serve LGBTQ communities. Key areas include increasing competence in providing transition-related care for transgender people and providing sexual health and HIV prevention services that are sensitive, relevant, and empowering for LGBTQ communities.
- Strengthen HIV/AIDS and LGBTQ Health Policy and Advocacy Infrastructure: The LGBTQ movement has built a fairly robust set of organizations for policy advocacy at the national and state levels, but much of this infrastructure has focused on civil rights issues such as marriage equality and protections from discrimination. Much of the HIV/AIDS infrastructure in the U.S. has shifted to a services focus, with only a small number of organizations focused on advocacy for people living with HIV. Funders have an opportunity to support LGBTQ and HIV/AIDS organizations in building advocacy programs around the health policy issues that affect LGBTQ communities, including inclusive implementation of ACA exchanges, repeal of HIV criminalization laws, improving data collection on sexual orientation and gender identity, and providing government funding for health services for LGBTQ communities.
- Address Mental and Behavioral Health and Other Social Determinants Related to Stigma: LGBTQ communities face an especially severe disease burden in mental and behavioral health. These challenges are driven by the stigma and marginalization related to homophobia and transphobia, which are also key social determinants of HIV/AIDS and other health disparities. This is an area that relates to the priorities of a range of funders, including LGBTQ-focused funders, HIV/AIDS funders, and funders broadly concerned about health disparities and inequity.
Additional details on the above recommendations are provided in Vital Funding Part Two: Grantmaking Strategies for Improving LGBTQ Health.