Differences in Health Care Access, Utilization, and Experiences Among LGBTQ+ Subgroups in the Southern United States

Abstract

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.

Barriers to Mental Health Care Identified by Sexual and Gender Minority Individuals in Georgia and South Carolina

“…In the context of psychotherapy, multiple forms of SGM-based microaggressions have been identified that can influence intentions to seek mental health services 32–34 . The lack of report of these barriers identified in other samples of SGM individuals should be interpreted cautiously, particularly for GM individuals who endorsed more discriminatory healthcare experiences compared with lesbian and gay individuals in a larger sample from our health needs assessment 35 . It also is possible that participants’ reported difficulties in even obtaining an appointment meant that they never had the opportunity to experience either microaggressions toward or microaffirmations of their SGM identities by providers.…”

“…[32][33][34] The lack of report of these barriers identified in other samples of SGM individuals should be interpreted cautiously, particularly for GM individuals who endorsed more discriminatory healthcare experiences compared with lesbian and gay individuals in a larger sample from our health needs assessment. 35…”

Gender Affirming Psychotherapy (GAP): Core principles and skills to reduce the mental healthcare "gap" for transgender youth

“…[103][104][105][106][107] Finally, providers universally expressed supportive attitudes towards gender-affirming practices. To make a maximally scalable intervention appropriate for use in regions with more transphobic attitudes, 91,108 future studies should recruit and elucidate the needs of providers who express hostility and/or hesitancy about genderaffirming practices. [109][110][111][112] An additional strength of GAP is its evidence-informed nature.…”

Sleep health challenges among women: insomnia across the lifespan

“…Moreover, queer, questioning, and transgender individuals might encounter more significant healthcare obstacles compared to their lesbian, gay, and cisgender counterparts (Macapagal et al, 2016). Notably, transgender and gender-diverse participants face higher levels of discriminatory experiences and increased barriers to accessing care, indicating the importance of targeted interventions to improve their healthcare experiences and outcomes (Holt et al, 2023). Addressing these disparities in health care requires policy, research, and practice changes, focusing on tailored health services that meet the unique needs of LGBTI individuals (Zeeman et al, 2019).…”