“Automatic assumption of your gender, sexuality and sexual practices is also discrimination”: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada

Abstract

Sexual and mental health disparities are reported in Arctic Canada as in other Arctic regions that experience shared challenges of insufficient healthcare resources, limited transportation, and a scarcity of healthcare research. Lesbian, gay, bisexual, transgender, and queer persons (LGBTQ+) report sexual and mental health disparities in comparison with their heterosexual and cisgender counterparts, and these disparities may be exacerbated in rural versus urban settings. Yet limited research has explored sexual healthcare experiences among LGBTQ+ persons in the Arctic who are at the juncture of Arctic and LGBTQ+ health disparities. We conducted a qualitative study from May 2015 to October 2015 with LGBTQ+ persons in the Northwest Territories, Canada that involved in‐depth individual interviews with LGBTQ+ youth (n = 16), LGBTQ+ adults (n = 21), and key informants (e.g. coaches, teachers, nurses, social workers, and healthcare providers) (n = 14). We conducted thematic analysis, a theoretically flexible approach that integrates deductive and inductive approaches, to identify and map themes in the data. Findings reveal geographical, social, and healthcare factors converge to shape healthcare access. Specifically, the interplay between heterosexism and cisnormativity, intersectional forms of stigma, and place limited LGBTQ+ persons’ sexual healthcare access and produced negative experiences in sexual healthcare. Limited healthcare facilities in small communities resulted in confidentiality concerns. Heteronormativity and cisnormativity constrained the ability to access appropriate sexual healthcare. LGBTQ+ persons experienced LGBTQ+, HIV, and sexually transmitted infections stigma in healthcare. Participants also discussed healthcare provider recommendations to better serve LGBTQ+ persons: non‐judgment, knowledge of LGBTQ+ health issues, and gender inclusivity. Findings can inform multi‐level strategies to reduce intersecting stigma in communities and healthcare, transform healthcare education, and build LGBTQ+ persons’ healthcare navigation skills.

A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities

“…We now have a much deeper understanding of some of the issues of 2SLGBTQ+ access and equity within health and social care services in Global North societies, with the growing body of research on access to care pointing to the detrimental impact of inequities on the health and well-being of 2SLGBTQ+ individuals and communities. A diversity of topics has been addressed within this scholarship and includes attention to challenges experienced across the life course such as those related to aging [ 15 , 16 , 17 ]; gender identity [ 18 , 19 , 20 ]; racialization [ 21 , 22 , 23 ]; Two-Spirit identity [ 24 , 25 ] health conditions [ 26 , 27 ]; rurality [ 28 , 29 , 30 ]; and health services policy and delivery [ 31 , 32 ].…”

‘Treat me with respect’: transgender persons’ experiences of encounters with healthcare staff

“…The experiences of transgender persons have often been studied together with those of LGBTQ + persons in general (10)(11)(12). To the best of our knowledge, only a few recent research studies of experiences with health care have a specific focus on transgender persons' perspectives (4,9,(13)(14)(15)(16)(17)(18)(19)(20).…”

Contextual factors associated with depression among Northern and Indigenous adolescents in the Northwest Territories, Canada

“…These findings signal that addressing depression among NWT adolescents is important to advance wellbeing, and that there are intervenable social contextual factors in the environment that may contribute to improved mental health (Erskine et al, 2015;Ross et al, 2020). We address knowledge gaps regarding multi-level factors that increase vulnerability to depression (Logie and Lys, 2015;Logie et al, 2019). We also highlight heterogeneity in factors that contribute to moderate-severe depression compared with minor depression, which itself is a risk factor for major depression (Rowe and Rapaport, 2006).…”

“…Participants also reported on their age, gender (cisgender women, cisgender men, transgender and non-binary), sexual identity [lesbian, gay, bisexual, queer, two-spirit or other sexually Global Mental Health diverse (LGBQ2S) or heterosexual], Indigenous identity, living in an urban (Yellowknife) or rural (outside Yellowknife) location. We assessed food insecurity with a single item utilized in prior research with this population (Logie et al, 2019) ('how often do you go to sleep hungry because you do not have enough food to eat', dichotomized to ever v. never).…”