Serving the Health Needs of Elder LGBTQ+ Adults in Puerto Rico
As team members of Community Catalyst’s Vaccine Equity and Access Program (VEAP), this fall we traveled to Puerto Rico to visit Waves Ahead, a community-based partner and the only LGBTQ+ direct service provider on the island.
Waves Ahead operates six service centers located across the island and during our visit, we toured the San Juan office. While there, we had the opportunity to meet with Executive Director, Wilfred Labiosa, and several members of the wider team. Waves Ahead was established to meet the needs of older, LGBTQ+ Puerto Ricans, a community who sits at the intersection of multiple identities and, as such, faces compounding barriers to access the care and supports they want and need to live healthy lives. Today, it offers a variety of services and supports with a focus on vaccine equity and health justice.
As an island and U.S. territory, often on the frontlines of climate disasters with both an aging and declining population, Puerto Rico as a whole faces unique challenges and burdens on its health system.
The intersectional nature of these realities was on clear display when, in 2017, Hurricane Maria made landfall as the worst hurricane to hit the island in nearly a century. The hurricane devastated critical infrastructure and claimed the lives of nearly 3,000 people; in many ways, Puerto Rico is still recovering and rebuilding its care systems to this day.
2017 is also the year that Waves Ahead was established with the mission of advocating for two historically marginalized and underserved communities: LGBTQ+ and older adult communities in Puerto Rico.
According to SAGE USA, LGBTQ+ older adults in the United States are twice as likely to live alone and four times as likely to not have children, making it more difficult to age successfully in their homes and communities. These communities also report facing issues due to a lack of health insurance, language barriers, loss of housing due to earthquakes or hurricanes, and difficulties accessing medical services due to the cost of medical care. Compounding issues like these often lead older LGBTQ+ people to experience loneliness, isolation, depression, and anxiety.
“When I moved back home to take care of my parents, I saw that there was a need for elder care. Elder care for my mom was terrible, and I advocated a lot for her. I saw a need and I told myself that, if this is my mom—a heterosexual woman married to the same man for over 50 years—then can you imagine LGBT elder care? I saw the need.”
Talking with Waves Ahead staff during our visit, we learned how the organization’s focus grew from addressing transphobia and homophobia in Puerto Rican politics to supporting Puerto Ricans who were dealing with the fear and mental health toll that comes with being a member of a marginalized community. As the organization grew, Waves Ahead incorporated supportive, free, and accessible mental health and psychosocial health services to all, with an emphasis on LGBTQ+ people over 50.
This is one early example of the holistic approach Waves Ahead takes to community health, offering “wrap-around” services meant to improve a person’s overall quality of life. It also has practical benefits too – for example, given Puerto Rico’s vulnerability to earthquakes and hurricanes, Waves Ahead began organizing emergency preparedness trainings and offering disaster response services. This both supports community members in situations of acute need, and allows Waves Ahead to stay connected and maintain community trust, which helps strengthen their other areas of work, like vaccine equity work.
We also learned about the organization’s deep resilience and the unique challenges that health justice organizations in Puerto Rico often face. As an island and a territory, Puerto Rico experiences heightened supply chain issues which affect vaccine delivery, availability of supplies needed for conducting outreach, and has political implications on their work. These challenges required Waves Ahead to build a self-sufficient model that was essential to providing health services to their community.
Our visit was a truly valuable experience to observe and learn from our partner’s critical work supporting elderly LGBTQ+ Puerto Ricans. The following excerpt is from our conversation with the Waves Ahead team is a beautiful demonstration of our shared efforts to put community at the center of community-first public health. Our interview has been edited for length and clarity.
There is a multi-layered vulnerability experienced by older adults in the LGBTQ+ community. Can you tell us about the unique strategies you have used to reach, engage, and support this community?
Waves Ahead was established in 2017 to stand against and address the homophobic and transphobic nature of the political climate in Puerto Rico. Through community assessments and extensive research, Waves Ahead found that the homophobic banters, policies, and practices exemplified by political leaders and institutions negatively impacts the physical and mental health of the LGBTQ+ community, especially older adults in this community. To address this adversity, Waves Ahead started the Empowerment Policy Project, where we teach LGBTQ+ community members and allies about the legislative process and politics behind advocacy.
We see our organization as a source of refuge and community so we also offer vaccines, health education services and referrals. We also offer sustainability and gardening classes, dance meditation/creative arts programs, therapy services, support groups, nutrition consultations, and more. Our overarching goal is to equip our community with the knowledge and resources needed to sustain a healthy and equitable life.
Can you tell us about the health services and vaccine equity work that Waves Ahead has implemented to support San Juan communities enduring hardships after Hurricane Maria and more recent tragedies?
Waves Ahead prides itself on being a first responder and a reliable resource in the face of disaster. To support communities impacted by natural disasters and other tragedies, Waves Ahead developed an internal Disaster Preparedness Plan, available through our procedures manual, that affected communities can reference and adhere to in case of emergencies. In the community’s time of need, we offered hot meals, emergency supply kits, resources to support the communities’ basic needs. We also try to inform the community with health information such as with guidance about COVID-19 to support the safety and well-being of those heavily impacted. Our organization has also built relationships with local restaurants and other partners who donate so many essential resources when needed.
How have you tried to help community members overcome barriers to vaccine uptake?
Transportation is a consistent barrier to vaccine uptake for the communities we serve. We’re intentional about expanding our reach to support populations in rural and underserved communities. In many of these areas, community members do not have access to cars or public transportation, which makes it difficult for them to attend events hosted in the inner city, or show up to appointments with vaccination providers. To help alleviate this barrier, Waves Ahead has applied for funding to purchase two vans, which will be utilized as mobile units for vaccinations and other health services. The approval and shipping processes for the vans has been extensive due to various policies and restrictions, but we are diligently working toward a solution to the transportation barrier experienced by many. It is currently prohibited to use federal funds for a transportation service. For Community Catalyst, programs like this highlight the importance of leveraging grant funds with our partners to meet community needs and address funding gaps in community-first public health work. In the meantime, Waves Ahead has partnered with a local organization who serves people with mental and physical disabilities. This organization has a van that has been used to transport and distribute resources in hard-to-reach areas.
Why is it important to host spaces for support groups at your facilities? Have you engaged any of the support groups members in your vaccination outreach or events?
Waves Ahead offers a number of ancillary services at our community centers to support the needs of our community. Community members regularly have access to mindfulness meditation, creative arts, physical therapy through yoga, individual and couples therapy, and bisexual and trans support groups, among others. All attendees have access to the vaccination education and resources offered by the organization. Waves Ahead takes a holistic approach to the addressing the health inequities in our communities. We have a comprehensive process for addressing the basic or emergent needs of the community (such as food insecurity, housing displacement, and mental health) while implementing vaccination health education and services.