The history of medical treatment in the LGBTQ community is riddled with stigma and discrimination — from the view of homosexuality as an illness to the criminalization of same-sex intercourse.
While policies and discussions have helped improve these perceptions, according to recent research, there is much work left to be done to support the health of queer and trans people, especially in rural areas.
Zac Ramsey, a doctoral candidate at the West Virginia University (WVU) School of Public Health, set out to uncover some of the barriers in healthcare directly impacting rural LGBTQ individuals. He talked to five rural healthcare providers and five researchers who study the LGBTQ population and learned that health encompasses far more than physical well-being.
“These providers and these researchers were really talking about health as a holistic idea,” Ramsey said. “Health as your physical, your mental and your social.”
This broader definition that connects physical, mental and social health took into account factors like discrimination and heteronormativity that can impact a patient’s relationship with healthcare. For example, assuming that a patient is cisgender or heterosexual, while that may not be the case, may lead doctors or healthcare providers to ask the wrong questions or give inaccurate advice.
“Go in without the assumptions and ask the questions, ‘Are you seeing somebody,’ not, ‘Do you have a girlfriend? Do you have a boyfriend?’” Ramsey said. “Having that open language certainly opens the door.”
Ramsey said asking open and inclusive questions allows individuals to believe that providers genuinely care about their health.
A specific challenge mentioned by two providers in the study was gaps in health insurance coverage for sexual and gender minorities. For example, many insurance companies do not understand prescribing testosterone to someone whose medical record is labeled female. Similarly, if all the markers are changed to male, insurance companies may not cover necessary procedures like a Pap smear.
Sensitivity training that makes physicians and providers more aware of their language and interactions with patients can lay a foundation to improve healthcare for the LGBTQ population.
“It just comes down to drilling into the individuals to not assume that they understand the patient just from a chart,” Ramsey said.
A Social and Emotional Check Up
Beyond primary care, the last few years have been especially fraught, with the Covid-19 pandemic affecting not only physical, but social and emotional health as well.
Deputy director of the University of Minnesota Rural Health Research Center, Carrie Henning-Smith, conducted a study focused on individuals’ systems of social and emotional support during the Covid-19 pandemic based on sexual orientation and rurality.
Research shows that being socially isolated or lonely is associated with higher risks of mortality, cognitive decline, hypertension, and a variety of other negative health outcomes. Therefore, social and emotional support are critical to ensuring an individual’s ability to be healthy in the long-term.
Within her study, Henning-Smith used data from the 2020 National Health Interview Survey to compare the prevalence of social and emotional support between lesbian, gay and bisexual adults and heterosexual adults, in addition to comparing rural and urban populations. She found that rural lesbian, gay, and bisexual adults reported the lowest levels of having their social and emotional needs met and the greatest decrease in social and emotional support during the pandemic, with 23.5% saying they had less support than they had a year earlier.
“It’s hard when you have a small population within a small population,” Henning-Smith said. “It’s hard to have adequate funding and adequate resources to make sure that you have funded programs and funded resources that you need.”
Rural spaces have additional challenges, with fewer resources and fewer people who share the same lived experiences. With high-speed internet and public transportation harder to come by, rural residents are less able to travel and connect with those that might provide them the social and emotional connection they need.
To help increase support for the rural LGBTQ community, Henning-Smith suggested adding more welcoming spaces like community centers, parks or cafes that signal to people that they are safe and accessible. Further, she said anti-discrimination laws in every state need to be put in place to protect peoples’ rights.
“There’s a tendency to assume that rural places just don’t understand LGBTQ issues or that if you’re a member of the LGBTQ community you wouldn’t want to live in rural places, and that’s just absolutely false,” Henning-Smith said.
“We know that LGBTQ folks live in every community across the country, so I think urban residents need to see and recognize their community and their peers in rural spaces.”