In New York City, over 50,000 people, i.e., 4% of the 8.38 million residents, identify as non-binary and transgender people. We do not know precisely the number of immigrants among this population. Alex Trifonov, a community health representative and patient navigator at NYU Langone Health, on May 11, 2022, presented on the issue of health equity at an event at RUSA LGBTQ+. What is known is that stress caused by minority status and stigma leads to chronic stress and cardiovascular problems. Chronic stress, in turn, can cause substance use and abuse, addiction, and mental health issues.

Mr.Trifonov specifically spoke about health inequity among LGBTQ+ people regarding cancer. He talked about very low levels, lower than immigrant populations, of preventative healthcare utilization among LGBTQ+ patients due to the abovementioned minority stress and consequent avoidance of medical care. At the same time, across the United States, over 80,000 LGBTQ+ people receive a cancer diagnosis every year. Lesbians and bisexual people have a double risk of acquiring cancer diagnoses. Transgender and nonbinary patients have double the chance of getting cancers caused by infectious diseases. Gay men are diagnosed with anal and prostate cancers and cancers caused by HIV younger than other patients.

The NYU Langone system provides special outreach and navigation services, often in several languages, to ensure LGBTQ+ people get regular medical check-ups and screenings. Patient navigators like Mr.Trifonov advocate for individual patients, train staff, nurses, and doctors, and help organize advisory committees with LGBTQ+ people and their families to improve healthcare services access and utilization. See Alex Trifonov’s presentation here: https://youtu.be/XcuggGQEEgI.

In addition, mental health is an area of glaring health inequity. The higher prevalence of PTSD and other severe and chronic mental health conditions among LGBTQ+ refugees and asylum seekers in the West has been newly documented. New traumas of asylum policies, which aim to deter, detain, and cause prolonged precariousness, layer on pre-migration trauma. In crossing the borders, LGBTQ+ migrants do not find much of the safety they seek. 

Asylum legal procedures and their implementers ignore intersectionality and force LGBTQ+ asylum seekers to produce “credible” narratives of uniform, Westernized, and linear LGBTQ+ identity development. In this painful psychological conundrum, asylum seekers are reluctant to reveal their group memberships because of the perceived shame and depression and histories of assault, and their habits of concealment and internalized heteronormativity. After settling in the new country, LGBTQ+ refugees face racism, xenophobia, Islamophobia, and the incompetence of gatekeepers. At the same time, the resourcefulness, resilience, survival, and organizing of LGBTQ+ asylum seekers have been slowly coming into focus.

The systemic discrimination that causes health inequities and barriers to healthcare among LGBTQ+ people, especially LGBTQ+ asylum seekers and nonbinary and transgender migrant women, are known, and the data has been accumulating. Medical systems, nonprofits, immigrant groups, social workers, and government systems should coordinate more to counter these existing health inequalities comprehensively, both at a systemic and customer-service level.

Search for LGBTQ+ health services on www.hermigranthub.org