When Anthony Fortenberry, MSN, RN, NEA-BC, was in high school in San Antonio, Texas, he had the opportunity to volunteer at the San Antonio AIDS Foundation, an experience that set the course for his career. Inspired by the nurses working at the foundation’s treatment program, he knew he wanted to work in HIV care and decided to pursue nursing.

After years in emergency medicine, Fortenberry’s path would lead him to become the first-ever Chief Nursing Officer at the Callen-Lorde Community Health Center, a comprehensive care center based in New York City serving the LGBTQIA+ community. Today, he’s the first Deputy Executive Director at Callen-Lorde with a nursing background.

Nurses like Fortenberry are on the forefront of community-based care models improving access to affirmative care. Nurses, he says, are uniquely suited to connect LGBTQIA+ patients to the resources they need, in a compassionate and affirming way.

“Nursing is the mortar between the bricks,” he says. “In any health care organization, we touch every area. We support the organization behind the scenes in many ways, but more importantly, we are the frontline, and the most consistent point of contact that patients have in the health care setting.”

LGBTQIA+ individuals face particular challenges in accessing healthcare. According to the Center for American Progress, more than 1 in 5 LGBTQIA+ adults reported postponing or avoiding medical care in the past year, including 1 in 3 transgender or nonbinary individuals, due to experiencing discrimination from the medical community.

As a result, the population experiences disparities in cancer diagnoses and survivorship rates, mental health conditions (including substance use and suicide), heart disease, and sexually transmitted infections, among others. They report higher rates of ongoing health conditions, disabilities, and chronic disease.

The ever-increasing issue of health disparities facing this population is even more pertinent as a growing number of policies seek to limit access to LGBTQIA+ health care services. In 2023, more than 400 anti-LGBTQIA+ bills went before state legislatures, with many aimed at limiting and eliminating gender-affirming health care for the population.

“It just further creates a barrier to access that I think nursing can play a really important role in mitigating,” Fortenberry says. “We’re out in the communities, and many people are not aware that these services are available, regardless of ability to pay, and it’s so important that we outreach and connect people to care.”

Legislation that impacts access to care doesn’t only affect patients seeking that care, Fortenberry says, but also the nurses and clinicians who provide it.

When bills seek to criminalize gender-affirming care by penalizing the clinicians who provide it, he says, they are “specifically criminalizing the work that nurses do and the moral distress that is connected to that is something that we are really focused on.” Such distress, and the accompanying burnout, is particularly acute for nurses who themselves are members of the LGBTQIA+ community, Fortenberry says.

Callen-Lorde is part of the National Association of Community Health Centers, a nationwide organization of Federally Qualified Health Centers (FQHCs). As the Chair of the association’s LGBTQ+ Health Task Force, Fortenberry works alongside his colleagues to provide technical assistance, legal support, and other supportive resources for the nurses who are at the forefront of changes affecting their ability to provide gender-affirming care.

Education is a key part of equipping the next generation of nurses to best serve the LGBTQIA+ community. That’s where the Keith Haring Nurse Practitioner Postgraduate Fellowship in LGBTQ+ Health comes in. Launched in partnership with the Keith Haring Foundation in 2019, the fellowship addresses a lack of LGBTQIA+ training for clinical providers at the national, state and local level to improve access to care that is comprehensive, anti-racist, patient-centered, accessible, and safe.

The full-time, year-long fellowship and mentorship program ensures that fellows have the experience in caring for Callen-Lorde’s patient population. Some fellows choose to join the staff at Callen-Lorde, but critically, many take what they’ve learned back to their communities, applying the clinical expertise and sensitivity training they’ve learned across the country.

For James Lauren, MS, AGPCNP-BC, a nurse practitioner at Westside Family Medicine in New York, the fellowship experience was life-changing.

“As a queer trans person, I wanted to become the provider I wished that I had,” he said.

“In addition to teaching the ins and outs of how to medically care for LGBTQ+ people in all their diversity, something that I feel made the fellowship special was that they spent time discussing the real-world implications of doing this type of work,” he said. “They also spent time discussing how to take care of myself so that I don’t burn out, and can continue to do this important, fulfilling, sometimes difficult work, for a long time.”

Currently, the program is available to three fellows per year, but it isn’t the only education opportunity Callen-Lorde offers. The health center also partners with nursing schools across New York City, inviting students to shadow nurses in the clinic so they can learn how to provide life-saving care to the LGBTQIA+ community.

While there is much work to be done to ensure LGBTQIA+ patients in every community can access the care they need, Fortenberry and the team at Callen-Lorde illustrate how nurses are leading efforts to expand access to affirming and compassionate healthcare services.

Explore more stories of LGBTQIA+ nurse innovators. Meet Dallas Ducar, MSN, APRN, the CEO of Transhealth Northampton, a comprehensive trans healthcare center in Western Massachusetts, and Kevin Moore, BSN, RN, a fierce patient advocate at NYU Langone.