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For many marginalized populations, Canada’s universal healthcare systems are lacking in access, knowledge, and quality, as several key dimensions that impact individuals’ well-being such as social determinants of health, stigma, discrimination as well as systems of oppression including racism, sexism, ableism, sizeism, homophobia, biphobia, and transphobia have often been reported when seeking care.
In furthering our understanding of the experiences reported by marginalized communities, the concept of intersectionality provides a foundation to acknowledge that individuals hold multiple identities when interacting with overarching systems and institutions. With this in mind, there are many ways in which individuals who hold multiple marginalized identities tend to experience feelings of invisibility, invalidation, stigma, discrimination, violence, and trauma when seeking care, support, and treatment within the healthcare system.
Stigma for LGBTQI2S people can be experienced individually, socially and structurally (Bolderston and Ralph, 2016):
- Stigma on the level of the Individual influences personal beliefs such as shame and internalized homophobia, biphobia, and transphobia.
- Social level stigma occurs in interactions such as hate crimes, homophobic slurs and language, and microaggressions.
- Structural level stigma is expressed through institutions as well as provincial, federal, and international jurisdictions. For example, anti-discrimination or human right laws that do not include sexual orientation and gender identity and expression.
- In addition to stigma, LGBTQI2S people may experience minority stress, which contributes to chronically elevated stress levels. This is even more likely if individuals also hold other marginalized identities such as being racialized and disabled (Chang and Chung, 2016; Sue et al., 2007).
- A growing body of research (Bolderston and Ralph, 2016; Bauer, Zong, Scheim, Hammond, Thind, 2016; Chang and Chung, 2015; Dean, Victor, Guidry Grimes, 2016; Human Rights Campaign Foundation, 2016; McNamara and Ng, 2016) shows that LGBTQI2S communities are experiencing stigma, discrimination as well as harmful interactions with healthcare professionals. These negative experiences often exacerbate, intensify, and widen these populations’ health disparities (Sharman, 2016).
- One in five trans identified persons report having been denied care or treatment by a doctor, and these rates are more prevalent among trans people of colour (AAMC, 2014; Nixon, 2013).
- TransPULSE, a trans health study, reported almost half of trans identified women and men have reported feeling uncomfortable discussing trans related health issues with their family physicians, among these participants approximately forty percent of trans identified patients have reported at least one trans-negative experience with their family doctors (Bauer, Zong, Scheim, Hammond, Thind, 2016).
- Lesbian, gay, bisexual, and transgender people have reported additional barriers to accessing healthcare stemming from the lack of cultural awareness and training in working with LGBTQI2S communities and marginalized populations (Dean, Victor, Guidry Grimes, 2016; Bolderston and Ralph, 2016; McNamara and Ng, 2016; McClain, Hawkins, Yehia, 2015; Obedin-Maliver et al., 2011).
Stigma, Discrimination, and Systems of Oppression
- Lesbian, gay, bisexual, transgender, and Two Spirit people frequently experience stigma, discrimination, and violence (AAMC Advisory Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities 2011; Bauer, Zong, Scheim, Hammond, Thind, 2016; Bolderston and Ralph, 2016; Hunt, 2016; McClain, Hawkins, and Yehia, 2016).
- Lesbian, gay, bisexual, and transgender people are twice as likely to be exposed to traumatic experiences over their lifetime in comparison to their heterosexual counterpart (AAMC, 2014).
- TransPULSE reported that 20 percent of participants have experienced physical or sexual violence, while 34 percent have experienced verbal harassment or threats as a result of being trans (Bauer et al., 2015).
- Lesbian, gay, bisexual, and transgender youth are more likely to be homeless, as they represent 20-40% of homeless youth population. LGBT youth are often homeless due to family relationship breakdown and additional barriers within the shelter system stemming from homophobia, biphobia, and transphobia (Abramovich, 2012).
- Lesbian, gay, bisexual, and transgender populations, including youth, have 2-4 times the higher rate of tobacco, alcohol, and drug use than the general cisgender and heterosexual population, which stems from social stressors including lack of safe non-partying social spaces, lack of cultural acceptance as well as coping stigma and trauma (Robinson, 2014; Law et al. 2016; Bolderston and Ralph, 2016).
- Lesbians and bisexual women have higher rates of smoking tobacco than their heterosexual counterpart (AAMC, 2014; McNamara and Ng, 2016).
- Lesbian, gay, bisexual, and transgender experience higher rates of mental health issues including mood, anxiety, and depression than their cisgender heterosexual counterparts (Law et al., 2015; McNamara and Ng, 2016; Bauer et al., 2015). These rates are even higher among Indigenous, racialized, and newcomer LGBTQI2S people (Logie et al., 2016).
- Lesbian, gay, bisexual, and transgender people are more likely to experience suicidal ideation and attempts. For example, according to the TransPULSE survey, almost 75 percent of trans adults had considered suicide and 43 percent had attempted suicide at some point in their lives (Bauer et al., 2015; AAMC Advisory Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities 2011; Ferlatte et al., 2015).
- Lesbian, gay, bisexual, and transgender youth are twice as likely to have suicidal ideation than their cisgender and heterosexual counterpart and are three to four times more likely to have attempted suicide that requires medical attention (Sharman, 2016; Bauer et al., 2015).
- Gay, bisexual, and other MSM (men who have sex with men) have higher rate of HIV and STIs (Law et al., 2015; ), which is more prevalent among men of colour.
- A growing body of research is showing that Indigenous lesbian, gay, bisexual, transgender, and Two Spirit people in Canada have high prevalence rates of HIV/AIDS and HIV related risk factors (Hunt, 2016).
- Trans women have higher rates of HIV and STIs, especially trans women of colour (Bauer et al., 2009).
- Lesbian, bisexual, and other WSW (women who have sex with women) sexual health concerns are often overlooked due to the erroneous assumption that STIs can not be transmitted from sexual activities performed between women (RHO, 2011). Due to this false assumption, WSW are put in higher risk of not being screened regularly for HPV and STIs.
- Gay men are at higher risk of anal cancer (different from colon and prostate cancers) than heterosexual men (Quinn et al., 2015).
- Lesbian and bisexual women tend to have higher rates of breast cancer and are also less likely to seek preventive care for cancer (Quinn et al., 2015).
- Currently, there is little data on the prevalence rates and outcomes for trans and gender variants populations (Quinn et al., 2015).
As a result of these health disparities, LGBTQI2S people often encounter multiple barriers, experience discomfort and discrimination as well as receive improper health care. These experience highlight the current service gaps within our healthcare system.
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