WEST NYACK – Adam Zaydenband remembers their first checkup at The Jacobs Family Pride Wellness Center, and not just because it was the very first medical appointment at the new health care center devoted to serving the region’s LGBTQ community.
Zaydenband said Dr. Raffaele Bernardo asked questions about their life, health concerns, support systems.
The visit made Zaydenband realize how medical care hadn’t really fit before. This visit was different and really made them feel seen.
In so many aspects of daily life, Zaydenband said, “everything is so heteronormative. I didn’t know that I wasn’t getting what I wanted and then I came here.”
“I was so overcome,” Zaydenband recalled. “I was crying in my car with joy.”
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That is precisely why Montefiore Nyack Hospital and the Phyllis B. Frank Rockland County Pride Center worked to create a freestanding clinical setting that allows people who are part of the LGBTQ community access to health care that addresses their needs.
“The medical aspects are pretty much the same” as a standard checkup, said Wellness Center Director Dr. Barry S. Zingman, who is director of the AIDS Center at Montefiore Medical Center, the largest multidisciplinary adult HIV/AIDS treatment and prevention program in the state. “But there are some significant differences culturally and demographically.”
Montefiore’s Oval Center, a Bronx community clinic specializing in sexual health care, is also part of the collaboration. Bernardo is clinical lead at the Oval Center as well as a clinician at the Pride Wellness Center.
Dr. Mark Geller, president and CEO of Montefiore Nyack Hospital, said the center offers “more safe, more affirming” care for people who are part of the LGBTQ community in Rockland and Orange counties, and beyond.
Approximately 24% of LGBTQ+ people travel outside of Rockland for primary and specialty medical care that is safe and affirming for them, according to the Rockland Pride Center.
Geller started hearing about the need for more services attuned to the LGBTQ community soon after he took the leadership position at Nyack Hospital about seven years ago. In 2018, the hospital and Pride Center developed educational programming on LGBTQ issues for about 2,000 staff members. It was important for all staff to understand, Geller said, “what does a safe, affirming environment look like?”
Building trust, providing care
Zingman said the partnership with the Pride Center engenders trust among people seeking health services.
With the local hospital part of the Montefiore Health Care System, Geller said the clinic gets support from the Bronx-based medical center’s long history in service the health care needs of the LGBTQ community. Besides the Oval Center, Montefiore’s network includes the Adolescent AIDS Center, which has provided AIDS care for 30 years and now includes LGBTQ and trans health care; and the Center for Positive Living/ID Clinic, which was founded in the 1980s and is one of the oldest and busiest HIV programs in New York.
Zingman said the need was underscored when he saw at the Wellness Center was a man in his mid-20s, who, during doctor-patient discussions, said he had sex with other men.
“Nobody had ever talk to him about new medications,” Zingman said. “No one had ever talked to him about preventing HIV.”
That patient had regular medical care, but, Zingman said, like many people, had not been asked about sexual health. This patient learned about preventive medications, like PrEP, or pre-exposure prophylaxis, that is considered highly effective in preventing HIV.
According to the U.S. Centers for Disease Control and Prevention, a number of health disparities exist among people who are part of the LGBT community.
LGBTQ youth are less likely to have health insurance and more likely to face homelessness.
Transgender individuals face victimization and abuse.
Elderly LGBT individuals also often lack support from culturally competent providers.
“Very few providers attend to the needs of trans patients,” Zingman said, which is highly individualized.
Trust in a doctor-patient relationship is key, Zingman said.
“If folks feel they can’t talk about some of their most persona aspects of who they are,” Zingman said, “that’s a barrier to whole care.” They are less likely to make regular visits for monitoring of blood pressure, screenings for colon cancer, mammography.
Whole care, Pride Center Executive Director Brooke Malloy said, means wraparound care. The center can help with housing and food insecurity and other supports that a wellness center visit may reveal.
COVID emphasizes need
Malloy said the Pride Center and Montefiore Nyack Hospital leaders had been thinking about the health center concept for a while. Then the pandemic hit, slowing down most things in the world.
Instead of seeing COVID as an impediment to standing up a health clinic, Malloy said, the pandemic underscored the need.
COVID also cut off NYC from many who went there to work and had access to a plethora of services to support the LGBTQ community. “COVID had changed certain fundamentals about everyday life,” Zingman said. “You need to get health care closer to home.”
The Wellness Center’s opening, Zingman said, was well-timed. “Anytime there’s a barrier to access it’s only compounded when a real emergency like COVID happens.”
Bernardo, who lives in Bergen County, NJ, said his patients have told him how glad they are to have health care close to home.
That’s really important for people who may not be accepted, supported or even safe – or may not even be accepting of who they are, Bernardo said.
“Sometimes we sublimate these feelings into something that’s maladaptive,” he said, adding to risks for substance abuse and other concerning behaviors.
The Wellness Center’s clinical staff represents the LGBTQ community, Bernardo said. That adds trust, he said, being “a member of the community myself.”
Zaydenband said the clinic’s attention to mental and physical health is key, especially for people who may still be on a journey to coming out. “Everything is confidential,” they added.
“All the information that we try to get, ultimately is so we can create a health care plan,” Bernardo said
Zayanband said that this kind of care, even for a person who has a strong support system for living authentically, the wellness center is key.
“It’s completed the puzzle,” he said.
Nancy Cutler writes about People & Policy. Click here for her latest stories. Follow her on Twitter at @nancyrockland.