Despite increasing visibility and acceptance, LGBTQ+ communities still face discrimination within many facets of life, even when accessing healthcare. A combination of fear of judgement, hostile reception from healthcare professionals, and a lack of knowledge about appropriate care for non-cisgender, non-heterosexual people are just some of the barriers that LGBTQ+ communities face when seeking medical advice or treatment. Digital health is an area that has huge potential to promote inclusivity, reduce health inequity, and lead by example when improving the healthcare experience for sexual minorities.
LGBTQ+ Healthcare Discrimination
Identity is integral to self-esteem and wellbeing. It also plays an important part in empowering individuals to exercise their rights and responsibilities in a modern society. When an individual faces restriction or discrimination on how they choose to self-identify, it simultaneously restricts their ability to freely access all parts of society, including healthcare.
Around 1 in every 14 Americans identify as lesbian, gay, bisexual, transgender or something other than cisgender (that is, those whose sex assigned at birth aligns with their gender identity) or heterosexual. Those in LGBTQ+ communities are often also members of other marginalized groups including Black, Indigenous, and People of Color (BIPOC), and those with disabilities. LGBTQ+ people often experience persistent discrimination in many parts of life – within work places, social environments, and even when trying to access healthcare.
In fact, more than one third of LGBTQ+ Americans experienced discrimination of some kind in 2020, according to a survey by the Center for American Progress. Discriminatory experiences ranged from seeing a physician who was visibly uncomfortable treating them, to being denied care, or having a healthcare professional (HCP) be verbally or physically abusive.
The net result of this is that LGBTQ+ people have poorer health outcomes than their non-LGBTQ+ peers, with higher risk of cardiovascular disease, diabetes, poor mental health, cancer, some sexual diseases like HIV, and alcohol and substance abuse.
What Causes LGBTQ+ Health Disparities?
A combination of factors contribute to the inequity faced by LGBTQ+ individuals. Many of these stem from a lack of sufficient knowledge in HCPs and health institutions on the unique healthcare challenges faced by those of sexual minorities. Other factors include:
- Lack of specific LGBTQ+ training for healthcare workers.
- Sparse clinical research on LGBTQ+ related health issues.
- Limited role models within healthcare systems for LGBTQ+ individuals.
- Fear due to stigma, discrimination, and institutional bias within healthcare.
- Poor past experiences with less-than-supportive HCPs.
- Inadequate open discussions about LGBTQ+ health, especially in the context of transgender people.
How Digital Therapeutics Can Make A Difference
Digital health and digital therapeutics (DTx), as clinical treatments, are obliged to acquire cultural competence regarding LGBTQ+ health. However, these treatments are uniquely primed to tackle health inequity. Inherently accessible by design, with over 85% of Americans owning a smartphone from which these health applications can be used, DTx can offer a safe, inclusive and discreet platform for LGBTQ+ people to improve their health.
61% of LGBTQ+ respondents from a recent survey were more satisfied with telemedicine experiences compared to in-person interactions, versus 52% of non-LGBTQ+ identifying adults. This demonstrates how valuable remote, digital healthcare already is for these communities.
Digital tools are essential, especially for LGBTQ teens who might not have other ways of reaching out to others who might understand them. – Julie Cerel, Ph.D, clinical psychologist and past president of the American Association of Suicidology
Increasingly, more DTx companies are upgrading their design to ensure use of inclusive language, culturally-appropriate, information and offering increased support to those in LGBTQ+ communities. Other digital health platforms are emerging that are LGBTQ+-centric from the outset, often designed by HCPs from marginalized sexuality groups themselves.
Some great examples of inclusive digital health companies include:
Plume is a digital health platform that offers video telehealth appointments in-app, prescriptions for hormone treatment, ongoing monitoring and support groups for their LGBTQ+ patients, injection tutorials, medical letters of support for surgery or name-changes, all coordinated by a trans-led care team.
Folx Health offers hormone treatments for LGBTQ+ people, but also primary healthcare appointments, including for problems relating to gastrointestinal issues, dermatology, common respiratory viruses, allergies, mental health and STI prevention and treatment. Folx also support patients on lifestyle issues such as smoking cessation, nutrition, safe sex, fertility and general health through coaching sessions.
Unfortunately, the monthly fee is not yet covered by insurance, but prescriptions can be reimbursed. The clinical team is made up of queer and trans HCPs, from medical doctors, registered nurses and experienced nurse practitioners, providing patients with empathetic healthcare.
NOCD is a virtual clinic for people with obsessive-compulsive disorder (OCD), primarily using a type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP).
In February 2022, the company partnered with Violet, the first platform designed to educate and benchmark health care organizations’ cultural competence. Violet aims to upskill clinical teams’ abilities to deliver culturally-aware care, with standardized ‘badges’ of certification for companies who demonstrate understanding and inclusivity for various communities, including BIPOC, LGBQ and Transgender and Gender Non-Conforming (TGNC).
Even if someone is able to get their foot in the door to see a clinician, if the environment is not supportive of their identity or circumstances, the individual cannot fully access care. – Violet
Awareness of the variety of sexual and gender identifications has certainly increased over recent years, and it is a trend that must be celebrated by looking to ways society can further support the LGBTQ+ community. In healthcare, there are still a number of gaps that could be addressed in future initiatives to ensure that medical care – right from scientific research to the first point of contact with a HCP – is as inclusive and comprehensive as it needs to be.
Expanded LGBTQ+ Care Across Age Groups
We know that child and adolescent LGBTQ+ groups have particularly poor mental health outcomes, so gender-inclusive care from a young age is vital to ensure these youths have a positive experience with healthcare from the start of their lives, building trust for accessing healthcare as adults.
Intersectional LGBTQ+ healthcare
Identity markers, e.g. ‘bisexual’ and ‘Hispanic’, often don’t exist independently of each other and may compound discrimination. Black LGBTQ+ adults, for example, are more likely to report clinical depression and economic insecurity (a known factor for poor health outcomes) than their white LGBTQ+ counterparts. Healthcare that can address these known risk factors through considerate, personalized care that does not treat issues in isolation will be needed to effectively transform healthcare from a one-size-fits-all approach, to a truly holistic one.
Better LGBTQ+ Inclusion in Research and Data Collection
Historically, details of sexual orientation and gender identity were not included in national surveys or clinical trials and so today’s standard of care is not based upon research that includes LGBTQ+ communities. This has resulted in underrepresentation of these marginalized groups in treatment protocols, hospital standard operating procedures, health policies, and health product developments.
The PRIDE study is the first large-scale, long-term national health study of people who identify as LGBTQ+ and shows promise for greater interest in minority health research. With careful planning, DTx can help address this health data gap by collecting information on LGBTQ+ users and using findings from the analysis to develop improved iterations of the therapeutic.
Discrimination is still rife even within healthcare, with people in the LGBTQ+ community suffering medical prejudice simply for existing as their true self. This has sadly created a barrier of fear for these individuals, resulting in delayed or entirely absent healthcare. Whilst the optimal outcome would be for people of all marginalized groups to feel comfortable accessing any form of healthcare when it is needed, DTx can pave the way for being an inclusive, well-designed, and informed modality that can give LGBTQ+ people the discreet, confidential, and accessible care they need and deserve whilst we strive for health equity for all.
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