Helping serve health needs of LGBTQ community 'was always on my radar'

Dr. Jeremy Stoepker says that, for the most part, catering to the LGBTQ community is just providing good primary care in a welcoming and nonjudgmental environment. Stoepker practiced in New York City until about three months ago. Now in the Berkshires, he's trying to reach the same population, members of which can feel that their health care needs are underserved.

PITTSFIELD — Dr. Jeremy Stoepker was only in elementary school when his father, a gay rights activist, was diagnosed with AIDS.

Doctors initially told Stoepker's father that he had a year to live, but he ended up surviving 19 years with the disease.

"His doctors were, of course, these crazy heroes of my childhood," Stoepker recently said from his new office at Community Health Program's Lee Family Practice. "He was at my graduation, my medical school graduation and my wedding."

Inspired by the physicians who he believed extended his father's life, Stoepker went into primary care, practicing in New York City until about three months ago. There, about 50 percent of his patients were members of the LGBTQ community. Now in the Berkshires, he's trying to reach the same population, members of which can feel that their health care needs are underserved.

"It was always on my radar, but never something I necessarily chose to specialize in. It happened kind of naturally that gay people have always felt really comfortable with me because I'm really comfortable with gay people," Stoepker said of providing care to the LGBTQ community. "Then more and more people came to the practice, and I sort of learned as it went, the additional things that are available to that population."

High-quality primary care

In Berkshire County, members of the LGBTQ community say they want doctors who are not only competent with their varying sexual needs and risks, including prescribing HIV preventive medicine, but also comfortable talking about it.

For the most part, catering to the LGBTQ community is just providing good primary care in a welcoming and nonjudgmental environment, Stoepker said.

When it comes to sexual health, though, it's important to be extra vigilant with the methods of screening and prevention for sexually transmitted diseases, he said.

Anal pap smears, throat gonorrhea swabs, and rectal gonorrhea and chlamydia swabs should be administered in addition to the more common urine tests, he said.

"That's not exclusive to the gay population. There are lots of people who are having anal intercourse and no one ever talks about it, or asks about it," Stoepker said. "We miss a lot of cases when you just do the urine."

As for prevention, Stoepker said that he educates his patients on the availability of pre-exposure prophylaxis — it's known as PrEP — a daily medicine to prevent HIV from taking hold and spreading through the body.

Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99 percent when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74 percent when taken daily, according to the Centers for Disease Control and Prevention.

More than 75 percent of patients living with HIV are men, and men who have sex with men are at an elevated risk for the disease, according to the CDC.

"It's kind of amazing, and exciting and incredible," Stoepker said of the preventive drug. "Basically, it's one pill, once a day and it has almost no side effects."

Gilead, the company that produced the drug, Truvada, also has a program that assists patients with their copays, he said.

"I think having an identified place where people know that whatever they have can be brought up in an open and accepting and nonjudgmental environment is, for me, the most basic and important thing."

Advancing care

Members of the health care and LGBTQ communities have been discussing how to advance care in the Berkshires for nearly a decade.

Berkshire Health Systems began working on addressing the needs of the LGBTQ community about seven years ago, when it launched the Diversity and Inclusion Council.

In October 2017, Indivisible Pittsfield hosted a forum on the subject, with panelists from the LGBTQ and health care communities.

A lack of access to endocrinologists who can prescribe hormone therapy to transgender individuals was cited as one of the biggest needs in the county. To this day, several individuals travel hours to specialists in Northampton, Springfield and New York for treatments.

Jill Williams, a 65-year-old transgender woman from Pittsfield, travels to Oneonta, N.Y., about 2 1/2 hours away, to see a doctor for hormone therapy.

Williams said she's happy with her local primary care doctor, but he had told her he wasn't 100 percent comfortable monitoring her hormone levels. But he was willing to take care of her medication in coordination with an endocrinologist.

"I told him for now I will stick with the doctor in NY," Williams said, in an email. "The drawback of course is that she is so far away. It would be nice to get a provider similar to her right here in the Berkshires."

Stoepker said that he already has learned that access to endocrinology is an issue in the county.

Transgender individuals face a "set of additional issues" than do other LGBTQ individuals, he said.

"One being social," he said. "It's actually cool to be gay now, but actually incredibly difficult, in our society, to be trans. And so their access to everything is harder. Endocrinology is a huge part of that."

Drew Herzig, who hosted last year's forum through Indivisible Pittsfield, said the county, and rural counties across the country, needs to be vigilant about implementing "LGBTQ-inclusive, competent health care."

"It means the doctors, the nurses, the staff including receptionists, they all have to be informed on LGBTQ issues and they have to be comfortable enough with them so people don't feel a chill in the air when they're signing in," he said.

A big part of that is starting the conversation about sexual health, he said. Being a marginalized community, LGBTQ individuals, especially seniors, might be uncomfortable bringing up sex, he said.

"That needs to be part of the process because otherwise a lot of people will be ashamed to bring it up if the doctor doesn't initiate that conversation," Herzig said. "It should be part of everyone's checkup, that sort of thing, but for the LGBTQ population it's particularly important because, in some ways, we're more exposed to various things. It takes a proactive provider to break through some of these things, like personal shame."

Alex Reczkowski, a new patient of Stoepker, has felt dissatisfied with physicians in the past. Despite asking during two visits, a year apart, Reczkowski said that his previous doctor was unwilling to prescribe him PrEP.

"There was no investigation into why this was important to me. The doctor didn't ask any sexual health questions; none," said Reczkowski, 38. "Now I am a relatively young person. I'm not in a long-term committed relationship currently. It seems to be natural, especially since the previous year I had asked about PrEP, to bring that up."

After bringing up his concerns to a friend, he was referred to Stoepker, who prescribed him the medication, he said.

Other than a few days with an upset stomach — it's a common reaction to beginning a new drug — he has been happy with the prescription.

Moving forward

While there is still much to be done, including the recruitment of endocrinologists, Kenneth Mercure is pleased to see so many people and providers buying into the idea of increasing access for a community that had felt "left out."

Mercure, a Monterey resident and facilitator for Rainbow Seniors, said that one of the biggest issues members of the trans community addressed at the 2017 forum was that sign-in forms at their providers didn't allow them to choose their own pronouns or genders. Mercure, who prefers to be referred to by they/them pronouns, already has seen this put into place at some offices.

Stoepker said that patients are encouraged to tell their doctors what pronouns they'd like to use, and that as their intake system is updated, that will be an option at sign-in as well.

Berkshire Health Systems also has begun the process of making companywide changes to its intake forms, as a result of conversations with the LGBTQ community.

The changes will be complete early next year, according to BHS spokesman Michael Leary.

"It's been amazing to watch over the past couple years, to see this community coming together," Mercure said of efforts to make the Berkshires more LGBTQ-friendly. "If it's not there, they either facilitate that happening or they rise up and build it together."

Haven Orecchio-Egresitz can be reached at, @HavenEagle on Twitter and 413-770-6977.

This story has been modified to correctly attribute comments to Kenneth Mercure.