Back in the early ’80s, when a mysterious “gay cancer” was taking lives across America and the government did nothing to address it (the president wouldn’t even discuss it publicly), the message seemed clear: Gay lives don’t matter. But life and death and homosexuality were even more bizarrely contextualized when Vietnam veteran and activist Leonard Matlovich, a Purple Heart and Bronze Star recipient discharged for being gay, died in 1988 from AIDS complications and arranged for his tombstone to read: When I was in the military, they gave me a medal for killing two men and a discharge for loving one.

Times have changed, of course, but with members of the LGBT community celebrating marriage equality and favorable visibility in media, politics, education and other realms, there’s still a life-and-death-related issue sending many back into the closet—the doctor visit.

Equality organizations and health agencies press the importance of LGBT people coming out to their doctors, emphasizing health-care disparities even while reporting statistics of discrimination in the industry. According to Human Rights Campaign, more than half of lesbian, gay and bisexual Americans have said they’ve been seriously discriminated against when seeking health care, with 70 percent in the trans community reporting discrimination.

It’s a paradox Dina Proto, a registered nurse and president of the Gay and Lesbian Chamber of Commerce Nevada, is familiar with after 20 years in health care. She says risk factors for LGBT patients differ for various reasons from those of heterosexual counterparts, but doctors can’t address them when they don’t know about their patients’ lives. “We’re susceptible to substance abuse issues. Lesbians are one and a half times more likely to smoke. With gay men there are more risks for cancer—prostate, anal and testicular. Lesbians have higher risk factors for breast cancer. People go without health care for a long period of time. Many lesbians forego breast exams and annual pap smears.”

The Human Rights Campaign’s nationwide Healthcare Equality Index evaluates facilities based on four criteria: patient and employee non-discrimination, equal visitation and training in LGBT care. In 2014 it looked at 1,507 facilities, including 23 in Nevada. Seven in Las Vegas responded favorably to all four. This summer Nevada banned transgender discrimination by in-state health insurers, and it prohibits health-care discrimination based on sexual orientation.

But that, and the blanket guarantee of confidentiality between doctor and patient, does little sometimes to alleviate concerns that LGBT disclosures might result in hostile treatment, neglect or insurance companies revealing sensitive information to employers. Even at the Huntridge Family Clinic, a local practice with an emphasis on the LGBT community, staffer Katie Cleaves says patients are hesitant. “Our whole purpose here is to make people feel completely comfortable. Sometimes we get people in here who won’t even come out to us until later.”

Proto says health-care providers might not be knowledgeable about LGBT issues, that advancing change is a process dependent on patients, the community and the industry. She encourages patients who find a physician helpful and receptive to alert the Gay and Lesbian Chamber of Commerce.

“There are many physicians and health-care providers and ancillary staff who are open and receptive, and I’ve worked with some who are not,” Proto says. “The nurse in me says that as a health-care professional, I can’t help you if you don’t tell me. It’s important to be honest with your physician. Nothing is worth your life. Share who you are.”