LGBTQ2S+ Pride Month can provide us with a time not only to celebrate but also to reflect on questions related to shame and alliances in medicine.
I’ve lived a significant portion of my life as a queer person in and near rural desert areas. These settings have made me attentive to the ways that land and geography affect access to healthcare and resources. I also think of the number of desert metaphors used to describe healthcare barriers. Food deserts, maternal health deserts, pharmacy deserts, cancer care deserts—all of these determine health outcomes.
Further, with my work focusing on healthcare disparities, I recognize the reality that social terrain and climate also create deserts of access and care. Accordingly, the opportunities that Pride Month presents remind me of those few riparian areas a person might be fortunate to find on a desert hike. Desert canyons with streams and the occasional sounds of water among vividly contrasting green leaves and red rocks give a sense of abundance. But even on a streamside trail, the overall conditions mirror the rest of the desert—the air is thin, dry, and hot. Even in the shade, the heat on a red dirt incline extracts energy and fluids at a rate that can be insidious.
Pride Month is important because the visibility and attention associated with celebration have the potential to be nourishing, healing, and hopeful. Pride Month emerges on our paths in healthcare as an opportunity to be mindful about diverse genders, gender expressions, and sexualities as they relate to health. Pride Month thus offers a chance to re-energize the medical landscape with education and trainings that emphasize vital needs in LGBTQ2S+ health.
However, it’s no secret that there’s ongoing and resurging anti-LGBTQ2S+ tension in the US. And, this tension frequently intensifies with the visibility of Pride Month. With the positive messaging of June Pride, it can be easy to overlook the fact that the theme of the festivals developed in response to the 1969 Stonewall Uprising and thus in the shadow of a global and historical projection of shame onto LGBTQ2S+ people.
Queer people live with diverse healthcare histories, disparities, uncertainty, and access barriers today in the U.S., regardless of celebrations of progress. Not everyone realizes, for instance, that Lawrence v. Texas, the Supreme Court case that decriminalized homosexuality in the United States, was only decided in 2003 and sits on similar, vulnerable legal ground as did Roe vs. Wade. Further, this context of projected (and often then internalized) shame has been, and continues to be, an impediment to healthcare.
Looking at Pride Month from the vantage point of the desert, we can also consider the question as to whether queer people in the U.S. have arrived at a moment where they can truly feel safe seeking medical care. The answer to this question, for many complex reasons, is no or not yet— especially when we consider intersectional queer identities and the role of race.
We need to combat the prevalent mythology that queer sexuality and gender do not relate to an individual’s health broadly, because they do. Gender identity and sexuality are factors in access to, comfort with, disparities in and/or attitudes about healthcare in terms of sexual and reproductive health, diabetes, cardiovascular health, health information, memory-related conditions, disability, cancer, care partner relationships, palliative care, medical education, and electronic health records. This means that it’s important for clinicians to ask about their patients’ sexuality and gender identity in respectful and safe ways, because these identity factors are key social determinants of health.
Since queer history has been characterized by a lack of safety in medicine, Pride Month can provide us with a time not only to celebrate but also to reflect on questions related to shame and safety in healthcare.
Asking ourselves questions like the following can lead to important self-knowledge:
1. Do I feel safe and comfortable supporting my LGBTQ2S+ patients, colleagues, and trainees in a healthcare environment? At what point did this feeling of safety begin, and is there anything that still impedes it? Have I always been an advocate with the same confidence and visibility?
2. What factors—place, people, legislation, training, beliefs, culture, education—have influenced my capacity to support LGBTQ2S+ health?
3. What is the role of shame in my relationship to queer health?
Our unique answers to these questions can help us see some of the most important factors influencing our roles in the health of those LGBTQ2S+ patients in our circles of care.
Considering the work yet to be done, it’s important for Pride Month to be a reminder to meditate on the global and historical taboos and deserts of care that have been the reality for queer people up to, and including, today.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.