During Pride Month, it’s easy to find health and wellness products in every color of the rainbow—from bandages to mouthwash to fitness trackers—in stores or online. But real medical care that meets the needs of members of the LGBT community is more difficult to obtain.
New Qualitative Research by Zachary Ramsey – PhD Candidate West Virginia University School of Public Health— suggests that sexual and gender minorities may face unique barriers to accessing health care, especially in rural areas.
His findings appear in Social Services Magazine for Gays and Lesbians.
“Research on sexual and gender minorities is growing rapidly, but mostly in major urban centers,” he said. “There are many differences between urban and rural populations for the general population, so it goes without saying that there will be many differences between urban and rural LGBT people. Without more research on rural LGBTQ people, these differences will not be known, and the policies and programs of rural LGBTQ centers can only use the urban population as a guide.”
Ramsey’s study is the first of its kind to examine researchers’ perspectives on the healthcare needs of LGBTQ people.
He interviewed five researchers studying the LGBTQ population. The researchers were professors at the universities of California, Michigan, Pennsylvania, and Texas.
He also spoke with five physicians practicing in Appalachia, Pennsylvania, Virginia and West Virginia.
“Surveying researchers and health care providers allows for a population survey with a much smaller sample size because each researcher and provider can speak to multiple LGBTQ people, while a non-provider or researcher LGBTQ person can only talk about their personal experience. ,” he said.
Eeach interview included open-ended questions about the priority health needs of sexual and gender minorities.
For example, Ramsey asked each participant what they thought were the most pressing health issues facing the LGBTQ community.
Participants’ responses were dominated by four questions:
- The relationship of physical, mental and social health.
- The harm caused by discrimination.
- Heteronormativity, or the belief that heterosexual and cisgender identities are the only “normal” ones.
- Health system barriers, such as insurance plans that do not cover essential treatments and health care providers that are not trained to address LGBTQ issues.
These questions may seem abstract, but their implications for LGBT people are anything but.
For example, “a heteronormative worldview puts a lot of pressure on a patient to reveal information when the provider isn’t asking the right things or making assumptions,” Ramsey said.
Imagine a 45-year-old patient who was born female, self-identifies as male, but has not had gender reassignment surgery. A mammogram may reduce the risk of death from breast cancer, but he may not get one if the doctor decides he is a cisgender male and underestimates the risk of breast cancer.
Now imagine that the patient is a cisgender male. He has sexual partners of different sexes, but he keeps quiet about it because he lives in a small, rural, socially conservative town where the stigmatization of same-sex relationships persists. He may not benefit from breast cancer screening, but if he cannot speak frankly with his doctor, he may skip screening for cancers associated with the human papillomavirus– a cancer that is more common in men who have sex with men.
“A provider who is open and does not take on aspects of their patient can show the patient that they are receptive to expansive sexuality and gender beyond heterosexual and cisgender,” Ramsey said. “It takes the pressure off the patient and relieves the stress associated with the fear that the provider won’t be receptive to their sexuality or gender.”
The interviews that Ramsey and his colleagues conducted, transcribed, and analyzed were replete with real-life examples.
One participant mentioned that if sexual and gender minorities grow up in families that do not accept them, rejection can cause mental health problems that persist into adulthood.
Other participants mentioned that violence and related post-traumatic stress can be a major concern for LGBTQ people.
Still others noted that sexual and gender minorities have higher rates of suicide and suicidal ideation, and that teaching in medical schools often excludes the trans community from their curriculum.
And they noted that insurance companies may refuse to pay for treatment if, at first glance, it does not correspond to gender.
The countryside can present its own challenges. Participants noted that neither LGBTQ social media nor doctors familiar with LGBTQ issues are likely to increase in rural areas. As a result, isolation can sabotage the health of sexual and gender minorities.
“Bringing more providers to rural areas would be a big advantage, not only for people who have to travel several hours to see an endocrinologist for hormones, but also for the general population, who sometimes find it difficult to find suitable services,” Ramsey said.
Consider this: 20% of Americans live in rural areas, but according to the Association of American Medical Colleges, only 11% of doctors practice there. Three of the five federally identified areas of medical shortages are in rural areas.
In addition, trainings that prepare healthcare professionals to talk to LGBT patients can be helpful. This is especially true in rural areas where providers may have relatively little experience with patients who are “absent”.
“Breaking this stigma and removing the pressure from patients to inform and educate their provider can greatly increase access by simply making healthcare professionals accessible,” Ramsey said.
“Issues such as social and geographic exclusion, lack of service providers and medical systems, and transportation barriers are particularly acute in rural areas,” he said. Daniel DavidovAssociate Professor of the Department Department of Social and Behavioral Sciences and part of the research team. “These disparities in access to medical and support services, combined with the risks of discrimination and stigma, may put LGBTQ patients in rural areas at a greater disadvantage when it comes to quality healthcare.”
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