Faculty Q&A with Tam Phan

March 21-25 is LGBTQ+ Health Awareness Week (“Live Out Loud”), a national movement that raises awareness of the unique and important health needs of the LGBTQ+ community. Tam Phan, PharmD ’18, assistant professor of clinical pharmacy at the USC School of Pharmacy, talks about his work as a clinical pharmacist at the Los Angeles LGBT Center, how the healthcare system can improve in providing inclusive and accessible health care for LGBTQ+ patients, and how he lives out loud in the LGBTQ+ community and at USC. 

Can you explain the work you do in LGBTQ+ care and HIV/AIDS care at the Los Angeles LGBT Center?

I am a clinical pharmacist and HIV pharmacist certified through the American Academy of HIV Medicine. At the Los Angeles LGBT Center, I help oversee the clinical pharmacy services program to help patients who are referred for polypharmacy or have complex medication lists. I work in an interdisciplinary care team with physicians, nurse practitioners, and physician associates to optimize medication-related outcomes. I’m currently focusing on two projects that I lead, which is our controlled substances stewardship monitoring program and our geriatrics program.

Why is it important to focus on providing health care to LGBTQ+ patients?

LGBTQ+ health is important because of the health disparities within the community. There have been many studies and statistics to cite that LGBTQ+ individuals have increased negative health outcomes [compared to] their heterosexual/cisgender counterparts. A lot of times, LGBTQ+ patients come to my clinic reporting that their prior health care experiences have been negative because they are often misgendered, deadnamed or have experienced microaggressions with their health care providers when it comes to their health records.

One of the things that I share with new trainees is Transgender Broken Arm Syndrome: when a transgender patient is seeking care at a clinic for a broken arm but then the whole conversation ends up being about their transgender status or their surgery, completely disregarding their health needs. The patient then feels inclined to educate the physician about their identity and the care they would like to seek, which then heightens medical mistrust. Health care providers should be educated on these disparities for LGBTQ+ individuals actively seeking mental health services, immunizations, and STI and HIV testing. Health care providers should continue to practice and refine their skills to provide an affirming experience. The healthcare system for LGBTQ+ individuals could overall be significantly improved in clinical hospitals and local pharmacies. 

How does stigma affect LGBTQ+ health?

There has always been misinformation and pathologization about LGBTQ+ health. In the 1950s, the American Psychiatric Association (APA) classified homosexuality as a mental disorder and was then removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. This alone was very harmful to the LGBTQ+ community and led to many LGBTQ+ individuals being pressured to undergo conversion therapy.  

In the late 1970s and early 1980s, the HIV virus began to spread throughout the U.S. which became a harmful stigma for gay men who were the primary group affected by the virus. HIV has created harmful stereotypes for those living with HIV and has created barriers for them as they seek clinical care and mental health services.

We can combat stigma and discrimination and encourage more LGBTQ+ individuals to seek care if we make it more accessible and affirming. Healthcare facilities should update their systems by removing themselves from the binary model of gender. They can also be vocal about the healthcare facility being an inclusive space by having gender-neutral bathrooms, putting up signs that say the space is LGBTQ+ friendly, or by offering educational resources to health care providers and staff members (custodial staff, security guards, etc.) on how to adopt inclusive terminology.

What can pharmacists and other health care providers do to ensure they are promoting a safe and welcoming environment for LGBTQ+ individuals?

Our role as health care providers is to take that cultural humility approach, where we respect our patients for who they are. Health care providers should engage in a collaborative decision-making process with LGBTQ+ patients to achieve their health goals. We should not rely on our patients to educate us about their health care needs or LGBTQ+ health disparities – we should be educating ourselves outside of the clinic.

Medical and pharmacy schools should also reconstruct their curriculums in terms of offering classes on how to provide LGBTQ+ inclusive health care. With that being said, the change that is needed is going to involve day-to-day activities, all the way up to legislative and policy changes to create a more inclusive, welcoming and equitable environment for LGBTQ+ individuals.

In 2019, California became the first state in the nation to pass a bill (Senate Bill 159) that allows community pharmacists to prescribe PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), an HIV prevention approach for people who are HIV-negative after a single high-risk exposure. Can you expand on why this bill is important and how bills such as this one could significantly enhance accessibility for people seeking care?

Senate Bill 159 is one of the bills that I have been very passionate about. The bill allows for pharmacists to have a significant impact within the LGBTQ+ community in terms of medication management on top of offering preventive services. As of 2019, about 13% of 1.2 million people in the U.S. who have HIV don’t know it and need testing, which again ties to the stigma associated with HIV screening because patients are often judged or reprimanded by their health care provider for going in to get a screening.

This bill allows community pharmacists to get the proper training and independently prescribe pre-exposure and post-exposure prophylaxis to the patient. Pre-exposure prophylaxis is highly effective and can prevent HIV transmission by about 99% through sex. Unfortunately, there are survey results that indicate most providers were lacking knowledge with prophylaxis and did not feel comfortable prescribing the medication because of their lack of medical expertise with initiating it. The goal is to end the HIV epidemic in the U.S. by 2030, so granting pharmacists the ability to independently prescribe these medications can help increase utilization by making them more accessible.

The theme of the 20th National LGBTQ Health Awareness week is “Live Out Loud.” How do you live out loud in your personal life and at USC?

I’ve always been an openly gay man. From my entire academic training to now, I have always strived to be the health care professional I needed when I was young and trying to navigate the healthcare system as a patient. Going into the healthcare profession, sexual orientation and gender identity is not something that is often talked about. Living out loud for me means that I get to express myself fully by being confident in who I am and creating an environment for myself and those around me to be able to genuinely express who they are. I continue to educate myself on the health care needs of the LGBTQ+ community and continue to use inclusive terminology in my practice.

I teach several classes a year at USC to undergraduates and PharmD students. I mainly teach about social determinants of health, health disparities, and overall LGBTQ+ health. I am grateful to say that almost every student I have taught has been respectful and open to having challenging conversations about sexual orientation and gender identity. As an educator, I highlight what is being misunderstood and discuss controversial topics about LGBTQ+ health—by creating this space, conversations become more positively received. Creating inclusive affinity groups like RX Pride at USC will also continue to provide and promote an inclusive and welcoming environment for the LGBTQ+ community and generate more conversations that will bring awareness to sexual and gender diversity.

For resources on LGBTQ+, please visit the following:

Human Rights Campaign: For educational resources and to learn more about advocacy for the LGBTQ+ community.

Healthcare Equality Index: National LGBTQ+ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors and employees.

The Fenway Institute: Educational resources that are focused on healthcare. Informative webinars can be used as continuing education and are redeemable for Continuing Medical Education (CME) credits. 

LGBTQIA+ Patient Care Resources: For pharmacy professionals, created by the California Pharmacists Association (CPhA).