LGBTQ+ Healthcare Overview

Last Updated Dec 5, 2023

This guide is intended to help donors gain a deeper understanding of the issues related to LGBTQIA+ populations dealing with the U.S. healthcare system and outlines opportunities to address the root causes of inequitable outcomes. By Lucy Brennan-Levine

What is LGBTQIA+ Healthcare?

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. 

Who Is Affected?

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.” 

Aging and Elderly LGBTQIA+ Communities

Additionally, lesbian and bisexual women are more likely to experience disability and poor mental health than their heterosexual peers. This is compounded by the fact that older LGBT adults have lower health insurance coverage rates and are less likely to seek coverage. For mental health, the picture is similar: Studies indicate that older LGBTQ adults have higher rates of stress and anxiety, eating disorders, and loneliness. Medicare systems that provide care for retired and elderly workers do not always support LGBTQ individuals who have been intentionally left out of traditional employment or haven’t been able to keep a job due to workplace discrimination. This is especially true for transgender individuals who are chronically unemployed.

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.”

LGBTQ+ healthcare

What Causes These Disparities?

Lack of Training and Inclusion

A survey of LGBTQ participants found that they are very likely to have a range of negative experiences with providers and have medical concerns dismissed or blamed on them.

Studies have shown that some sensitivity training and curricula can effectively reduce bias in medical professionals, but interventions aren’t common practice. Research shows that not all providers feel comfortable around LGBTQIA+ populations and lack specific training. For instance, while many medical professionals surveyed said they were fearful of asking about patients’ sexual orientation, 90% of patients did not have that same fear about questions being asked. While more medical education needs to be prioritized, there are training models worldwide that are seeing success.

Another roadblock to health equity is the lack of clinical centers that solely focus on LGBT healthcare patient needs. There are still 13 states that don’t have any community LGBT health centers.

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.

Employer-based Healthcare Barriers

Employment discrimination can create barriers to health insurance and healthcare, and research shows that unemployment rates and uninsured rates are higher among LGBTQ individuals. Additionally, LGBTQ workers have high rates of “underemployment” (temporary/part-time jobs), which impacts income and future earnings. Both discrimination and lack of workplace protection policies account for these employment gaps. The U.S. only recently had a Supreme Court case that ruled to protect LGBTQ+ people from employment discrimination against sexual orientation and gender identity.

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. 

Lack of Health Data and Research on LGBTQIA+ Populations

Data collection and research on LGBTQ+ patients is limited and experts in healthcare fields are calling for that to change. The lack of research won’t help address clear health disparities for these communities. Federal health forms usually don’t include extensive questions on sexual orientation or gender identity, making accurate data collection more difficult. However, some improvements are afoot. The Affordable Care Act provides opportunities for the Department of Health and Human Services to ask more demographic data questions but barriers still exist for this type of comprehensive data collection. The Healthy People 2030 initiative declares that it has goals to support LGBT populations by focusing on improved population-level surveys that include more extensive demographic data. The Household Pulse Survey from the U.S. Census recently added sexual and gender orientation questions to its questionnaires. These are steps in the right direction but they are only recent improvements for marginalized people who make up 7% of the population.

Why Should Donors Care?

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.

Get Involved

  • The Black Aids Institute focuses on providing HIV services for Black individuals by centering Black perspectives. 
  • The Trevor Project aims to end the suicide of young LGBTQ individuals. 
  • Outfest is a nonprofit organization that highlights queer history and brings visibility to the diversity of LGBTQIA+ stories. 
 
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