Pride Month is a time to celebrate diversity, promote dignity and equal rights, and increase visibility for the LGBTQ community. That being said, it's important to openly discuss that people who are lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) have importantly unique health needs that must be recognized and addressed by their healthcare providers. Culturally competent care is the key to overcoming LGBTQ health disparities and improving health outcomes for this population. Continue reading to learn more about health risks that are common to the LGBTQ community and how training programs are increasing awareness for providers. 

LGBTQ health disparities

LGBTQ individuals come from all races and ethnicities, religions, and social classes, and make up approximately 7% of all adult Americans (1). Research suggests that they face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights (2-5). This often begins during adolescence as seen by statistics from the 2016 Youth Risk Behavior Survey. As an example, approximately 34% of LGBT teens reported being bullied in school, which increases their risk for depression, substance abuse, and suicidal behaviors. In addition, 23% stated that they were victims of physical or sexual violence (6). It is shocking to realize that LGBT youth represent up to 40% of all young people experiencing homelessness (7). 

These disparities continue into adulthood as LGBTQ individuals struggle to receive satisfactory treatment from healthcare providers. In the not-so distant past, people who identified as LGBTQ were routinely denied health insurance. Prior to the Affordable Care Act (ACA), which became law in 2010, insurance companies could deny coverage, exclude certain services, or charge higher rates based on sexual orientation or gender identity. They also discriminated against individuals with health conditions that disproportionally affect LGBTQ individuals such as HIV, mental illness, and substance abuse disorders (8,9). Despite the protections offered by the ACA, significant healthcare barriers remain, including insufficient social services and a lack of culturally competent providers. As a result, members of the LGBTQ community are less likely to visit doctors or receive routine preventative healthcare screenings. Specifically, LGBTQ women are less likely to have annual mammograms, leading to higher rates of breast cancer in this population (2,3,5,10-12). 

Improving LGBTQ health care

 In response to the shortage of providers who are knowledgeable and culturally competent in LGBTQ health needs, the healthcare industry is making progressive steps to improve health outcomes for this community (7-9,13). Training programs are now including educational interventions to increase understanding and communication between providers and LGBTQ patients. For example, nursing students demonstrated significant increases in knowledge about sexual orientation and gender identity after participating in scripted interviews with standardized patients (14). Second-year medical students made similar gains after a series of case studies and patient panels about primary care issues for LGBTQ patients (15). Finally, an interactive theater experience was shown to help practitioners better understand their sexual and gender minority patients (16). 

Final thoughts

Although social acceptance and insurance coverage have improved over recent years, LGTBQ individuals continue to face significant health challenges. Providers can help improve healthcare for at-risk populations by recognizing and accepting their patients’ sexual orientation, gender identities, and unique health risks. By taking these steps to provide culturally competent care, providers can improve mental and physical well-being for their LGTBQ patients. 

References

1. Jones, J. (2022). LGBT identification in U.S. ticks up to 7.1%. Retrieved from https://news.gallup.com/poll/389792/lgbt-identification-ticks-up.aspx 
2. Hafeez, H., Zeshan, M., Tahir, M., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay, bisexual, and transgender youth: A literature review. Cureus, 9(4), e1184.
3. Centers for Disease Control and Prevention. (2019). Health disparities among LGBTQ youth. Retrieved from https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm  
4. Centers for Disease Control and Prevention. (2019). Health considerations for LGBTQ youth. Retrieved from https://www.cdc.gov/healthyyouth/disparities/health-considerations-lgbtq-youth.htm 
5. U.S. Department of Health and Human Services. (2022). Lesbian, gay, bisexual, and transgender health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health#top  
6. Kann, L., Olsen, E., McManus, T., Harris, W., … Zaza, S. (2016). Sexual identity, sex of sexual contacts, and health-related behaviors among students in grades 9-12. MMWR Surveillance Summaries, 65(9),1-202.
7. Morris, M., Cooper, R., Ramesh, A., Tabatabai, M., … Matthews-Juarez, P. (2019). Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: A systematic review. BMC Medical Education, 19(325). 
8. WebMD. (2021). Why healthcare isn’t equal for people in the LGBTQ+ community. Retrieved from https://www.webmd.com/sex-relationships/features/lgbtq-health 
9. Harvard Health System. (2018). The problems with LGBTQ health care. Retrieved from https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-lgbtq-patients-harvard-forum-says/ 
10. Agenor, M., Perez, A., Tabaac, A., Bond, K., … Austin, S. (2020). Sexual orientation identity disparities among White, Black, and Latina U.S. women. LGBT Health, 7(6), 312–320. 
11. Schabath, M., Blackburn, C., Sutter, M., Kanetsky, P., … Quinn, G. (2019). National survey of oncologists at National Cancer-Institute Designated Comprehensive Cancer Centers: Attitudes, Knowledge, and Practice Behaviors about LGBTQ patients with cancer. Journal of Clinical Oncology, 37(7), 547-558. 
12. Ceres, M., Quinn, G., Loscalzo, M., & Rice, D. (2018). Cancer screening considerations and cancer screening uptake for lesbian, gay, bisexual, and transgender persons. Seminars in Oncology Nursing, doi: 10.1016/j.soncn.2017.12.001
13. Rowe, D., Ng, Y., O’Keefe, L., & Crawford, D. (2017). Providers’ attitudes and knowledge of lesbian, gay, bisexuall, and transgender health. Federal Practitioner, 34(11), 28–34.
14. Carabez, R., Pellegrini, M., Mankovitz, A., Eliason, M., & Dariotis, W. (2015). Knowledge of lesbian, gay, bisexual and transgender issues: Effectiveness of a multi-purpose assignemtn in a public health nursing class. Journal of Nursing Education, 54(1), 50-53. 
15. Kelley, L., Chou, C., Dibble, S., & Robertson, P. (2008). A critical intervention in lesbian, gay, bisexual and transgender health: Knowledge and attitude outcomes among second year medical students. Teaching and Learning in Medicine, 20(3), 248-253. 
16. Tarasoff, L., Epstein, R., Green, D., Anderson, S., & Ross, L. (2014). Using interactive theatre to help fertility providers better understand sexual and gender minority patients. Medical Humanities, 40, 135-141.