LGBTQ+ HealthCare

The acronym LGBTQ+ (or LGBTQIA+) is evolving. It includes people with all gender identities and sexualities, such as lesbian, gay, bisexual, transgender, questioning, queer, intersex, asexual, pansexual, and allies.

In the US, 3.5% of adults consider themselves lesbian, gay, or bisexual, and 0.3% more adults identify as transgender. In the past decade, LGBTQ+ people made rapid progress in winning and securing equal rights. While there is still opposition in some policy areas, Americans are finally recognizing LGBTQ+ people as a social minority that should have equal access to civil rights, including health care.

LGBTQ+ HEALTH ISSUES AND DISPARITIES

Members of this group usually experience less optimal health outcomes than their heterosexual counterparts. Almost 17% of people in this group have experienced discrimination at the doctor’s office or another healthcare setting. In comparison, 20% say they have avoided seeking medical care out of fear of discrimination.

With low rates of health insurance coverage and high rates of stress due to systematic harassment and discrimination, LGBTQ+ people are also at a higher risk for numerous medical and psychological conditions. For example, people who experience ongoing discrimination have an elevated risk of heart disease. That risk rises further without routine medical care. They are also more probably to suffer from preventable medical conditions due to lifestyle choices that include risky behaviors, such as having sex without using condoms or having multiple sex partners.

We can only evaluate the full extent of LGBTQ+ health variation due to a consistency of data compilation on sexual orientation and gender identity.

Members of the community suffering from health disparities are often not asked on surveys about their sexual orientation and gender identity.

The nature and extent of the distinctions, therefore, cannot be systematically evaluated and addressed. Where such information is available, we find concerning trends in the health of this population compared to heterosexuals.

Multiple health disparities affect these populations, including:

• Heightened rates of HIV and other sexually transmitted infections
• Higher rates of substance abuse, including smoking
• Increased unhealthy weight control or body self-perception
• Higher rates of depression and anxiety
• Increased victimization through violence
• Lower rates of mammography and Pap smear screening

For example, studies of males who have sex with males (MSM) are numerous. This group includes more than two-thirds of all people diagnosed with HIV each year in the US, despite making up only 2% of the population.

Black, young MSM are especially at risk. The number of new HIV infections in them rose by 20% from 2008 to 2010. Decreased access to antiretroviral therapy to treat HIV in non-White communities may be the explanation.

MSM accounts for 75% of syphilis infections and more than one-third of gonorrhea infections. Hepatitis C infections transmitted by HIV-infected MSM through sexual contact are notable. Also, rates of Human papillomavirus-associated anal cancers in MSM are seventeen times those of heterosexual men.

IMPACT OF SOCIAL BIASES ON PHYSICAL HEALTH

LGBTQ+ people report poor treatment at work because of their gender identity or sexual preference. For example, transgender people report verbal or physical harassment, removal from client-facing positions, or dismissal without cause consistently.

Because most people have health insurance through their employers, these disruptions in employment also create insurance coverage gaps. Then, disparities in treatment accumulate to affect health.

LGBTQ+ adults are less likely than heterosexual adults to:

• Have good or excellent health
• Receive regular mammograms

LGBTQ+ adults are more likely to:

• Have cancer

LGBTQ+ youths are more likely to:

• Be threatened or injured with a weapon
• Get in fights that result in injuries requiring medical treatment
• Be overweight

With these disparities, health and quality of life suffer.

IMPACT OF SOCIAL BIASES ON MENTAL HEALTH AND RISKY BEHAVIOR

LGBTQ+ people face harassment and discrimination starting early in life, leading to adverse mental health outcomes and higher rates of risk-taking that increase the likelihood of physical harm.

Adverse, punitive, and traumatic reactions from parents in response to their children’s LGBTQ+ identity are closely correlated with LGBTQ+ youths having poor mental health and an increase in substance abuse. In the young and adult LBGTQIA+, poor mental health and risk-taking behavior display themselves in many ways.

LGBTQ+ youths are more likely to:

• Abuse tobacco
• Drive while drunk
• Ride with a drunk driver
• Attempt suicide

LGBTQ+ adults are more likely to:

• Abuse alcohol
• Abuse tobacco
• Experience psychological distress
• Need medication for mental health
• Think of suicide

ACCESS TO HEALTH CARE FOR LGBTQ+ PEOPLE

LGBTQ+ people face hurdles obtaining health care related to sexual and transgender lifestyles. Some of them are further isolated by added barriers such as racial/ethnic status, low income, immigrant status, or limited English comprehension. Reduced access to health care relative to heterosexuals is revealed in many ways.

LGBTQ+ people are less likely to:

• Have health insurance coverage than heterosexual males

LGBTQ+ people are more likely to:

• Delay or skip medical care
• Delay or skip taking prescription medication

Compounding these problems is the fact that few states ask patients their sexual orientation or gender identity. This limits researchers’ ability to understand the LGBTQ+ peoples’ needs and hinders public policies.

LGBTQ+ people lack health insurance for several reasons. Persistent workplace discrimination and harassment mean that LGBTQ+ people are more likely to lose or quit their jobs or not to get the job in the first place.

As many employers do not provide health insurance benefits for the same-sex domestic partners of their employees, those uninsured people are likely to have to resort to visiting emergency rooms for care.

Surprisingly, most insurance contracts do not cover the care that LGBTQ+ people need. Transgender people are often unable to access even basic preventative and primary care due to insurance exclusions.

Similarly, because discriminatory practices lead them to either not seek preventive treatment or receive low-quality treatment, they are more likely to have HIV/AIDS or certain cancers.

UNDERSTANDING LGBTQ+ PATIENTS

LGBTQ+ people often do not want to reveal their sexual orientation or gender integrity in the health care environment for fear of discrimination and provider bias. Therefore, they are less likely to seek timely treatment.

Doctors and others frequently do not know their LGBTQ+ patients’ specific needs. This ignorance results in undiagnosed conditions and doctors missing the opportunity to inform their patients about delicate behaviors or other physical or mental health concerns.

Few medical schools offer health care providers instruction on the health needs of LGBTQ+ people. For instance, researchers have found that over half of medical school instruction has no information about this minority population. Public health schools also rarely include such information beyond work related to HIV/AIDS.

For medical providers, homosexuality was listed as a disorder for which they had little or no training until the 1970s. Because some doctors, nurses, and therapists are unable to meet the needs of LGBTQ+ patients, they often do not encourage patients to disclose their sexual preferences or gender identity.

CLOSING THE GAP IN LGBTQ+ HEALTH

One partial solution involves gathering more data on patients’ sexual preferences and gender identity to help identify specific health needs of members of the minority population. So, simple questions on registration forms asking:

• Do you engage in sex with men, women, or both?
• What gender were you assigned at birth?
• What gender do you identify with now?

Can help a physician understand and treat their patients’ health needs. A second solution is educating health professionals on the needs of LGBTQ+ people so they better know that they have unique needs and that ignoring those needs can cause harm.

The National Coalition for LGBT Health organizes and promotes an annual National LGBT Health Awareness Week in March. The 2021 event reached over 1.7 million people and included a survey to identify trends in LGBTQ+ health and to collect data for future advocacy and research.