Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers

"Ripping Off the Band-Aid": uncovering future health care Professionals' "Fractured Knowledge" about sexual and reproductive health

Background

Research has shown the role of identity on future health professionals' confidence and competence in addressing the sexual and reproductive health (SRH) needs of their patients. While there has been some work in increasing the sexual health literacy of future providers via various curricular approaches and comprehensive clinical-based training, there are research gaps on how social differences around identity impact future healthcare professionals' knowledge and practices around SRH.

Objectives

This article presents research findings on the experiences of US undergraduate students attending a campus that provides training in the health sciences and health professions. Our study aims to understand the perspectives of these students as they pertain to their future career choices in healthcare, with a focus on how their past experiences learning about sex, sexuality, and reproduction impact their current and future professional trajectories.

Methods

We present a qualitative analysis from 40 in-depth interviews with U.S. undergraduates. The interview questions were designed in collaboration with undergraduate researchers interested in sexual health education. These student researchers collected all the interview data and worked with senior researchers to analyze some of these data.

Results

The themes that emerged from the interviews were around experiences with what students perceived as "fractured" sexual and reproductive health (SRH) knowledge they received as children and adolescents. This knowledge shaped essential aspects of their identity as young adults and future healers. Data indicated unique processes implicated in how past as well as present socialization experiences learning about sex, sexuality, and reproduction positions undergraduates in health professions to see young adulthood as a journey of "catching up" on sexual knowledge but also as an ongoing experience of anticipation and planning influencing their career-building journey.

Conclusions

The importance of sexual health literacy among healthcare professionals cannot be overstated, as it is vital in providing patient-centered and non-judgmental sexual and reproductive health (SRH) care and services. To date, there is a shortage of studies looking at the impact of sexual health knowledge on healthcare professionals. More research is needed on educational strategies that could be implemented at the intra-personal level to assist college-aged young adults in healthcare career tracks to "catch up" or "fill in the gaps" in their sexual education journey.

Two Gender Medicine: Provider-Side Barriers to Caring for Transgender and Gender Diverse Patients

Experienced and anticipated discrimination during health care visits result in lower health care utilization rates, which contribute to persistent health disparities between transgender and gender diverse (TGD) individuals and the general population. Most strategies for improving health care delivery to TGD patients place the responsibility on providers, overlooking the role of medical systems and institutions in creating the environments where negative health care experiences occur. Relying on the inhabited institutionalism framework, this study explores system- and institutional-level barriers to the provision of quality care to TGD patients identified by health care providers and administrators, including relevant contextual details of, and interactions between, these barriers. Based on interview data from health care providers and administrators from a variety of practices across Texas, we identified two overarching themes and six subthemes. We demonstrate how our interviewees' responses reveal an institutional logic of "two-gender medicine," which creates barriers to health care provision in both formal medical education and training and throughout the managed care model of practice. We also illustrate how health care workers find ways to resist this logic in the course of their practice. Addressing these barriers to delivering competent and compassionate care to TGD patients that providers encounter could make long overdue strides toward addressing health disparities.

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

Exploring Factors Affecting Patient-Provider Interactions and Healthcare Engagement Among a Diverse Sample of Women Who Have Sex with Women in New York City

Women who have sex with women (WSW) have lower rates of engagement in health care and preventive screenings than women who have sex exclusively with men. Existing literature provides limited insight into how intersecting and overlapping identities, such as race, ethnicity, sexual orientation, gender identity, and identities related to gender expression, may shape individuals' experiences within health care. We conducted qualitative interviews in New York City with 30 people who identified as women, reported sex with people who identify as women, were age 18-65, and were diverse in race, ethnicity, and sexual orientation and gender identity. The semi-structured questionnaire asked participants about positive and negative healthcare experiences to elicit what could encourage or prevent seeking care, with a focus on provider-related factors. Factors that led to positive healthcare experiences included having a provider who was knowledgeable about LGBTQ experience and health and who affirmed their sexuality, gender identity, and other intersecting identities. Factors that contributed to negative healthcare experiences included poor interactions with providers, and providers' perceived heteronormativity and lack of awareness of WSW healthcare needs. WSW of different races, ethnicities, sexual orientations, and gender identities seek validating healthcare experiences that acknowledge and affirm their identities. We present a visual summary of the main thematic factors that contributed to positive and negative WSW healthcare experiences. Increasing access to care requires training providers on how to engage WSW patients, including WSW of diverse race/ethnicity and gender identity and expression.

Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care

Purpose: Sexual minority (SM) women are a heterogeneous group who commonly report negative health care experiences at the intersection of their diverse sexual orientations and racial/ethnic identities. However, scarce research has evaluated how negative health care experiences may affect health outcomes among this population. Informed by the Health Equity Promotion Model for SM health, this study evaluated mediation models in which delayed care mediated the association between provider discrimination and poor health outcomes in SM women. Sexual orientation (plurisexual or monosexual) and race/ethnicity (women of color or White) were evaluated as moderators of the direct and indirect pathways. Methods: The sample included SM women (N = 1530) from the nationally representative Association of American Medical Colleges biannual Consumer Survey of Healthcare Access (2010-2020). Mediation models were conducted with lavaan structural equation modeling software. Results: Reported discrimination from a health care provider was associated with higher physical and emotional impairment, and these associations were partially mediated through delayed care. Sexual orientation and race/ethnicity also moderated several indirect and direct pathways. Conclusion: Results provide evidence of delayed care as a possible mediation pathway between provider discrimination and worse health in SM women and that the strength of these associations may vary by sexual orientation and race/ethnicity. Results indicate a need for policy change and clinical trainings to reduce the harm of provider discrimination on SM women.

Learning with experts: Incorporating community into gender-diverse healthcare education

The Association of American Medical Colleges (AAMC) encourages but does not require medical schools to train students on LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc.…) care and education on transgender, gender-diverse and/or intersex care is particularly lacking. This study evaluated the efficacy of a patient-centred educational intervention co-developed and facilitated with transgender and gender-diverse (TGD) patient collaborators on students' knowledge of TGD healthcare needs, perceived value of TGD healthcare training and TGD healthcare competency. The authors recruited second-year medical students from the Primary Care, Family and Community Medicine Clerkship at the University of Texas at Austin Dell Medical School (UT Dell Med) in Spring 2021. Students (n = 36) completed an online survey with closed- and open-ended questions that included AAMC TGD healthcare competencies, perceived value of TGD healthcare training, and knowledge of TGD healthcare needs before and after an educational intervention utilising clinical cases developed and delivered in collaboration with six TGD patient collaborators. The TGD patient collaborators completed a post-intervention survey evaluating the patient-centredness of the educational intervention's design and implementation and their perception of the student's competence during the intervention. There was a statistically significant increase in each AAMC TGD healthcare competency post-intervention, except for discussing sexual health practices. No changes in perceived value or knowledge were noted. Students reported that authentic engagement with TGD patient collaborators during the educational intervention had the most impact (n = 10, 58.4%). All responding TGD patient collaborators (n = 5, 100%) strongly agreed that their input was valued and at least somewhat agreed that they felt supported by the organiser of the educational intervention. Three respondents (75%) somewhat agreed that the development of the educational intervention was a collaborative process, with one (25%) somewhat disagreeing. Educational interventions that are co-developed with TGD patient collaborators may improve medical student understanding of gender diversity. Additional efforts are needed to further the patient-centredness of educational interventions.

Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States

BACKGROUND

Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling.

METHODS

Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12 months among U.S. women aged 15-44 years (N = 14,019).

RESULTS

Adjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12 months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider.

CONCLUSIONS

Person-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.

Sexual Health Information Sources, Needs, and Preferences of Young Adult Sexual Minority Cisgender Women and Non-Binary Individuals Assigned Female at Birth

BACKGROUND

Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication among SMW is sparse.

METHODS

In-depth interviews conducted in 2016-2017 investigated sexual health communication in a sample of 29 racially/ethnically diverse cisgender women and non-binary individuals assigned female at birth who were between 19 and 36 years of age and identified as a sexual minority. Data were analyzed using a thematic analysis approach that involved inductive and deductive coding to identify themes.

