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UNDERSTANDING LGBT HEALTH DISPARITIES

Numerous studies highlight health disparities involving the care of lesbian, gay, bisexual, and transgender (LGBT) people. Lesbian and bisexual women are less likely to receive recommended preventive screenings such as breast, cervical, and colorectal cancer screenings. Among men who have sex with men, rates of human papillomavirus–associated anal cancers are 17 times higher than those of heterosexual men. In addition, gay and bisexual men accounted for 67% of all new HIV diagnoses in the United States in 2014, and they disproportionately contract sexually transmitted infections. In 2014, men who have sex with men accounted for 83% of primary and secondary syphilis infections in the United States where the sex of the sexual partner was known. Transgender individuals have a higher prevalence of HIV infection and suicide compared with other groups; 41% of transgender adults report ever attempting suicide compared with 1.6% of the general population.

Research has found that LGBT individuals are more likely to experience depression, anxiety, and alcohol and drug use than their counterparts. Most concerning are the rates of suicide attempts and ideation among the LGBT community, particularly youth. LGB youth are more than twice as likely to attempt suicide than their heterosexual peers, and approximately 30% of LGB students report having attempted suicide over a 12-month period. In addition, U.S. studies indicate that substance abuse is twice as common in LGBT youth compared with their counterparts. These findings are mirrored among LGBT adults: the prevalence of substance abuse disorders is 20–30% compared with approximately 9% in the general population.

These disparities are compounded by structural barriers to healthcare, including decreased access to medical care, lack of awareness to the unique health needs of LGBT individuals, and stigma and discrimination toward the LGBT community. Many LGB individuals perceive the healthcare setting and providers as threatening, which may lead to avoiding needed medical care or withholding important medical information. A large U.S. survey identified that 8% of LGB and 27% of transgender individuals were refused needed healthcare, and almost 11% of LGB and 21% of transgender people reported being subjected to harsh or abusive language by healthcare professionals. Apart from healthcare settings, more than two-thirds of LGB people report discrimination in their personal lives, and 90% of transgender individuals report harassment, mistreatment, or discrimination at work. Chronic exposure to high levels of stress from real or anticipated discrimination, referred to as “minority stress,” may be an important factor contributing to the poor health outcomes experienced by LGBT populations.

While some research on LGBT health has been conducted, the Institute of Medicine has called for more study to better understand the needs and experiences of LGBT individuals. Moreover, many LGBT individuals experience health disparities across their life cycle (e.g., LGBT youth are at greater risk of suicide and homelessness, while elderly LGBT individuals face barriers to health because of isolation and fewer family supports), necessitating a longitudinal approach to ...

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