Health and health care of rural sexual and gender minorities: A systematic review.

Abstract

Prior research describes significantly worse health outcomes experienced by lesbian, gay, bisexual, and transgender (LGBT) people relative to their heterosexual and cisgender counterparts. A prevalent research focus on urban LGBT populations has created a gap in understanding rural LGBT health care and outcomes from a holistic perspective. The present article provides a literature review focusing on the health and health care experiences of LGBT people living in rural areas and highlighting challenges and opportunities for growth in providing culturally competent rural health care. We conducted a systematic review that resulted in the inclusion of 58 articles focused on the health of rural LGBTQ people published between 1998 and February 2016. Findings clustered around 3 themes: (1) individual health outcomes and risk behaviors, (2) experiences of health care and interactions with the health care system, and (3) sociocultural factors at the intersection of rurality and health. Evidence-based recommendations for systemic change and interventions to promote health among rural LGBT people are provided.

“Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada

“…The study findings corroborate prior research that highlights healthcare barriers for LGBTQ+ persons in general (Elliott et al, ; Logie, ), LGBTQ+ persons in rural areas and persons in Arctic Canada (Corosky & Blystad, ). For instance, researchers identified healthcare barriers among rural LGBTQ+ persons including stigma, limited healthcare provider knowledge, geographical challenges, and heterosexism (Rosenkrantz et al, ). Our findings build on this knowledge by highlighting the importance of considering intersectional stigma targeting LGBTQ+ identities as well as HIV and STI, and cisnormativity.…”

“…The study has several strengths: it is among the first Arctic studies to centre LGBTQ+ persons’ voices regarding sexual healthcare experiences. The study also provides examples of healthcare provider‐patient communication, filling a literature gap (Rosenkrantz et al, ). Finally, we heed the call for strength‐based, solution‐focused research with LGBTQ+ persons (Coker et al, ) by eliciting their sexual healthcare recommendations.…”

“…This may be exacerbated in rural settings. A recent systematic review of predominantly U.S. studies found that rural residency among LGBTQ+ persons was associated with: lower likelihood of disclosing sexual orientation/gender identity, healthcare access barriers, negative healthcare provider attitudes and treatment, and the perception that providers lack competence with LGBTQ+ issues (Rosenkrantz, Black, Abreu, Aleshire, & Fallin‐Bennett, ).…”

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

“…Perceived stigma in clinical settings may discourage MSM from accessing needed health care services to advance sexual health and overall well-being (Clift & Kirby, 2012;Eaton et al, 2015;Sabin, Riskind, & Nosek, 2015). Experiences may be exacerbated in socially conservative and rural areas where LGBT populations have less access to quality, LGBT-sensitive care (Kano, Silva-Bañuelos, Sturm, & Willging, 2016;Rosenkrantz, Black, Abreu, Aleshire, & Fallin-Bennett, 2016;Whitehead et al, 2016). As such, MSM are required to travel farther to find LGBT-affirming providers within Oklahoma and neighboring states who may be willing to see LGBT patients and who would also be willing to prescribe PrEP.…”

Rural Primary Care Providers’ Experiences and Knowledge Regarding LGBTQ Health in a Midwestern State

“…Many of these LGBTQ subpopulations face unique challenges that warrant specific investigation and mediation . Rural LGBTQ individuals are one such subpopulation . Emerging research findings indicate that, when compared to their urban LGBTQ counterparts, rural LGBTQ individuals experience exaggerated health risks.…”