Lesbian, Gay, Bisexual, and Transgender Health
Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals.
LGBT individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs.
Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBT persons has been associated with high rates of psychiatric disorders,1 substance abuse,2, 3 and suicide.4 Experiences of violence and victimization are frequent for LGBT individuals, and have long-lasting effects on the individual and the community.5 Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals.6
The LGBT companion document to Healthy People 20107 highlighted the need for more research to document, understand, and address the environmental factors that contribute to health disparities in the LGBT community. As part of this work, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity (SOGI).
At the beginning of the decade, the following 6 national data systems collected sexual orientation data:
- Behavioral Risk Factor Surveillance Survey (BRFSS)
- National Health and Nutrition and Examination Survey (NHANES)
- National Survey of Family Growth (NSFG)
- Youth Risk Behavior Survey (YRBS)8
- National Crime Victimization Survey (NCVS)
- American Community Survey (ACS)
Since the beginning of the decade, 2 additional national surveys have begun collecting sexual orientation data:
- National Health Interview Survey (NHIS) – added in 20139
- National Survey of Drug Use and Health (NSDUH) – added in 201510
Why Is LGBT Health Important?
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include:
- Reductions in disease transmission and progression
- Increased mental and physical well-being
- Reduced health care costs
- Increased longevity
Efforts to improve LGBT health include:
- Collecting SOGI data in health-related surveys and health records in order to identify LGBT health disparities11
- Appropriately inquiring about and being supportive of a patient's sexual orientation and gender identity to enhance the patient-provider interaction and regular use of care12
- Providing medical students with training to increase provision of culturally competent care13
- Implementing antibullying policies in schools14
- Providing supportive social services to reduce suicide and homelessness among youth14
- Curbing human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) with interventions that work15
Understanding LGBT Health
In order to effectively address LGBT health issues, we need to securely and consistently collect SOGI information in national surveys and health records. This will allow researchers and policy makers to accurately characterize LGBT health and disparities.
Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.17
Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:
- Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits
- Lack of laws protecting against bullying in schools
- Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders
- Shortage of health care providers who are knowledgeable and culturally competent in LGBT health
The physical environment that contributes to healthy LGBT individuals includes:
- Safe schools, neighborhoods, and housing
- Access to recreational facilities and activities
- Availability of safe meeting places
- Access to health services
LGBT health requires specific attention from health care and public health professionals to address a number of disparities, including:
- LGBT youth are 2 to 3 times more likely to attempt suicide.18
- LGBT youth are more likely to be homeless.19, 20, 21
- Lesbians are less likely to get preventive services for cancer.22, 23
- Gay men are at higher risk of HIV and other STDs, especially among communities of color.24
- Lesbians and bisexual females are more likely to be overweight or obese.25
- Transgender individuals have a high prevalence of HIV/STDs,26 victimization,27 mental health issues,28 and suicide29 and are less likely to have health insurance than heterosexual or LGB individuals.30
- Elderly LGBT individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.31
- LGBT populations have the highest rates of tobacco,32, 33 alcohol,33, 34 and other drug use.33, 35, 36
Continuing Issues in LGBT Health
A number of issues will need to continue to be evaluated and addressed over the coming decade, including:
- Nationally representative data on LGBT Americans
- Prevention of violence and homicide toward the LGB community, and especially the transgender population
- Resiliency in LGBT communities
- LGBT parenting issues throughout the life course
- Elder health and well-being
- Exploration of sexual/gender identity among youth
- Need for a LGBT wellness model
- Recognition of transgender health needs as medically necessary
1McLaughlin KA, Hatzenbuehler ML, Keyes KM. Responses to discrimination and psychiatric disorders among black, Hispanic, female, and lesbian, gay, and bisexual individuals. Am J Public Health. 2010;100(8):1477-84.
2Ibanez GE, Purcell DW, Stall R, et al. Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS. 2005;19(suppl 1):49-55.
3Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353-75.
4Remafedi G, French S, Story M, et al. The relationship between suicide risk and sexual orientation: Results of a population-based study. Am J Public Health. 1998;88(1):57-60.
5Roberts AL, Austin SB, Corliss HL, et al. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health. 2010 Apr 15.
