Abstract
BackgroundPrior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.MethodologyLBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.ResultsHigher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.ConclusionsThe results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Highlights
Healthy People 2020 [1] identified increasing access to quality healthcare for LGBT populations as a priority for further research and intervention
While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples
Little is known about the impact of stigma for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers
Summary
Healthy People 2020 [1] identified increasing access to quality healthcare for LGBT (lesbian, gay, bisexual, and transgender) populations as a priority for further research and intervention. Health disparities affecting LGBT people are well-documented, and span each subgroup of this population Among these disparities is increased prevalence of a number of risk factors for poor health. Some LGBT individuals incur increased risk through behaviors that can be associated with LGBT identity These behaviors include hormone therapy among certain transgender persons, which can increase risk for cardiovascular conditions and organ damage [6], and receptive anal intercourse, which has been associated with increased risk for certain anal cancers [7], HIV [8], and other sexually transmitted infections [9] among gay and bisexual men. Little is known about the impact of stigma for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers
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