Lesbian, gay, bisexual, transgender, queer, 2-spirit (LGBTQ2S) persons experience a number of health care disparities for many reasons: discrimination and social pressures, personal sexual behaviours, limited access to health insurance, higher rates of smoking and alcohol/substance misuse, higher rates of anxiety and depression, greater risk of sexually transmitted infections (including HIV), and increased incidence of some cancers.
Health care curricula in colleges and universities are still sadly lacking content regarding the unique needs of, and health risks for, individuals who fall outside the “traditional” heterosexual orientation of society. However, you can prepare for meeting the needs of these individuals by informing yourself, listening, and making some simple and practical adjustments in your practice.
1. Expand your knowledge about sexual orientation and gender identity.
To understand the needs of LGBTQ2S clients, it’s important to expand your knowledge on the subjects of sexual orientation (SO) or attraction, and gender identity, or how one identifies with and experiences the world.
2. Know key LGBTQ2S definitions.
You can read about the meanings of asexual, gay, lesbian, bisexual, pansexual, and “queer,” descriptors that fall under the SO umbrella. Note that “queer,” formerly considered a derogatory term, is now considered by some to be a more fluid and inclusive descriptor than other words related to sexual orientation. Also, learn the meaning of terms such as agender, cisgender, transgender, gender fluid, and others that typically describe an individual’s gender identity.
3. Expand your LGBTQ2S knowledge.
Expanding your knowledge base will enrich your understanding of sexuality in general, and increase your nimbleness in identifying potential health risks for clients seeking your care.
4. Create a welcoming environment for LGBTQ2S clients.
LGBTQ2S individuals have a long history of discrimination at the individual and institutional levels, including the health care system. They may “scan” an environment to determine if it is a safe place to reveal personal information, especially about sexuality.
5. Use inclusive language.
It may take a little practice, but you can shift your vocabulary towards inclusiveness, opening the door for more open health care discussions. This can begin right in the waiting room as clients complete required forms. Rather than asking marital status, for example, the form might read, “relationship status: married, partnered, or other.” Also, include an additional space indicating “Preferred Name,” as a transgender individual may not wish to be called by a name that reflects their gender identity. Including “preferred pronoun” on a form shows understanding that someone may not identify as they appear.
6. Investigate mental and physical health risks for LGBTQ2S clients.
Be aware of the unique social pressures and health risks of LBGTQ2S clients. Societal phobias, violence, and hate crimes – and the fear of them — are all too real for these individuals. Along with the potential for being ostracized by family and other social groups, this can contribute to chronic anxiety and depression.
Those with non-conforming sexual orientation or gender identity may also experience a higher risk of suicide, as well as increased likelihood of tobacco use and drug/alcohol misuse.
7. Convey respect.
Always remember that the LGBTQ2S client in front of you has taken a courageous step to be in your office and disclose some of the most personal information about their lives. Having as positive and affirming an experience as possible will make it more likely the individual will seek future care in a timely manner.
Additional transgender health resources:
Rainbow Health Ontario (RHO) is a province-wide program of Sherbourne Health that works to promote the health of Ontario’s LGBT2SQ communities and improve their access to services. RHO creates resources, provides information and consultation services, delivers education and training, and supports research to develop evidence-based practice and informed public policy.
The Trans PULSE Project is a community-based research (CBR) project that is investigating the impact of social exclusion and discrimination on the health of trans people in Ontario.
CPATH is the largest national multidisciplinary, professional organization in the world, working to support the health, wellbeing, and dignity of trans and gender diverse people.