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Accessing Healthcare

Finding a primary healthcare provider or family doctor can be difficult-something we see confirmed in the Sex Now Data. Whether it be inconvenient hours or the fact that healthcare providers accepting patients might be at inconvenient locations, there are lots of different reasons why just about anyone might have a hard time finding quality care. For GBQT men and other sexual and gender minorities, things can be even more difficult.

You see, in addition to the common reasons many people give for why finding quality care can be difficult, GBQT men and other sexual and gender minorities experience other barriers such as stigma and discrimination and a lack of LGBTQ cultural competency in healthcare settings. (For more info on stigma and how it affects the health of GBQT guys, visit our social health section).

While there have been many positive changes in recent years as it relates to LGBTQ healthcare—such as the rejection of ex-gay or reparative therapies—there’s still a lot of road left to cover.1 Although there are many reasons why healthcare providers might find providing LGBTQ competent healthcare challenging, whether rooted in personal bias or a lack of training and understanding, the difficulty sexual and gender minorities have in accessing  quality care can have a range of negative effects on their health.2

For one, sexual and gender minorities may delay seeking necessary medical care if they’ve had negative healthcare experiences in the past or anticipate facing a lack of LGBTQ competency. Even if they do seek care, they may fail to disclose their sexual or gender identity.3This is reinforced by recent Edmonton Sex Now data which shows that less than 2/3 of GBQT men were out to their primary healthcare provider.

Even more troublesome is the fact that Edmonton appears to be behind other urban centres such as Vancouver. Sex Now data shows us that less than 2/3 of Edmonton GBQT men are satisfied with their healthcare provider’s respect of gay sexuality and less than 50% are satisfied with their healthcare provider’s knowledge of gay health. Compared to the data we have from Vancouver, these numbers are significantly lower – and get worse when we look at the experiences of Edmonton GBTQ men below the age of 30.

So, what do we do about it? Truthfully, a lot of what needs to happen has to occur at a structural level. Currently, students at the University of Alberta’s Med School are not required to complete any significant amount of mandatory LGBTQ health training, leaving LGBTQ competency training to those who find it important or who express personal interest.

This is troubling as studies have uncovered that most healthcare providers assume off-hand that any given patient is heterosexual.2 Providers have also expressed discomfort in caring for sexual and gender minorities4 and have demonstrated both explicit and implicit preference for heterosexuals.3  Therefore, leaving LGBTQ health training as an option is likely not enough.

These sorts of changes take time, however, and your health shouldn’t have to wait for the rest of the world to come around. So, what can you do now? And what can the EMHC do?

Firstly, you can get linked to care. Less than 60% of Edmonton Sex Now respondents receive routine care from a family doctor. That number drops below 40% for guys under 30. Sure, it can be a pain: trying to find a doctor that’s accepting patients; trying to find a doctor in your area; trying to find a doctor that you’re comfortable with and who might understand the needs of GBQT guys. But one of the reasons the EMHC exists is because our community is significantly more likely to experience negative health outcomes, across the board. One of the best ways to lower the chance of you developing a significant negative health outcome–or to catch and treat it early–is to get regular care from a healthcare provider.

Next, be your own advocate. The truth is, your life and health are just as valuable as anyone else’s. So, be as honest as you can with your healthcare provider. Things like your sexual orientation and gender identity, although not always, are often relevant to the care you should receive.

If you agree with that, you’re not alone. The vast majority of LGBTQ identifying people who have been surveyed about the use of standard sexual orientation and gender identity questions in primary healthcare environments have agreed that they are important and should be asked.5 Until policies and recommendations are in place encouraging healthcare providers in Edmonton to start asking these questions, find a way to share this information with your doctor if you haven’t. And if you don’t feel safe or comfortable speaking with your healthcare provider about your sexual orientation or gender identity, perhaps it’s time to consider a change.

And finally, here’s where the EMHC comes in. We are currently working with other stakeholders to address LGBTQ competency across various levels of the healthcare system. Until we see movement on that front, we hope to compile a list of LGBTQ friendly family doctors in the city. So, if you have a great doctor, tell us about them. We want to talk to them about possibly taking other patients from our community. And, if you’re looking for an LGBTQ friendly doctor and don’t have one, let us know. We can put you on a list and let you know when local LGBTQ friendly doctors are taking patients.

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  1. Mundle G, Mahler L, Bhugra D. Homosexuality and Mental Health. Int Rev Psychiatry. 2015;27(5):355-356. doi:10.3109/09540261.2015.1109790.
  2. Kalra G, Ventriglio A, Bhugra D. Sexuality and mental health: Issues and what next? Int Rev Psychiatry. 2015;0261(November):1-7. doi:10.3109/09540261.2015.1094032.
  3. Sabin JA, Riskind RG, Nosek BA. Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. Am J Public Health. 2015;105(9):e1-e11. doi:10.2105/AJPH.2015.302631.
  4. Khan A, Plummer D, Hussain R, Minichiello V. Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections. Sex Transm Infect. 2008;84(2):150-151. doi:10.1136/sti.2007.028050.
  5. Cahill, S., Singal, R., Grasso, C., King, D., Mayer, K., Baker, K., & Makadon, H. (2014). Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers. PLoS ONE,9(9).