LGBTQ patients face barriers accessing healthcare. Modesto clinics want to change that
Dr. Andie Silva likes to wear a rainbow pin on the lapel of her white coat. To her, it’s a symbol of acceptance and safety for her LGBTQ patients.
Physicians like Silva play a crucial role in bridging healthcare disparities within Modesto’s LGBTQ community. Beyond mere scarcity, additional obstacles persist, exacerbating the challenge of obtaining essential healthcare services for LGBTQ individuals.
The Rainbow Clinic, opened by Silva in 2019, not only provides primary care but also prioritizes critical services such as gender-affirming therapy, mental health support, medication for HIV prevention and treatment for substance use disorders for the community.
Since its inception, the Rainbow Clinic has become a lifeline for queer individuals seeking hormone therapies, surgical interventions or simply a supportive community connection.
“I think that it has been instrumental in trying to get safer access to gender-affirming care in a conservative place,” Silva said.
Despite resources like this, the LGBTQ community in Modesto continues to encounter barriers to healthcare access.
Fear of discrimination keeps LGBTQ community from care
A major concern among the community is not seeking care due to fear of discrimination.
According to a UCLA report, LGBTQ patients are more likely to experience unfair treatment when receiving medical care — with 45% of bisexual women and 32% of gay men reporting negative experiences.
Transgender adults are more than twice as likely as cisgender adults to delay or forgo necessary medical care.
Bettie Mercury, director of a burlesque production called the Glitter Coven Cabaret, said she has experienced discrimination in the past as a queer person.
“There are a ton of queer people here and we need to know where we can go, where we’ll be respected and taken care of truly,” Mercury said.
Jorge Fernandez, director of behavioral health at Golden Valley Health Centers, said that in a focus group held last year in Merced, stigma emerged as the primary barrier for the community.
Melody Castillo, a nurse practitioner at GVHC, noted that many LGBTQ patients are covered by Medicaid or are people of color.
She explained that these patients often encounter challenges in accessing care, and when they do, they are more likely to have negative experiences. These experiences can subsequently create additional barriers to receiving future care.
“It’s just people being afraid to come in because of past experiences,” Castillo said.
Veronica Ambrose, a community organizer at MoPride, noted that some doctors lack the necessary knowledge to treat LGBTQ patients effectively.
“We see a lot of our trans community and also our chronically ill community having to educate their providers on their individual health issues,” Ambrose said.
Castillo emphasized that it is unacceptable for patients to have to educate providers on clinical management as it should never be the patient’s responsibility to advocate for their own needs.
She said this issue stems from shortfalls in medical education, where providers often graduate without adequate preparation to meet the needs of a diverse population.
Patients don’t always have to travel far
Fernandez said GVHC now offers hormone treatment locally and is among several places where gender-affirming care is available.
GVHC also has started providing services through the Rainbow Clinic to broaden access to a variety of healthcare services for residents.
Castillo said she has been providing services at GVHC for seven years and still sees patients who didn’t know about its services.
Though patients occasionally need to travel outside of Modesto, being close to centers in the Bay Area and Sacramento is a significant advantage. Those locations draw individuals from across the country who seek these specialized services, Castillo said.
“The only thing better would be being in the Bay Area,” she said.
She said California also is advantageous for gender-affirming services, and sexual and reproductive health care, which are well-covered and accessible.
“Our patients in California have really good access to services, that if we were in another state might not be the case,” Castillo added.
Creating an inclusive environment
Mercury said Silva was one of the first openly queer professionals she had encountered.
“There’s not enough of them that are out there,” Mercury said.
She finds comfort in Silva’s short haircut and the pride flag displayed in her office.
Silva believes the entire healthcare community should embrace LGBTQ inclusivity, rather than having patients relying solely on places like the Rainbow Clinic. She encouraged all healthcare providers to be allies and welcoming to LGBTQ patients.
She said people are afraid to jump into the field out of fear of making mistakes. Her best advice to them is to just apologize and learn. She said it’s very rewarding when you provide those safe spaces and make people feel accepted.
“There’s not enough of us sort of queer gender diverse folk, so you really need our allies to be able to step in and help us,” Silva said.
Fernandez said there are efforts at GVHC to educate staff on culturally sensitive care, including using correct pronouns and treating everyone with respect. The behavioral health team at GVHC has collaborated with UC Davis trainers to enhance knowledge on LGBTQ topics such as HIV treatments and cultural sensitivity.
He stressed the importance of creating a safe environment through visible symbols like rainbow flags in offices or by including pronouns in email signatures.
He said it’s helpful when providers are part of the community because they will better understand their patients’ experiences. However, he believes you don’t have to be LGBTQ to be able to understand.
“That could help them feel a little more comfortable that they’re going to have an advocate. They’re going to have somebody who looks out for them,” Fernandez said.