RESULTS

Three broad themes were identified: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. Participants expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information.

CONCLUSIONS

Participants expressed clear desires for relevant, high-quality sexual health information delivered through a variety of channels, especially the Internet, other mass media, and health care providers.

POLICY IMPLICATIONS

Findings call for policies that improve provision of sexual health information through health care providers, online resources, and school-based sex education.

Combating LGBTQ+ health disparities by instituting a family medicine curriculum

Research shows that a growing number of people in the United States are identifying as LGBTQ+. Therefore, it is more important than ever that clinicians are trained to be knowledgeable, inclusive, and culturally aware. Unfortunately, there is a lack of LGBTQ+ health education requirements in graduate medical education. As a result, fewer clinicians are prepared to care for this growing population. The shortage of knowledgeable clinicians contributes to LGBTQ+ health disparities and barriers to care. One strategy to combat these deficiencies in health care is for Family Medicine residency programs to create and carry out an LGBTQ+ health curriculum. This article will review LGBTQ+ health topics, identify efforts that Family Medicine residency programs can make, and summarize curriculum developments made by the St. Vincent's Family Medicine Residency Program.

Internalized Body Stigma as a Barrier to Accessing Preventative Healthcare for Young Women

Internalizing stigma toward the body can have negative implications for women's sexual health. In the current study, we examined how young women's internalized stigma toward their body shape, genitals, and menstrual periods are associated with their use of preventative healthcare services for sexual health. Additionally, we tested two mechanisms that may mediate the relationship between internalized body stigma and preventative care: self-objectification (in the form of a loss of autonomy) and comfort communicating with a healthcare provider. We collected and analyzed survey data from 685 undergraduate women. We tested a serial mediation model, such that the internalization of body stigma predicted greater self-objectification, greater self-objectification predicted less comfort communicating with a provider, and discomfort communicating with a provider predicted lower receipt of preventative care. Results partially supported the proposed serial mediation model, such that internalizing stigma towards body shape, genitals, and menstrual periods was associated with discomfort communicating via greater self-objectification. Internalized stigma toward genitals and menstrual periods were significant predictors of preventative care use, even when accounting for self-objectification and communication. Findings suggest that interventions to address genital and menstrual stigma could be especially beneficial for enabling young women to seek preventative care.

Healthcare experiences of urban young adult lesbians

Purpose:

This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing.

Methods:

Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models.

Results:

Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05).

Conclusion:

Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.

Healthcare professionals' assumptions as barriers to LGBTI healthcare

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with LGBTI people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender and non-intersex by default; second, the assumption that LGBTI people do not experience significant problems (and therefore that their experience is mostly irrelevant to healthcare). On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.

Exploring the Q in LGBTQ: Demographic characteristic and sexuality of Queer people in a U.S. representative sample of sexual minorities

Although queer identity has been used among sexual minorities for decades, little is known about the population of queer-identified people in the U.S. We compared people who identify as queer (unweighted n = 88; weighted % = 5.8%) with those who identify as lesbian/gay (n = 833; 46.9%), bisexual (n = 493; 40.6%) or other sexual minority identities (n = 93; 6.7%), in order to describe queer-identified people as a distinct sexual minority group. The study is the first to estimate demographic characteristics and sexuality of queer-identified people using a U.S. nationally representative sample. We found that queer people are overwhelmingly cisgender women and genderqueer/ nonbinary (GQNB), younger, and more highly educated than other groups. After stratifying by gender identity (cisgender women; cisgender men; GQNB), survey-weighted descriptive differences in attraction, sexual partnering, and relationship patterns show that queer individuals are more likely to report attraction to, and sexual relationships with, transgender and GQNB people, though differences by respondent gender identity were noted: The majority of queer women are attracted to and partnered with both women and men, and were more likely than other groups to be attracted to and partnered with cisgender and transgender people. In contrast, queer men are split in their attractions-about half were attracted exclusively to men, and half to men and women-but the majority partnered with men only. Of all groups, queer men are the most likely to partner with transgender men, but none had partnered with transgender women. GQNB people are more likely than cisgender people to identify as queer (25.9%) and are attracted to both cisgender and transgender women and men, yet predominantly partnered with cisgender people. The results provide support for queer as a distinct sexual identity.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

