When LGBTQ+ patients are unsure if they can be open about their identity and related health needs, it becomes more difficult for them to access high-quality health care.
In our recently published research, my colleagues and I found that how LGBTQ+ people are treated at the doctor’s office has a measurable effect on whether they stay up to date with lifesaving preventive care like flu shots, colorectal cancer screenings and HIV testing.
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Results of affirming care
We examined how LGBTQ+ adults rated their health care provider across three areas: LGBTQ+ cultural competency, such as if providers used inclusive language on forms and in person; LGBTQ+ clinical competency, such as their doctor’s knowledge on all aspects of their health; and experiences of discrimination, such as being told to seek care elsewhere.
After analyzing survey data on the experiences of more than 950 LGBTQ+ adults from across the U.S., we saw that three clear patterns emerged.
First, 34% of participants reported having positive health care experiences – meaning their providers were culturally and clinically competent about LGBTQ+ health needs, and did not discriminate against them. These patients were more likely to be up to date on at least one preventive service recommended by the U.S. Preventive Services Task Force, compared to those receiving neutral or discriminatory care.
Second, 60% of participants reported having neutral experiences, when their providers were clinically competent about LGBTQ+ health needs and didn’t discriminate against them, but were not culturally competent. These patients were 43% less likely to get an HIV test compared to patients reporting affirming care.
Third, 6% of participants reported experiencing discrimination, when their providers were neither culturally nor clinically competent on LGBTQ+ health. These patients were 24% less likely to get a colorectal cancer screening compared to patients reporting affirming care.
Most LGBTQ+ adults in our study reported neutral or even discriminatory care, which leads to avoidable health risks and higher costs for the health system. This provides additional evidence that being supportive of LGBTQ+ patients has measurable improvements for health outcomes.
Why preventive care matters
Preventive care saves lives and saves money. When diseases like colorectal cancer or HIV are caught early, treatments are often simpler, more effective and less expensive.
When LGBTQ+ patients are made to feel unwelcome or unsafe, we found that they are less likely to get routine preventive care, ultimately driving up long-term costs across the health system. States like North Carolina and Georgia that have more health systems participating in the Human Rights Campaign’s Healthcare Equality Index, which evaluates policies and practices around LGBTQ+ care, had higher rates of LGBTQ+ patients reporting positive care experiences compared to states with few participating health systems, such as Tennessee and Alabama.
Other researchers have found that health systems participating in the Healthcare Equality Index have lower rates of nurse burnout and better quality of care, along with higher patient satisfaction among all patients.
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Public health in crisis
This study was originally funded by the National Institute on Aging, but it was among the first LGBTQ+-focused projects terminated by the Trump administration in its efforts to eliminate “gender ideology.”
Our team has continued the work independently to ensure that the over 1,250 participants who already shared their experiences and data would not have this information sit idly.
Our findings reinforce what many LGBTQ+ patients already know – nonjudgmental and competent care is not a luxury, but a public health necessity.
