As a conclusion to my blog series on transgender inclusive practice, I wanted to explore the topic of sexual health and the potential for reductivity in regards to the delivery of care to LGBTQ2SIA+ clients. For gay men, it would appear that the primary risk is becoming HIV+. For gay women, it could appear that they aren’t at risk for anything given that they are the most unlikely subgroup of sexual minority women to have a care provider (Przedworski, McAlpine, Karaca-Mandic & VanKim, 2014). Due to gaps in the research, evidence on other LGBTQ2SIA+ communities is limited at best which creates another layer of marginalization for those who are unrepresented (Smalley, Warren, Barefoot, 2016). The harm in using the “T” in the LGBTQ2SIA+ as an umbrella for the diverse group of those who are gender non-conforming needs to be addressed (Smalley, Warren, Barefoot, 2016). Perhaps if gender identity and sexual orientation were addressed separately in the research, evidence would be produced that would provide insights into specific health risks of each subgroup which could then inform how healthcare professionals delivered care to LGBTQ2SIA+ clients (Smalley, Warren, Barefoot, 2016).
I personally find it interesting that LGBTQ2SIA+ healthcare is so often reduced to sexual health. Perhaps this is also due to the fact that gender identity and sexual orientation are variables that are not measured independently from one another. As long as they are not controlled for, it makes perfect sense that practice hasn’t evolved. I imagine evidence informed practice will remain reductive as long as research fails to produce evidence that exposes the many health risks of the LGBTQ2SIA+ communities. It remains no wonder why trans women, trans men and gender non-conforming people have the highest percentages of individuals who do not follow medical advice or failure to access any care at all (Smalley, Warren, Barefoot, 2016) insofar as their unique needs are not just misunderstood but instead they are most certainly completely misrepresented. Smalley, Warren & Barefoot (2016) suggest that future research should move away from sexual and substance abuse behaviours and begin to focus on personal habits of diet and exercise. They cite evidence to support this from their sample of transgender women who had the lowest rate of regular unprotected sex out of all gender groups studied however 50-60% of this group reported never or rarely exercising three times per week or eating five servings of vegetables (Smalley, Warren, Barefoot, 2016). Clearly our efforts in health promotion with the LGBTQ2SIA+ communities is missing the mark somewhere along the line.
It would appear that research into LGBTQ2SIA+ healthcare must start comparing the subgroupings if we are to produce evidence that will provide insights into the actual challenges that each subgroup faces (Smalley, Warren, Barefoot, 2016). For example, doing so could begin to teach us about the structural barriers that transgender women face as compared to cisgender women (Smalley, Warren, Barefoot, 2016) which would better control for the variable of sexual orientation. Results such as transgender men having higher rates of extra exercise as compared to transgender women could allow for new areas of investigation so as to gain new insights into challenges and risks to the health of LGBTQ2SIA+ subgroups (Smalley, Warren, Barefoot, 2016). Finally, incredibly important evidence such as stark differences between results on transgender groups as compared to gender non-conforming/genderqueer groups could be among the final arguments in the danger of assuming that the members of these diverse groups face similar challenges and/or the same behavioural practices (Smalley, Warren, Barefoot, 2016). It seems quite obvious however the evidence that current research is producing is not representative of this. What about members of the LGBTQ2SIA+ communities who identify as straight who apparently have the highest rates of many at risk behaviours (Smalley, Warren, Barefoot, 2016)? The lack of representation seems to be never-ending.
As a researcher, I’m fascinated. As a healthcare provider, I’m invested. As a member of the LGBTQ2SIA+ communities, I’m concerned. It would appear that healthcare must be delivered equally to all clients however this is an essentialization of the human experience that fails to address systemic inequity. Obviously all humans require adequate diet and exercise to have good health so this is a better starting point for LGBTQ2SIA+ clients than sexual health and substance abuse although in the absence of available evidence on how to proceed, it would appear that healthcare delivery will inevitably be limiting or reductive until the research begins to fill in the gaps.
Przedworski, J. M., McAlpine, D. D., Karaca-Mandic, P., & VanKim, N. A. (2014). Health and Health Risks Among Sexual Minority Women: An Examination of 3 Subgroups. American Journal Of Public Health, 104(6), 1045-1047 3p. doi:10.2105/AJPH.2013.301733
Smalley, K. B., Warren, J. C., Barefoot, K. N. (2016). Differences in health risk behaviors across understudied LGBT subgroups. Health psychology, 35(2), 103-114.
Featured Image Credit: Niyazz via Shutterstock