7Gay and Lesbian Medical Association (GMLA). Healthy People 2010: A companion document for LGBT health [Internet]. San Francisco: GMLA; 2001 Apr. Available from: http://www.glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf [PDF - 2.3 MB]
8Centers for Disease Control and Prevention [Internet]. Atlanta: Centers for Disease Control and Prevention. LGBTQ youth programs at-a-glance; [updated 2017 Nov 28; cited 2018 Apr 12]. Available from: https://www.cdc.gov/lgbthealth/youth-programs.htm
9Ward BW, Dahlhamer JM, Galinsky AM, Joesti SS. Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013 [Internet]. Hyattsville (MD): National Center for Health Statistics; 2014 [cited 2018 Apr 12]. 12 p. Available from: https://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf [PDF - 200 KB]
10Medley G, Lipari RN, Bose J, Cribb DS, Kroutil LA, McHenry G. Sexual orientation and estimates of adult substance use and mental health: results from the 2015 National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration; 2016 Oct [cited 2018 Apr 12]. 54 p. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.pdf [PDF - 1.1 MB]
11Cahill SR, Baker K, Deutsch MB, etal. Inclusion of Sexual Orientation and Gender Identity in Stage 3 Meaningful Use Guidelines: A Huge Step Forward for LGBT Health. LGBT Health. 2015; 0(0):1-3.
12Steele LS, Tinmouth JM, Lu A. Regular health care use by lesbians: A path analysis of predictive factors. Fam Pract. 2006;23:631-6.
13Sanchez NF, Rabatin J, Sanchez JP, et al. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Med Stud Edu. 2006;38(1):21-7.
14Suicide Prevention Resource Center. Suicide risk and prevention for lesbian, gay, bisexual, and transgender youth. Newton, MA: Education Development Center, Inc.; 2009. Available from: http://www.sprc.org/sites/default/files/migrate/library/SPRC_LGBT_Youth.pdf [PDF - 428 KB]
15Centers for Disease Control and Prevention (CDC). Compendium of HIV prevention interventions with evidence of effectiveness [Internet]. Atlanta: CDC; 2017. Available from: https://www.cdc.gov/hiv/research/interventionresearch/compendium/
16Ponce NA, Cochran SD, Pizer JC, et al. The effects of unequal access to health insurance for same-sex couples in California. Health Affairs. 2010;29(8):1-10.
17Bux DA. The epidemiology of problem drinking in gay men and lesbians: A critical review. Clin Psych Rev. 1996;16:277-98.
18Garofalo R, Wolf RC, Wissow LS, et al. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999;153(5):487-93.
19Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010 Oct;100(10):1953-60.
20Kruks, G. Gay and lesbian homeless/street youth: Special issues and concerns. J Adolesc Health. 2010;12(7):515-8.
21Van Leeuwen JM, Boyle S, Salomonsen-Sautel S, et al. Lesbian, gay, and bisexual homeless youth: An eight-city public health perspective. Child Welfare. 2006 Mar–Apr;85(2):151-70.
22Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health. 2010;100(3):489-95.
23Dilley JA, Simmons KW, Boysun MJ, et al. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. Am J Public Health. 2010;100(3):460-7.
24Centers for Disease Control and Prevention (CDC). HIV among Gay and Bisexual Men [Internet]. Atlanta: CDC; 2017 Feb [cited 2017 Aug 23]. Available from: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf [PDF-78KB]
25Struble CB, Lindley LL, Montgomery K, et al. Overweight and obesity in lesbian and bisexual college women. J Am College Health. 2010;59(1):51-6.
26Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS Behav. 2008;(12):1-17.
27Whitbeck LB, Chen X, Hoyt DR, et al. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. J Sex Research. 2004;41(4):329-42.
28Diaz RM, Ayala G, Bein E, et al. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from three US cities. Am J Public Health. 2001;91(6):141-6.
29Kenagy GP. Transgender health: Findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19-26.
30National Gay and Lesbian Taskforce. National transgender discrimination survey: Preliminary findings. Washington, DC: National Gay and Lesbian Taskforce; 2009 Nov.
31Cahill S, South K, Spade J. Outing age: Public policy issues affecting gay, lesbian, bisexual and transgender elders. Washington: National Gay and Lesbian Task Force; 2009 Nov.
32Lee GL, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA: 1987 to May 2007: A systematic review. Tob Control. 2009;18:275-82.
33Xavier J, Honnold J, Bradford J. The health, health-related needs, and lifecourse experiences of transgender Virginians. Virginia HIV Community Planning Committee and Virginia Department of Health. Richmond, VA: Virginia Department of Health; 2007. Available from: http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf [PDF - 646 KB]
34Hughes TL. Chapter 9: Alcohol use and alcohol-related problems among lesbians and gay men. Ann Rev of Nurs Res. 2005;23:283-325.
35Lyons T, Chandra G, Goldstein J. Stimulant use and HIV risk behavior: The influence of peer support. AIDS Ed and Prev. 2006;18(5):461-73.
36Mansergh G, Colfax GN, Marks G, et al. The circuit party men's health survey: Findings and implications for gay and bisexual men. Am J Public Health. 2001;91(6):953-8.