The LGBT community faces several barriers to access to care that qualifies them as a special or vulnerable population. In particular, some barriers include structural (for example, lack of LGBT inclusive demographic intake forms), financial (for example, insurance benefits), and personal (for example, fear of disclosure and lack of provider cultural competency).

In 1998, the American Medical Association stated that “unrecognized homosexuality by the physician or the patient’s reluctance to report his or her sexual orientation can lead to failure to screen, diagnose, or treat important medical problems” [10] and noted that barriers to care exist within the patient-clinician relationship. Patients are often not willing to disclose their sexual orientation to medical providers due to past negative experiences or perceived threat of discrimination and substandard care.

Studies on the utilization of health care services have revealed that a significant number of lesbians and bisexual women surveyed concealed their sexual orientation or behavior when seeking medical care and up to 40 percent feel that disclosure would hinder the quality of medical care.[11, 12] Fears of discrimination are not unfounded with documented reports of discriminatory attitudes held by medical providers and nurses to the sexual orientation of their patients.[13, 14]

In addition to negative attitudes, LGBT persons often encounter medical providers who lack knowledge of the health issues and counseling needs relevant to this cohort.[15, 16] Medical education in the United States, both during medical school and in residency, is often unlikely to include adequate cultural competency related to the care of sexual orientation and gender identity minorities. A survey conducted to assess curricula in U.S. medical schools found that less than 3.5 hours were dedicated to teaching about health issues related to homosexuality.[17]

Financial barriers also exist, which further reduce access to health care. The most recent national survey conducted by Harris Interactive revealed that nearly one in four gay and lesbian adults (22 percent) lack health insurance compared with 12 percent of their heterosexual counterparts.[18] The lack of domestic partner benefits and tax penalties in instances where benefits are offered create a situation in which members of the community are more likely to go uninsured or underinsured.

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Anita Radix, MD, MPhil, MPH, and Gal Mayer, MD, MS

Anita Radix, MD, MPhil, MPH, Director of Research and Education, Callen-Lorde Community Health Center
Dr. Gal Mayer MD practices internal medicine in New York, New York. Callen Lorde Community Health Center

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REFERENCES

1. The Gay and Lesbian Medical Association. Healthy People 2010 companion document for LGBT Health.
2. Solarz AL,  Institute of Medicine,  eds.  Lesbian Health:  Current Assessment and Directions for the Future. 1st ed. Washington, DC: National Academies Press; 1999.
3. Dean L, Meyer I, Robinson K, Sell R, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101-151.
4. Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sex: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
5. Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City. Men Ann Intern Med. 2006;145:416-425.
6. Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age,  United States,  2002.  Vital Health Stat. 2005;362:21-26.
7. Goodenow C, Szalacha L, Rubin L, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Pub Health. 2008;98(6):1051-1058.

Full References  »