A new survey conducted by the National Coalition for LGBTQ Health highlights significant barriers to care, a lack of provider training and a rise in stigma and criminalization. The Coalition released a digital report on these findings March 18 for its 22nd National LGBTQ Health Awareness Week, themed “Vital Vibrant Voices.”
The survey was conducted among more than 1,000 clinical and service providers throughout the United States. The Coalition stated, “The survey consisted of a mix of 197 open- and closed-ended survey questions. Internal and external advisory groups reviewed the survey to ensure the questions encompassed salient issues facing LGBTQ+ people as described in the literature.”
These providers were asked to describe the state of LGBTQ+ health in one word as they completed the survey. “Lacking,” “poor” and “inadequate” were the top three words used to describe LGBTQ+ health care. The researchers explained this indicates “a widening gap between the need for care and the available resources to provide care.”
The Coalition reports that “despite the critical need for greater allocation of resources to support LGBTQ+ health, healthcare providers continually report feeling unprepared to meet the needs of their LGBTQ+ clients and patients.”
Demographics
Participants were all members of the healthcare workforce with direct experience providing or supporting care to the LGBTQ+ community. A total of 1,023 providers participated in the survey, responding to questions on training needs, HIV/STI prevention, workforce burnout, gender-affirming care, LGBTQ+ health policy and more.
Participants hailed from a wide range of U.S. states and geographies, with representation from 48 states and two territories. Survey participants were predominantly white, cisgender women between the ages of 35 and 54. However, there was also strong representation of Black/African American respondents and older people aged 55-64. Eighteen percent identified as Latino/a/x.
California (9.5%), New York (7.0%) and Pennsylvania (6.4%) had the highest number of respondents, with D.C. (5.9%), Florida (5.7%), New Jersey (4.8%), Indiana (4.4%), Texas (4.2%), Michigan (4.0%) and Virginia (3.9%) rounding out the top 10. All other states were 2% and under. This signifies where the most data was collected.
Health Threats
The report states that LGBTQ+ individuals are disproportionately impacted by a wide range of “health threats” compared with their heterosexual or cisgender peers. The consequences of these health variants are compounded by anti-LGBTQ+ discrimination and other systemic barriers to accessing healthcare services prevalent across location and setting in the U.S.
In addition, LGBTQ+ people are more likely to report poor physical and mental health than the general population. These health problems include increased incidence of HIV and other sexually transmitted infections (STIs), long-term conditions such as arthritis and chronic fatigue and elevated risk of depression, anxiety and other mental illness.
Also, trans and gender nonconforming (GNC) people and LGBTQ+ youth are particularly at risk. Trans and GNC individuals are far more likely than their cisgender counterparts to self-report poor health, disability and activity-limited days. A recent study from the Trevor Project demonstrated that over 40% of LGBTQ+ youth have seriously considered suicide in the past year.
The Coalition states, “Research shows that many sexual health providers still receive no training on and feel comfortable providing care to their transgender patients. Crucially, even where training does exist, providers report its inadequacy; a 2018 study examining variations in LGBTQ health across medical disciplines found that less than 50% of participating students felt their formal training prepared them for treating LGBTQ patients. This is a remarkable gap given the extent of health disparities facing LGBTQ people, and transgender people in particular.”
Key Findings
The survey highlights specific areas that need attention to address barriers to care. These include elevating LGBTQ-centered care through the recruiting of sensitive staff, providing comprehensive training and collaborating with experienced providers. Prioritizing LGBTQ+ health advocacy: focus on vital issues such as LGBTQ+ equality, gender-affirming care protections and affordable housing for LGBTQ+ individuals. Increase awareness of anti-LGBTQ+ bills by educating providers on specific, state-by-state legal challenges affecting LGBTQ individuals, especially trans individuals.
Providing comprehensive continuing education for LGBTQ+ providers was viewed as essential to battle stigma, create inclusive spaces and address health disparities. Also, removing barriers to LGBTQ+ healthcare by addressing pervasive stigma as well as distrust in the healthcare system. Focus on mental health challenges, cost constraints and insurance issues for LGBTQ+ patients.
In addition to these findings, 80% of respondents said using culturally appropriate terminology when communicating with LGBTQ+ patients fosters a more welcoming environment.
Scott Bertani, lead researcher for the Coalition said, “Our survey exposes a stark reality — numerous healthcare providers, typically outside LGBTQ-specific health centers, still lack the necessary training to deliver basic LGBTQ care, let alone affirming care that is specific to transgender patients.”
Bertani said, “This shortfall in education leads to provider uncertainty, which in turn leads to less meaningful patient engagement; and that has a true impact on both the physical and mental health outcomes for all our communities.”
Addressing LGBTQ+ Health
The survey findings illustrate the need for a multi-pronged approach to address LGBTQ+ health. Increased funding for training healthcare providers in LGBTQ-specific care is essential, as is expansion of gender-affirming healthcare services. Stronger protections against discrimination in healthcare settings must be established. Rising stigma and criminalization must be combatted through education and advocacy.
When asked to rank the advocacy and policy issues they are most concerned about, respondents prioritized LGBTQ+ equality issues and nondiscrimination protections (54%), followed by gender-affirming care protections (48.5%) and affordable housing (48.2%).
LGBTQ+ Health Criminalization
The Coalition notes that “more than half of U.S. states have introduced, advanced or passed healthcare bills targeting LGBTQ+ rights.”
They explain that despite the prevalence of healthcare criminalization targeting LGBTQ+ people, fewer than half of respondents reported being aware of anti-LGBTQ+ healthcare bills in their state or region.
Among the majority of respondents who were aware, the providers said such policies impact the health of their clients or patients. Many attest that the recent escalation of anti-trans healthcare legislation is having a negative impact on the mental health of transgender and/or GNC clients or patients. Some said that local legislation prevented them from providing healthcare to LGBTQ+ clients or patients.
What Is the National Coalition for LGBTQ Health?
The National Coalition for LGBTQ Health urges policymakers, healthcare providers and LGBTQ+ advocacy groups to work collaboratively to create a more equitable and inclusive healthcare system for all.
The National Coalition for LGBTQ Health was formed with the aim of eliminating health disparities across issues of sexual orientation, gender identity and presentation, gender, race and ethnicity, education or income, disability, nationality, geographic location and age, and represents the rich diversity of the LGBTQ+ communities nationwide and reaches across gender/gender identity, race/ethnicity, disability, education, income, age, and geography. Coalition membership includes the leading LGBTQ+ health centers and local and state health departments, as well as leaders in LGBTQ+ policy across the U.S.
The Coalition’s individual membership also includes leading researchers and health care providers who work in HIV/AIDS, biomedical prevention, health disparities in minority communities, mental health in the LGBTQ+ communities and other vital areas of medicine and public health. The Coalition draws its vision and its focus of mission from the breadth of work, experiences and perspectives lent by its members.
The National Coalition for LGBTQ Health is committed to improving the health and well-being of lesbian, gay, bisexual and transgender individuals through federal and state advocacy, medical and consumer education, and health services research. The Coalition addresses the entire LGBTQ+ community, including individuals of every sexual orientation, gender, gender identity, race, ethnicity, and age regardless of disability, income, education, and geography.
Read the entire report at https://healthlgbtq.org/stateof/lgbtqhealth/.