The social inequality and stigma afflicting the LGBTQ+ and TGNC (transgender and gender non-conforming) populations in Chicago creates a health-care quandary; they’re more susceptible to issues such as HIV, cancer, and suicide, yet less likely to receive care.
Nationally, LGBT youth are two to three times more likely to attempt suicide, gay men are at higher risk for HIV and other STDs, and transgender individuals have a higher prevalence of mental health issues, HIV/STDs, suicide, and less access to health insurance, according to the CDC.
In Chicago, the story is not much different. The same health and wellness issues persist, and in 1999, the city established its Office of Lesbian, Gay, Bisexual and Transgendered Health within the Chicago Department of Public Health. The department has spent the last few decades assessing the health issues of LGBTQ and TGNC Chicagoans, offering training for health-care providers, launching projects such as Chicago Black Gay Men’s Caucus, and most importantly, making promises.
The most consistent promise to Chicago’s LGBTQ+ and TGNC population: better access to health care. However, that promise still mostly relies on whether citizens are employed and the type of employment they have.
The LGBTQ and TGNC population in Chicago is about 146,000 people, according to the Chicago Department of Public Health. Of that population, 80,000 people identify as male, 66,000 identify as female, and 10,000 identify as transgender or gender non-conforming. According to the same assessment, 65.5 percent of the queer community is employed for wages, 9.7 percent are self-employed, 13.4 percent are students, and 9.9 percent are unemployed. The unemployment rate for the queer community is 3 percent higher than the 6.9 percent unemployment rate for Chicago’s general population.
A 2019 LGBTQ Community Needs Assessment by the Morten Group and the Chicago Community Trust’s LGBT Community Fund reported that 20 percent of survey-takers earned $20,000 or less, and 56 percent earned an income of less than $50,000. The survey-takers’ vocational areas included: social services (18 percent), education (13 percent), medicine/health care (9 percent), and arts and entertainment (8 percent). Only 53 percent of survey-takers felt they had access to physical health care and resources, and one third strongly disagreed that they have access to mental health care and resources.
Other than employment, another method of gaining access to health care for many queer folks in Chicago and its surrounding suburbs is legal partnership.
“The marriage factor is weirdly huge when it comes to health care,” says area resident Jessica Gamba. Although they are employed and in a polyamorous relationship, Gamba says their partner’s insurance plan was foremost in their decision to wed.
Most queer people in Chicago self-report being employed with access to health care, however those who are employed in the arts or entertainment industries, who are unemployed, self-employed, unable to work, or are single find themselves on the margins of Chicago’s promise for better health care. Community health centers such as Center on Halsted, Howard Brown Health, and Brave Space Alliance attempt to move affordable, equitable health care for queer people in Chicago out of those margins.
Center On Halsted, a community center that also serves as an incubator for smaller LBGTQ+ nonprofit organizations, serves more than 1,000 community members a day. Brave Space Alliance, the first Black-led, trans-led LGBTQ+ center in Chicago, provides HIV testing, wellness services, relief funds for trans folks, and has a forthcoming telehealth program that will provide mental health services for trans individuals. Practical Audacity, a gender and sex therapy group practice, offers mental health services to queer Chicagoans through insurance and affordable out-of-pocket options.
Health-care centers and providers with LGBTQ+ and TGNC sensitivities are fulfilling many of the needs the city has neglected, says Dr. Zyra Gordon-Smith, nurse practitioner and assistant site medical director for Howard Brown Health’s Englewood location. The Englewood location opened after the city of Chicago began taking bids to take over an HIV clinic it was closing. At that same location, the Board of Health Building, the city closed down its STI clinic in 2016, forcing Howard Brown to fill that void, too.
Although centers like Howard Brown offer more robust and inclusive services to LGBTQ+ and TGNC communities in Chicago, the clinics’ reputation with queer folks make them more inviting than city services as well.
“I had one patient who had a primary care provider who managed his diabetes and high blood pressure, but he came to Howard Brown for pre-exposure prophylaxis. I asked him, ‘Why are you fragmenting your care?’ He said, ‘You all are the sex health experts,’” says Gordon-Smith.
Dr. Gordon-Smith acknowledges that city funding is integral to Howard Brown’s mission, but says the city isn’t doing much more to address the needs and wellness of many marginalized communities. “There are a lot of needs, but there’s a lot of community groups addressing things,” Gordon-Smith says when asked about the unique challenges of a Howard Brown health center in a community like Englewood.
While Chicago’s queer-focused health-care centers and initiatives fill a huge void for those lacking state assistance or employment, others are still left seeking aid.
Barbara Cruz, a 24-year-old from North Lawndale, recently quit their job due to COVID-19 concerns and says they’ve been struggling with health-care access since graduating from college.
“I was looking at places like Howard Brown, who had therapy low-cost for queer people, but the waitlist was insane. All that stuff is in Boystown. It’s kind of inaccessible to even get up there,” Cruz says.
Cruz turned to apps such as Lemonaid, an online doctor’s office and pharmacy, to fill prescriptions for their chronic illness after having trouble navigating Illinois’s Medicaid system.
Apps such as Lemonaid, MedRX, and lucky Google searches can assist in finding medication, but physical health care is still integral. Physical, queer-focused health care in Chicago is largely out of reach for west-side residents as the bulk of the centers are on the north side, with a few sprinkled throughout the south side. Center on Halsted is located in Boystown, Howard Brown has centers in Buena Park, Hyde Park, Englewood, and Edgewater, Practical Audacity is located in Logan Square, and Brave Space Alliance is in Hyde Park.
Neighborhood alternatives are often equally hit-or-miss.
“We do have the Lawndale Christian Center. But I don’t feel super comfortable there. I’m not Christian and I look pretty gay,” Cruz says.
Overall, the city of Chicago is not keeping its promise of better health care and wellness to the LGBTQ+ and TGNC communities. Chicago’s 2012 LGBT Community Action Plan stipulated promoting participation in LGBTQ health initatives, increasing state funding for LGBTQ mental health services, and dedicating more resources to queer wellness in general as city goals. However, a Chicago Department of Public Health assessment found that six years later, LGBTQ folks are still being left behind.
LGBTQ youth are less likely than heterosexual youth to receive annual checkups, and nearly a quarter of LGBTQ adults aged 18-44 needed mental health services in 2016 and didn’t receive them, according to the city’s assessment.
COVID-19 is impacting access to health care and exacerbating the social determinants of health such as hunger and housing. City STI centers such as the Lakeview STI Specialty Clinic have closed as COVID-19 cases spike, and thousands of Chicagoans are unemployed and unhoused due to the pandemic. Even queer folks with health care, like Gamba, are struggling with receiving comprehensive care through telehealth services as they try to avoid pandemic-ridden hospitals.
“I’ve tried to use telehealth through NorthShore [University HealthSystem] and it’s been really bad,” Gamba says. “They just tell me to come in person, which I don’t.”
Chicagoans like Cruz shouldn’t have to patch together pharmaceutical apps for prescriptions and mental health-care service waitlists. Private health centers such as Brave Space Alliance and Howard Brown shouldn’t have to swoop in to vacant city health clinics for that matter, either.
The city of Chicago must revisit the health-care drawing board. It has not kept its promise to improve the health and wellness of its LGBTQ+ and TGNC citizens, and lives depend on that promise. v
This coverage is made possible by support from the Chicago Foundation for Women.