Service provider recognition of the significance of animal companionship among trans and cisgender women of diverse sexualities

Extensive literature reveals the many health benefits animal companions can bring to the humans who live with them. However, much of this work has taken place with heterosexual and cisgender populations. To address this gap, we conducted qualitative interviews with 19 trans and cisgender women of diverse sexualities in Australia who reported having significant relationships with animal companions. In this article, we explore the benefits of healthcare providers (e.g. doctors, counsellors) recognising the potential significance of interspecies companionship for the health of trans and cisgender women of diverse sexualities. Findings relating to interactions with animal service providers are used to further illustrate themes of recognition and non-recognition as they relate to the women's genders, sexualities, and relationships with animal companions. In the discussion we consider some of the contextual challenges for such recognition to occur in service provision. Suggestions are then offered in relation to how providers might think about service provision which is both inclusive of all women and takes into account close connections with animal companions.

The discursive construction of low-risk to sexually transmitted diseases between women who are sexually active with women

This paper uses a discursive analytical method to explore dominant discourses concerning the sexual health of women who have sex with women. In-depth interviews were conducted with a cross-cultural sample of women from England and Brazil. Sex between women was discursively constructed as 'safe', and women who have sex with women were seen as being at low to negligible risk of contracting/transmitting sexually transmitted infections. Analysis identified two discourses underlying these constructions: a binaries discourse which focused on dichotomies of gender, sexuality and risk; and a sexual double-standard discourse, which focused on the positioning of sex between women as safe and the use of barrier methods of protection as indicative of not engaging in or fully enjoying the sexual act.

Caring Adults: A Brief Report Assessing Adults' Needs in Feeling More Comfortable Having Sexual Health Conversations with Youth in South Texas

Objectives

As part of a larger Substance Abuse and Mental Health Services Administration-funded project in South Texas, this study sought to understand adults' needs with regard to engaging in sexual health conversations with youth and young adults.

Methods

A total of 223 participants were surveyed to assess comfort engaging in sexual health conversations. Data were analyzed using thematic coding. Stigma surrounding sexual health conversations underlined all themes.

Results

Differences by gender and sexual orientation in the data were noted. Stigma around sexual health topics reduced participants' comfort.

Conclusions

To this end, interventions must go beyond psychosocial and educational programs and address societal factors that contribute to the stigma.

The Needs of LGBTI People Regarding Health Care Structures, Prevention Measures and Diagnostic and Treatment Procedures: A Qualitative Study in a German Metropolis

(1) Background: Studies indicate that lesbian, gay, bisexual, transgender and intersex (LGBTI) people constantly face challenges and disadvantages in the health care system that prevent them from getting the best possible patient-centered care. However, the present study is the first to focus on LGBTI-related health in a major German metropolis. It aimed to investigate health care structures, prevention measures and diagnostic as well as treatment procedures that LGBTI individuals need in order to receive appropriate patient-centered health care and health promotion. (2) Methods: Following a participatory approach, five expert interviews with LGBTI people with multiplier function, i.e., people who have a key role in a certain social milieu which makes them able to acquire and spread information in and about this milieu, and three focus groups with LGBTI people and/or health professionals were conducted. Qualitative data were analyzed according to the principles of content analysis. (3) Results: The specific needs of LGBTI individuals must be recognized as a matter of course in terms of depathologization, sensitization, inclusion, and awareness. Such an attitude requires both basic knowledge about LGBTI-related health issues, and specific expertise about sufficient health care services for each of the minorities in the context of sex, sexual orientation and gender identity. (4) Conclusions: For an appropriate approach to LGBTI-centered health care and health promotion, health professionals will need to adopt a better understanding of specific soft and hard skills.

