Pride Month is a time for celebrating and promoting visibility for the LGBTQ+ community, but its origins are rooted in protesters’ demands to be seen, heard, and treated equally. Unfortunately, the community is still fighting for those rights today, as well as experiencing disparities in care. Let’s look at the particular challenges facing LGBTQ+ members, including those who also belong to other minority communities, and how telehealth and other resources can help overcome these barriers.
Greater Risk with Less Representation
The LGBTQ+ population is at higher risk for a number of health conditions, including overall poorer health, more chronic conditions, and higher risk for a number of cancers (LGBTQ+ Health Disparities). LGBTQ+ persons also tend to have less reliable access to care. The 2017 study “Addressing Healthcare Disparities among Sexual Minorities” reports that “lesbian women were more likely to report moderate psychological distress, poor or fair health, multiple chronic conditions, heavy driving and heavy smoking compared to heterosexual women.”
In the Human Rights Campaign Foundation’s 2022 Healthcare Equality Index, facilities from more than 160 different non-profit, for-profit and public health systems were surveyed to develop a picture of current health equality for the LGBTQ+ community. They found that only 34% of the institutions surveyed provide medical and comprehensive health benefits to domestic partners of benefits-eligible employees. Only 41% offer FMLA-equivalent benefits that allow employees to take family and medical leave to care for same-sex partners as well as the children of a same-sex partner, regardless of biological or adoptive status. If health systems are not supporting the health of their own LGBTQ+ employees, how can they be trusted to uphold equitable care for their LGBTQ+ patients?
Barriers to care make patients less likely to trust in and seek out medical care, leading to larger health disparities in minority communities as health concerns go unaddressed. According to Baptiste-Roberts, Kesha, et al ”…encounters with the health care environment are often negative due to perceived or internalized stigma. As such, several studies show that sexual minority women are more likely to delay health care and less likely to have a usual place of care.”
Further impacting the quality of care available, the community is often excluded, whether intentionally or not, from relevant medical research that could otherwise provide valuable insights. For example, research on postpartum depression often does not reflect the sexuality of women involved in the studies, despite the fact that 34.9% of lesbian women and 44.8% of bisexual women have given birth. There is speculation that sexual minority women may be at higher risk for postpartum depression, but this cannot be validated because studies do not take sexuality into account (“Addressing Healthcare Disparities among Sexual Minorities”).
The Double Minority
For patients who are both LGBTQ+ and migrants, the situation can be even more dire. Dr. Alesi’s 2021 study explored the impact of the refugee and migrant LGBTQ+ population in Europe and how their access to reliable healthcare was impacted by their minority status. In Alessi’s European study of 24 asylum seekers who were sexual and/or gender minorities, almost 65% of them met criteria for PTSD. Oppression and violence in the migrant’s country of origin can greatly impact the mental and overall health of patients. Compare that impact to similar communities in the United States: of the 51 million migrants in the United States (the largest number in the world), it’s estimated that more than 1.5 million are sexual and gender minorities.
Social and structural barriers continue to plague sexual and gender minorities after they’ve sought refuge, including financial difficulties, lack of family support, limited access to appropriate interpreter services, limited access to care in rural areas, and providers who lack the necessary cultural sensitivity.
The Digital Bridge
While it does not bridge every disparity, digital care can be a huge help in achieving health equity for LGBTQ+ patients. For example, those with chronic conditions who struggle to access reliable or affirming care can benefit from telehealth, which alleviates the burden of in-person appointments. “People living with HIV may be required to frequently attend doctor’s appointments to obtain antiretroviral therapy. Telehealth can make these appointments more accessible and sustainable” (Telehealth: LGBT Tech).
In the same way that telehealth can be used to reach rural communities, where many LGBTQ+ patients live, technology can also be used to connect patients with gender- and sex-confirming practices. Finding providers that make patients feel safe can be a massive barrier for the community, especially young LGBTQ+ individuals who may not have support at home. “Many LGBTQ+ individuals struggle to find a doctor they can trust, particularly when it comes to disclosing their sexual orientation or identity. As a result, some 18 percent of LGBTQ+ Americans simply avoid going to the doctor’s office altogether out of a fear of being discriminated against, putting them at greater risk” (“Making Telehealth Work for All Americans, Especially LGBTQ”).
Healthcare leaves much to be desired in its treatment of minorities, but technology and an eagerness to learn make a huge impact in our strides toward health equity. Want to know how you can improve your practice? Check out these tips for How to Provide Better Care for LGBTQ+ Patients.
Alessi. Identifying and Addressing Social and Health Inequalities among LGBTQ+ Migrants. YouTube, USC Center for LGBTQ+ Health Equity, 19 Apr. 2021, https://www.youtube.com/watch?v=KVapdk7rrkA. Accessed 9 June 2022.
Baptiste-Roberts, Kesha, et al. “Addressing Health Care Disparities among Sexual Minorities.” Obstetrics and Gynecology Clinics of North America, U.S. National Library of Medicine, Mar. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444328/.
“Center of Excellence – LGBTQ+ Behavioral Health Equity.” Lgbtqequity.org, https://lgbtqequity.org/.
“Healthcare Equality Index 2022.” Human Rights Campaign Foundation, https://reports.hrc.org/hei-2022.
“LGBTQ+ Health Disparities.” Cigna, https://www.cigna.com/individuals-families/health-wellness/lgbt-disparities.
“Making Telehealth Work for All Americans, Especially LGBTQ.” Lgbttech, 29 July 2021, https://www.lgbttech.org/post/making-telehealth-work-for-all-americans-especially-lgbtq.
“Resources: USC LGBT Health Equity Initiatives & Research.” USC Suzanne Dworak-Peck School of Social Work, https://dworakpeck.usc.edu/research/centers-affiliations/center-for-lgbtq-health-equity/learning-resources.“Telehealth: LGBT Tech.” Lgbttech, 12 July 2021, https://www.lgbttech.org/telehealth.