LGBTQ+ Healthcare Overview

LGBTQIA+ individuals have long faced discrimination within the U.S. healthcare system. Until 1973, the Diagnostic and Statistical Manual of Mental Disorders listed homosexuality as a mental illness. This “diagnosis” could cause someone to be institutionalized against their will and denied housing and employment. Fifty years later, LGBTQ+ people still feel the effects of decades of discrimination while facing new stressors.

LGBT+ people more commonly report being in fair or poor health than non-LGBT+ people, despite being a younger population, and report higher rates of ongoing health conditions and disability or chronic disease. 

As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. And, 18% of LGBTQ adults have no health insurance compared to an estimated 13% of non-LGBTQ adults.

LGBTQ individuals are more likely to need healthcare and less likely to get the care they need. Mental healthcare for LGBTQ populations also has gaps in services:

This population also struggles with substance abuse at disproportionate rates. Studies estimate that between 20% to 30% of gay and transgender people abuse substances, compared to 9% of the general population. 

Transgender Communities

Access to gender-affirming care for transgender people is difficult due to insensitive and diminishing provider care. Transgender patients often experience misuse or misgendering of their pronouns, uncoordinated care, and very few accessible providers that offer gender-affirming care. In rural areas specifically, studies found that trans people receive suboptimal levels of preventive sexual health screenings. Providers often have limiting practices and policies related to gender-affirming care, making it more difficult to have procedures done because they are not deemed “medically necessary.”

“Twenty-two percent of transgender individuals say they have avoided doctors or health care out of concern they would be discriminated against.” 

LGBTQIA+ People of Color

LGBTQIA+ communities of color face intersectional challenges due to race and sexual orientation. These communities face higher rates of police violence, and Black transgender women are being killed at higher rates than other sub-populations within LGBTQIA+ communities. Furthermore, 29% of Black transgender women are diagnosed with HIV, a much higher percentage than other racial groups. Mental health challenges for LGBTQ people of color are also alarming. Three in 10 LGBTQ+ adults of color have been diagnosed with a depressive disorder. Since LGBTQIA+ populations of color face racism, discrimination, and bias, there are opportunities for stress and trauma, creating a higher risk for mental health issues.

LGBTQIA+ Youth

Gay, bisexual youth, and other sexual minorities are eight times as likely to have attempted suicide, according to the CDC. Meanwhile, sexual minorities, such as intersex children, born with variances in external genitals, internal reproductive organs, and/or sex chromosomes, can be subjected to surgeries deemed “medically necessary” but are actually high-risk surgical procedures. There are documented experiences of the long-term impact of these traumatic events on intersex children. 

Additionally, LGBTQIA+ youth who are removed from their home, kicked out, or run away may lack insurance if they are no longer covered under their parents’ healthcare plan. Homelessness is also linked to health issues. LGBTQ youth already face mental health challenges, and homelessness only exacerbates these conditions:

“69% of youth who reported past housing instability and 68% of youth who were currently homeless reported that they had engaged in self-harm in the last year – compared to 49% of youth who had not experienced housing instability.”

Homophobia and Racism in Healthcare Systems

Homophobia, transphobia, and racism impact healthcare experiences for LGBTQIA+ populations and contribute to inequities in health and poor quality of care.

Surveys have found that LGBTQ individuals experience homophobic and transphobic comments during care and encounter unprepared providers or providers that are heteronormative and can’t offer comprehensive care. In some cases, transgender patients said their doctors wouldn’t see them due to perceived gender identity.

Research has shown that Black LGBT patients “are prescribed less pain medication, receive less aggressive heart attack treatments, receive fewer cardiovascular referrals, achieve poorer reproductive outcomes, experience less patient-centered communication, and rate care quality worse than white patients.”

Stigma and Bias Across Social Determinants of Health

Social factors such as income, access to health insurance, housing, and education can influence health outcomes. LGBT individuals face higher rates of cancer, mental illness, and other diseases and have low rates of health insurance coverage and high rates of stress due to systematic harassment and discrimination. 

Poverty rates are steeper among LGBTQ adults than cisgender adults and can increase the risk of negative health outcomes. One study found that “among women 18-44 years of age, 29% of bisexual women and 23% of lesbians are living in poverty, compared to 21% of their heterosexual counterparts.” Black LGBTQ individuals face biased policies that make it more difficult to access jobs, housing, and healthcare.

Reproductive Healthcare Barriers

A Guttmacher study found that queer women do not access routine preventative tests for breast or cervical cancer at the same rate as heterosexual individuals, putting them at greater risk for these diseases. Abortion bans also negatively impact those already experiencing discrimination in healthcare, and sexual minorities may become more at-risk due to these restrictive policies. Research indicates that “LBQ cisgender women are statistically as likely to have had abortions in their lifetime as straight, cisgender women and need comprehensive reproductive healthcare. 

Societal progress and setbacks for LGBTQIA+ populations have impacted funding to advocacy and direct service groups. A record number of anti-LGBTQ legislation has been introduced into state legislatures this year in an attempt to use public policy against these communities. Additionally, Obama-era protections for LGBTQ+ individuals were reversed during the Trump Administration, when transgender individuals specifically saw an increase in discriminatory practices. 

There has been a rise in violence and crime against LGBTQ individuals in the last couple of years, since the Pulse Nightclub shooting, and more recently, at anti-drag protests. These setbacks can offer opportunities for funders to give more and help repair the harm that LGBTQIA+ communities are experiencing, which impacts their health trajectories. 

While philanthropic funding for LGBTQIA groups has increased in some areas, LGBTQ funding only comprised 0.13% of all philanthropic funding in 2019. Nearly 300,000 individuals receive healthcare services from small LGBTQ community centers, but these centers remain small and struggle to survive on limited resources. 

According to IRS data compiled by GC Insights (part of Giving Compass), since 2018, organizations focused on LGBTQ+ issues have a combined annual revenue of $8.03 billion, and LGBTQ community healthcare clinics only make up a small portion ($576 million) of that revenue.

There are also a number of states whose policies openly disadvantage LGBTQ populations by not expanding Medicaid insurance or lack protections for discriminatory practices. Funders for LGBTQ Issues shares ways donors can help.