A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities

Abstract

Background Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. Methods A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. Results LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. Conclusion Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.

Co‐producing knowledge of lesbian, gay, bisexual, trans and intersex (LGBTI) health‐care inequalities via rapid reviews of grey literature in 27 EU Member States

“…Some LGBTI people feared negative consequences such as being treated as different or as ‘other’ whilst accessing (or attempting to access) health care . Due to the effects of discrimination and stigma, research reported that specialist mental health or psychological support services for LGBTI people where they could make meaning of adversity were lacking . Rapid reviews were consistent with wider academic literature in reporting that gay, bisexual and trans people can be deterred from accessing health care such as seeking HIV testing and treatment if they feared discrimination or encountering the stigmatizing attitudes of health professionals .…”

“…In relation to conversion therapy, health professionals’ assumptions framing LGBT identities as ‘disorders’ were based on dated diagnoses that were removed from the psychiatric systems of diagnosis and classification (DSM and ICD) as part of the demedicalization of sexual orientation . This lack in knowledge supports the need for education and training of health professionals widely reported in research to question normativity and promote more inclusive health‐care practices for LGBT people . Health professionals will benefit from further education and training to help them navigate their way through changing terminology and complex health‐care systems.…”

“…Much of the research on intersex health relates to surgical intervention that is focused on assigning one sex within the male/female binary often without consent in relation to intersex minors. More research is needed to account for the views of intersex people themselves regarding their health and experiences of accessing health care …”

“…The health inequalities of lesbian, gay, bisexual, trans and intersex (LGBTI) people are well documented in global research. Several recent systematic reviews and narrative syntheses of research summarize these health inequalities . Large‐scale global reviews increasingly reflect how the health and health‐care needs of LGBTI people are often poorly understood with evidence of a higher burden of certain conditions for both the physical health and mental health of LGBTI people compared with the general population …”

“…These factors such as discrimination and minority stress are linked to the causes of health inequalities; however, the causes are complex and often a combination of a range of individual as well as cultural, political and social factors . Efforts to reduce LGBT health and health‐care inequalities is a social justice issue requiring targeted research, policy and practice intervention at multiple levels . Consequently, research with LGBTI people and their engagement in health service delivery, research and policy is increasingly important as a collaborative effort to tackle inequalities .…”