Perceptions of body size and health among older queer women of size following participation in a health programme

Little research examines how older queer (lesbian and bisexual) women understand and construct meanings around their body size in the context of individual and community norms and identities. Grounded theory was used to analyse transcripts from 31 interview participants drawn from a health programme in the San Francisco Bay Area. Older queer women of size navigate tensions between body ideals and community ideals in and through their experiences of body size. Women's embodied experiences of fatness, chronic pain and weight changes shifted in tandem with their experience of interactions with other queer women, as well as what bodies and body ideals should be in 'the lesbian community'. This study found that bodily norms and health ideologies are embedded and embodied in communities and navigated through the ongoing formation and configuration of communities over time. Body acceptance movements may be out of touch for this population based on their internalisation of the medical model in which weight loss automatically means improved health. Health interventions for older, queer women of size must be community-based to effectively shift behaviours, norms and expectations around healthy living in fat, ageing bodies.

Patient-Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals

BACKGROUND

Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.

METHODS

We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18-36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient-provider STI prevention communication.

RESULTS

Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers' heteronormative assumptions.

CONCLUSIONS

Our study describes several barriers that AFAB sexual minorities felt inhibited their patient-provider sexual health communication. Interventions are needed to improve patient-provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.

Healthcare Experiences of Underrepresented Lesbian and Bisexual Women: A Focus Group Qualitative Study

Purpose: To understand the complex healthcare experiences of women identifying as lesbian or bisexual. who are also women of color, veterans, and/or 65 years of age and older. Methods: Inclusion criteria were age 25 or older, Los Angeles County resident, self-identification as a lesbian or bisexual woman, and as an African American, Latina, Asian-Pacific Islander, and/or a veteran. For the age 65 years and older group, participants were eligible regardless of their veteran status or race/ethnicity. Five focus groups were conducted (n=35) and the same questions were asked addressing their comfort interacting with healthcare providers, the provider knowing their sexual orientation, characteristics of a perfect provider, and barriers to care. Structured qualitative analyses were performed. Results: Participants identified concerns that providers often hold to heterosexual cultural norms. Participants varied on preferences for providers of the same race/ethnicity as themselves. Lesbians who are 65 years and older identified legal barriers as major concerns. All groups identified incorrect provider assumptions about sexual orientation and sexual practices as frequently compromising their care. Participants supported the idea of certification for providers skilled in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health, but expressed skepticism that such programs would necessarily result in better care. Conclusion: Healthcare provider trainings need to address the specific concerns and experiences of underrepresented lesbian and bisexual women. Healthcare environments must be transformed to effectively address their needs. More research is needed on the separate healthcare experiences of specific marginalized populations related to their sexual orientation and/or gender identity.

Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study

Background

Same-sex attracted women (SSAW) have higher rates of alcohol and mental health problems than heterosexual women, but utilisation of and satisfaction with treatment is limited.

Aim

This study investigated the influences on health service use for alcohol and mental health problems among SSAW.

Design & setting

The Gelberg-Andersen behavioural model of health service utilisation was used to generate outcome variables.

Method

A convenience sample of 521 community-connected Australian SSAW completed an online survey. Health service use according to sexual identity was compared using χ² analysis. Binary logistic regression examined associations between the independent variables with treatment utilisation.

Results

Reports of alcohol treatment were very low. Only 41.1% of participants with service need had utilised mental health and alcohol treatment. Bisexual women (adjusted odds ratio [AOR] = 2.76) and those with ‘other’ identities (AOR = 2.38) were more likely to use services than lesbian women. Enablers to service use were having a regular GP (AOR = 3.02); disclosure of sexuality to the GP (AOR = 2.42); lesbian, gay, bisexual and transgender (LGBT) community-connectedness (AOR = 1.11); and intimate partner violence ([IPV] AOR = 2.51). Social support was associated with a reduction in treatment use (AOR = 0.97). Significant access barriers included not feeling ready for help, and previous negative experiences related to sexual identity.

Conclusion

Disclosing sexual identity to a regular, trusted GP correlated with improved utilisation of alcohol and mental health treatment for SSAW. The benefits of seeking help for alcohol use, and of accessing LGBT-inclusive GPs to do so, should be promoted to SSAW.

Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters

OBJECTIVE

Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment.

METHODS

Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically.

RESULTS

Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment.

CONCLUSIONS

Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling.