│ LGBTQ INFORMATION NETWORK │ RAINBOW OF RELEVANT
LGBTQ Youth Need to Be Counted
Surgeon General Says LGBTQ Youth Should
be a Priority
LGBT Healthcare Publications: National
LGBTQ Health Education Center
Advancing Healthcare for the LGBTQ
of Depression Among Rural LGBTQ
Division of Gender, Sexuality & Health, at the New York
State Psychiatric Institute and the Columbia University
Department of Psychiatry, wrote this report regarding
LGBTQ health issues.
Over the past decade, and especially in the past few
years, there have been sweeping changes in US society,
law, and public policy, including the following:
--In 2003, the Supreme Court invalidated all remaining
anti-sodomy laws in its ruling in Lawrence v. Texas.
--In 2004, individual states began adopting same-sex
--In 2010, the “It Gets Better” online campaign was
launched, a signal of growing societal support for LGBTQ
youths, parents, and families. It now has over 50,000
videos and 50 million views on YouTube.
--In 2011, the federal government repealed the “Don’t
Ask, Don’t Tell" policy in the military and articulated
LGBTQ rights as a foreign policy goal.
--In 2011, the Institute of Medicine (IOM) released a
report on the health of LGBTQ people. Federal agencies
such as CDC, SAMHSA, and others have also highlighted
--In 2012, marriage equality was endorsed by President
Obama, the Democratic Party’s platform, and a plurality
of poll respondents.
--In 2013, President Barack Obama, in his second
inaugural address, articulated equality for a LGBTQ
people as a priority area of his administration.
--In 2013, the Supreme Court allowed the restoration of
marriage equality in California and struck down the
provision of the Defense of Marriage Act (DOMA) that
prohibited the federal government from recognizing
married same-sex couples.
--In 2014, a range of challenges to state same-sex
marriage bans are being pursued and the federal
government continues to proactively implement the
Supreme Court's partial overturning of DOMA.
the US Supreme Court legalizes same-sex marriage
Despite these advances, the health and mental health of
lesbian, gay, bisexual, transgender, and queer (LGBTQ)
individuals has emerged as a major concern across the
nation. Numerous examples of stigmatization,
discrimination and health inequities have been
documented, including the following:
--Increased rate of suicide attempts and of homelessness
among LGBTQ youth (Estimates indicate that as many as
40% of homeless youth are LGBTQ).
--Decreased utilization by lesbians of preventive
services for cancer and increased risk factors and
elevated rates of cancer (Estimated relative risk of
invasive breast cancer among lesbians is 1.74).
--Higher risk of HIV and STDs among gay men, especially
in communities of color (From 2006-2009, gay men
accounted for 56-61% of all new HIV infections; MSM
13–29 represented more than 27% of all new HIV
infections; among MSM 13-29, HIV among black MSM was up
--High prevalence among transgender individuals of
HIV/STDs, victimization, mental health issues, and
suicidal ideation (41% of trans respondents reported
suicide attempt vs. 1.6% of the general population; 23%
were impacted by at least three major life-disrupting
events due to bias.)
--Barriers to health faced by elderly LGBTQ individuals
because of isolation, and lack of social services and
culturally competent providers (Older LGBTQ people are 2
times as likely to live alone; 1/3 plan to hide LGBTQ
status if in long-term care).
Higher rates of mental health morbidities and tobacco,
alcohol, other drug use (Alcohol abuse and smoking are
more than 2 times greater among LGBTQ people).
--A significant proportion of people with serious mental
illness (SMI) in the US are LGBTQ (Estimates suggest
that about 720,000, or about 4% of people with SMI, are
At the same time, new areas of concern are also emerging
across the lifespan, such as:
--children "coming out" at ever-younger ages.
--schools trying to tackle the problem of bullying.
--early medical interventions becoming available for
--new family dynamics emerging among same-sex couples
who are legally married and/or who are raising children.
--the first large cohort of openly LGBTQ people becoming
no longer merely potential or emerging issues with
regard to mental and physical health. Rather, they are
immediate and pressing needs demanding focused efforts
in research, clinical practice, education, and public
policy. Yet far too few LGBTQ individuals, particularly
from within poor and marginalized communities have
access to the quality services they need. Through the
LGBTQ Health Initiative, we aim to address these and
many other related issues.
HHS: LGBTQ Health and Wellbeing
2016 Was a Banner Year for AIDS/HIV Research
US Health & Human Services Reports: LGBTQ Health and
Huff Post: LGBTQ Wellness
LGBTQ Access to
Care and Coverage
Lesbian, gay, bisexual, transgender, and queer (LGBTQ)
individuals often face challenges and barriers to
accessing needed health services and, as a result, can
experience worse health outcomes. These challenges can
include stigma, discrimination, violence, and rejection
by families and communities, as well as other barriers,
such as inequality in the workplace and health insurance
sectors, the provision of substandard care, and outright
denial of care because of an individual’s sexual
orientation or gender identity.
While sexual and gender minorities have many of the same
health concerns as the general population, they
experience certain health challenges at higher rates,
and also face several unique health challenges. In
particular, research suggests that some subgroups of the
LGBTQ community have more chronic conditions as well as
higher prevalence and earlier onset of disabilities than
heterosexuals. Other major health concerns include
HIV/AIDS, mental illness, substance use, and sexual and
physical violence. In addition to the higher rates of
illness and health challenges, some LGBTQ individuals
are more likely to experience challenges obtaining care.
Barriers include gaps in coverage, cost-related hurdles,
and poor treatment from health care providers.
[Source: Kaiser Family Foundation, 2015]
LGBTQ and Public Health
NIH: Launches Call for Input on LGBTQ Health
Gay & Lesbian Health
LGBTQ individuals are as diverse as the general
population in terms of race, ethnicity, age, religion,
education, income, and family history. A number of
health concerns are unique to or shared by the LGBTQ
community, however, including an increased risk of
certain cancers, infectious and sexually transmitted
diseases (STDs), and mental health disorders; issues
relating to nutrition and weight, tobacco use, and
substance abuse; and discrimination by health care and
The definitions of different sexual identities have
shifted over the years, as have the perceptions and
stereo-types of the general population. Because of the
wide range of behaviors and identities that exist in the
LGBTQ community, it is difficult to develop an inclusive
definition. It is generally accepted, however, that gay
men and lesbians are sexually attracted to or
participate in sexual behaviors with individuals of the
same gender, while bisexual men and women are sexually
attracted to or participate in sexual behaviors with
individuals of both genders. Transgender individuals
live part- or full-time in a gender role opposite to
their genetic sex.
It is estimated that approximately 2.8% of men and1.4%
of women identify as being gay, lesbian, or bisexual
while 9.1% of men and 4.3% of women have participated in
sexual behavior with someone of the same gender at least
once. The true extent of the transgender community has
not been well researched in the United States; one study
from the Netherlands in 1993 found that one in 11,900
males and one in 30,400 females are transgender.
Reporting on Health: LGBTQ Health Issues
Healthline: Gay and Lesbian Health
Issues and Sexual Concerns
There are a number of issues that arise when trying to
define sexual orientation. Many gay men and lesbians
have participated in or continue to participate in
sexual activities with members of the opposite sex but
choose not to identify as heterosexuals or bisexuals.
Others have never participated in sexual activities at
all yet still identify as gay, lesbian, or bisexual.
Some men and women identifying as bisexuals are in
long-term, monogamous relationships with individuals of
the same or opposite sex. Male-to-female (MTF) or
female-to-male (FTM) transgender individuals may or may
not identify themselves as gay or lesbian.
implications of these identity issues are far-reaching.
Misdiagnoses or improper medical recommendations might
come from health care providers who have mistakenly
assumed sexual behaviors or risks from the patient's
stated identity. For example, a provider might
incorrectly assume that a lesbian patient has never had
sexual intercourse with a male and therefore would not
have contracted STDs not normally transmitted by sexual
activities between women. It has been difficult to
closely estimate the numbers of LGBTQ individuals in the
United States because of varying definitions. Likewise,
the statistics in medical or social studies and surveys
on LGBTQ issues might vary widely depending on what
definitions were provided for the respondents. Because
of this, many researchers have opted for the more
inclusive terms of "men who have sex with men" (MSM) and
"women who have sex with women" (WSW) to categorize gay,
lesbian, and bisexual respondents.
LGBTQ Health and
Many LGBTQ individuals have difficulty revealing their
sexual identity ("coming out") to their health care
providers. They may fear discrimination from providers
or believe that their confidentiality might be breached.
In some cases health care workers have been poorly
trained to address the needs of LGBTQ individuals or
have difficulty communicating with their LGBTQ patient
(one study indicated that 40% of physicians are
uncomfortable providing care for gay or lesbian
patients). In addition, many questions posed in
questionnaires or examinations are heterosexually biased
(asking a lesbian which birth control methods she uses
or a gay man if he is married, single, or divorced).
Other reasons why LGBTQ individuals are often hesitant
to share their sexual identity are more logistical. Many
insurance companies deny benefits to long-term partners
on the basis that they are not married. LGBTQ patients
may have inadequate access to health care, either
because they live in a remote rural area or in the
crowded inner city. Some same-sex partners encounter
discrimination in hospitals and clinics when they are
denied the rights usually given to spouses of a patient
such as visiting, making medical decisions, and
participating in consultations with physicians.
Understanding & Eliminating Health Disparities in the
Kaiser Family Foundation: LGBT Health & Access to Care &
APA: LGBT Health Disparities
US Office of Disease Prevention & Health Promotion: LGBT
Notes: Risk Factors
Some of the health concerns and risk factors that are
relevant to LBGTQ individuals may be shared by the
general population, while others are more specific to
the LGBTQ community, and still others are specific to
different subgroups of LGBTQ individuals. These health
concerns may be grouped into the following areas of
Sexual behavior issues: STDs such as human
immunodeficiency virus (HIV) and acquired immune
deficiency syndrome (AIDS), hepatitis A virus (HAV),
hepatitis B virus (HBV), bacterial vaginosis, gonorrhea,
chlamydia, and genital warts (human papillomavirus or
HPV); anal, ovarian, and cervical cancer.
Cultural issues: body image, nutrition, weight, and
eating disorders; drug and alcohol abuse; tobacco use;
parenting and family planning.
Discrimination issues: inadequate medical care;
harassment at work, school, or home; difficulty in
obtaining housing, insurance coverage, or child custody;
Sexual identity issues: conflicts with family, friends,
and work mates; psychological issues such as anxiety,
depression, and suicide; economic hardship.
│ LGBTQ Information Network │ Established 2017 │