LGBTQ people may face unique barriers to health, according to a new study by Zachary Ramsey, a PhD student at the WVU School of Public Health. Interviewing researchers and doctors, Ramsey identified four pressing health issues facing sexual and gender minorities: discrimination, heteronormativity, health system barriers, and the interconnectedness of physical, mental, and social health. His findings appear in the Journal of Gay and Lesbian Social Services.
During the month of pride, it is easy to find rainbow-colored health and wellness products – from bandages, to mouthwashes, to fitness trackers – in stores or online. But actual health care that meets the needs of members of the LGBTQ community can be more difficult to obtain.
New qualitative research of Zachary Ramsey – PhD student in University of West Virginia School of Public Health– suggests that sexual and gender minorities may face unique barriers to health care, especially in rural areas.
His discoveries appear in Magazine for social services for gays and lesbians.
“Research on sexual and gender minorities is growing rapidly, but mainly in large urban centers,” he said. “There are many differences between urban and rural populations for the general population, so it is logical that there will be many differences between urban and rural LGBTQ individuals. Without more research specifically on LGBTQ individuals in rural areas, these differences will not be known, and LGBTQ center policies and programming in rural areas can only be used by the urban population for guidance.
Ramsey’s study is the first of its kind to examine researchers’ views on the health needs of LGBTQ individuals.
He interviewed five researchers studying the LGBTQ population. The researchers have taught at universities in California, Michigan, Pennsylvania and Texas.
He also spoke with five doctors who practice in the Appalachian regions of Pennsylvania, Virginia and West Virginia.
“Interviewing researchers and providers allows surveys of the population with a much smaller sample size, as each researcher and provider can talk to multiple LGBTQ individuals, while an LGBTQ individual who is not a supplier or researcher can only talk about experience. its as an individual, “he said.
Eeach interview included open-ended questions about the priority health needs of sexual and sexual minorities.
For example, Ramsey asked each participant what they thought were the most pressing health issues facing the LGBTQ community.
Four questions dominated the participants’ answers:
- The interrelationship of physical, mental and social health.
- The harm that causes discrimination.
- Heteronormativity or the belief that heterosexual and gender identity is the only “normal” one.
- Barriers in the health care system, such as insurance plans that do not cover the necessary treatment and health care providers that are not trained to deal with LGBTQ issues.
These questions may seem abstract, but their implications for LGBTQ individuals are anything but.
For example, “having a heteronormative worldview puts a lot of pressure on the patient to reveal information when the provider doesn’t ask the right things or make assumptions,” Ramsey said.
Imagine a 45-year-old patient who was born a woman, identifies as a man, but has not undergone gender reassignment surgery. Mammograms could reduce the risk of dying from breast cancer, but he may not get them if his doctor accepts that he is a gendered man and underestimates the risk of breast cancer.
Now imagine that the patient is a cisgender man. He has sexual partners of different genders, but is reticent about it because he lives in a small, rural, socially conservative town where the stigma remains around same-sex experiences. Breast cancer screenings may not be helpful, but if he can’t talk openly with his doctor, he may miss screenings for cancers associated with the human papillomavirus– cancers that are more common in men who have sex with men.
“A provider who is open and does not accept aspects of his patient can show the patient that he is receptive to expansive sexuality and gender beyond heterosexuals and gender,” Ramsey said. “This relieves the patient’s pressure and relieves the stress of dealing with the fear that the provider will not be receptive to their sexuality or gender.”
Real-life examples abounded in interviews that Ramsey and his colleagues conducted, transcribed, and analyzed.
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 the resulting post-traumatic stress – could be a critical concern for LGBTQ individuals.
However, others note that sexual and gender minorities have higher rates of suicide and suicidal thoughts, and that attending medical schools often excludes the trans community from its curriculum.
And they noted that insurance companies may refuse to pay for treatment if they do not appear to be gender-appropriate at first glance.
Rural areas may present their own difficulties. Participants pointed out that neither LGBTQ social networks nor doctors familiar with LGBTQ issues are likely to spread to rural areas. The resulting isolation can sabotage the health of sexual and gender minorities.
“Bringing more providers to rural areas would be of great benefit not only to people who have to drive a few hours to see an endocrinologist for hormones, but also to the entire population, which can sometimes struggle to find appropriate services,” he said. Ramsey.
Think about it: 20% of Americans live in rural areas, but according to the American Medical College Association, only 11% of doctors practice there. Three of the five federally designated areas with a shortage of health professionals are in rural areas.
In addition, training that prepares healthcare providers to talk to LGBTQ patients could be useful. This is especially true in rural areas, where providers may have relatively little experience with out-of-pocket patients.
“Breaking this stigma and removing pressure from patients to inform and educate their provider can significantly increase access by simply making the providers around them accessible,” Ramsey said.
“Problems such as social and geographical isolation, shortages of suppliers and the medical system, and transport barriers are particularly pronounced in rural areas,” he said. Daniel DavidovAssociate Professor Department of Social and Behavioral Sciences and part of the research team. “These differences in access to health and support services, combined with risks of discrimination and stigma, can put LGBTQ patients in rural areas at a disadvantage when it comes to finding quality healthcare.
Quote: An Ethical Look at LGBTQ Healthcare: Barriers to Access According to Healthcare Providers and Researchers
see / 06/23/22
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