Healthcare Barriers for LGBTQI+ Individuals: A Call for Change

When LGBTQI+ people walk into a doctor’s office, they should expect the same standard of care as anyone else. Yet for millions of queer and gender-diverse individuals, healthcare settings are not spaces of healing – they are sites of fear, judgment, and discrimination. From being refused treatment to having their identities reduced to pathologies, LGBTQI+ people face systemic healthcare barriers that directly harm their physical and mental health. Understanding how these barriers operate – and where they come from – is the first step toward dismantling them.

Healthcare discrimination against LGBTQI+ individuals 🔗

Discrimination in healthcare settings is not a rare occurrence for LGBTQI+ people – it is a documented, widespread pattern. Data from the Center for American Progress show that LGBTQ people experience discrimination ranging from harassment and humiliation by providers to being outright refused service at hospitals, pharmacies, and doctors’ offices. In one documented case, a hospital refused to provide HIV medication to a patient after he disclosed he had sex with other men. In another, a transgender teenager admitted for a mental health crisis was repeatedly misgendered and then discharged early – he later died by suicide.

These are not isolated incidents. A survey on LGBTQ+ patient safety found that 37% of gay, lesbian, queer, or bisexual respondents had experienced some form of negative or discriminatory treatment from a doctor or healthcare provider in the past year. For transgender respondents, that figure climbed to 59%. The consequences extend beyond the moment of discrimination: a study on seriously ill LGBTQ+ patients found that discrimination increased anxiety, depression, and loneliness, and made patients significantly less likely to seek care in the future.

The role of provider ignorance and bias 🔗

Much of the discrimination LGBTQI+ patients face is rooted not just in outright hostility, but in ignorance. Research applying the Health Stigma and Discrimination Framework found that healthcare professionals’ stigma toward LGBTQ+ patients is driven by knowledge deficits and transphobia, facilitated by the binary organization of medical education, cisnormative administrative systems, and a workplace culture that normalizes prejudice. The same research found that although the American Medical Association recommends including LGBTQ+ health topics in medical training, coverage remains poor – with some nursing programs dedicating only an average of 1.6 hours to LGB-related content. When providers have not been trained to understand queer health needs, patients frequently find themselves in the position of educating their own doctors about their bodies and identities.

The practical effect is stark. Researchers at the University of Colorado Anschutz describe a pattern in which LGBTQI+ people – particularly transgender individuals – skip routine care entirely because they fear having to hide their identity or endure disrespect to receive treatment. This avoidance compounds existing health disparities and results in conditions going undetected and untreated. For older LGBTQI+ adults, who are less likely to have strong family support networks to advocate on their behalf, this isolation is particularly dangerous.

Financial and structural barriers 🔗

Discrimination is compounded by economic hardship. The 2022 CAP survey found that LGBTQI+ adults were more than twice as likely as non-LGBTQI+ adults to report having postponed or not sought needed medical care because they could not afford it – 36% compared to 17%. For mental health care specifically, 40% of LGBTQI+ respondents said they wanted to see a therapist in the past year but could not afford to. Among transgender and nonbinary respondents, that figure rose to 57%. These financial barriers intersect with discrimination to create a situation where some of the most vulnerable people face the most significant obstacles to care.

The medicalization and pathologization of queer identities 🔗

The discrimination LGBTQI+ people encounter in healthcare today does not exist in a vacuum. It is rooted in a long history of medicine treating queerness not as a variation of human experience, but as a disease to be cured. As one open textbook on LGBTQ+ studies explains, drawing on philosopher Michel Foucault’s influential analysis, queer sexualities that had historically been framed in legal or religious terms became fully medicalized in the nineteenth century. By the Victorian era, homosexuality was classified as a psychiatric condition with its own supposed anatomical and neuropsychiatric pathology. What had been a moral failing became a medical diagnosis – and with that came the authority of medicine to define, study, and “treat” queer people.

Homosexuality remained listed as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) until 1973 – and even its removal did not fully end pathologization. As historical records show, in homosexuality’s place, the DSM introduced “Sexual Orientation Disturbance,” a diagnosis that still pathologized same-sex attraction if the individual found it distressing – a framing that conveniently continued to legitimize conversion therapy practices. Subsequent revisions added “Ego Dystonic Homosexuality” before this too was eventually removed in 1987. The pattern reveals a medical establishment that shifted its framing incrementally, often in response to pressure from affected communities rather than scientific evidence.

Conversion therapy and its harms 🔗

Conversion therapy – the pseudoscientific practice of attempting to change a person’s sexual orientation or gender identity to align with heterosexual or cisgender norms – emerged directly from these pathologizing frameworks. Medical and psychological consensus is clear: conversion therapy does not work, and it causes significant and lasting psychological harm. Experts have described it as a form of torture, cruel and degrading treatment, and child abuse when applied to minors. Yet it continues to be practiced in various forms in many parts of the world. A newer iteration, called “gender exploratory therapy,” delays social and medical transition for transgender individuals under the guise of exploring the “root causes” of their gender identity – a framing that critics and bioethicists have identified as functionally equivalent to older conversion practices.

A joint statement by UN human rights bodies is direct on this point: pathologizing LGBTQ+ identities has historically been, and continues to be, one of the root causes of the human rights violations these communities face. The statement calls on governments to reform medical classifications and prevent all forced or coercive treatments on LGBTQ+ persons, noting that pathologizing classifications are also used to justify criminalization, denial of legal gender recognition, and exclusion from healthcare, education, housing, and employment.

Intersex individuals and non-consensual surgeries 🔗

Among the most serious ongoing forms of medical harm against queer and gender-diverse bodies is the practice of performing non-consensual “normalizing” surgeries on intersex infants and children. Intersex people are born with biological characteristics – chromosomal, hormonal, or anatomical – that do not fit conventional definitions of male or female bodies. Rather than allowing these children to grow and make their own decisions about their bodies, medical institutions have historically intervened to enforce binary sex norms through irreversible surgical procedures, without the informed consent of the individual. Research on trans and intersex healthcare from a human rights perspective identifies such practices as violations of the right to bodily integrity and calls for health services to be grounded in informed consent and free from pathologization.

Public health responses and AIDS stigma 🔗

Perhaps no episode more clearly illustrates the intersection of healthcare and anti-LGBTQI+ prejudice than the AIDS crisis of the 1980s. When the epidemic emerged, as the United Nations documented, the stigma attached to homosexuality within medical, governing, law enforcement, and religious institutions became a direct barrier to understanding, prevention, and treatment. The disease was initially labeled “gay-related immune deficiency” – a framing that proved both medically inaccurate and deeply harmful, as it suggested the disease was inherent to gay identity rather than transmitted through specific behaviors regardless of sexual orientation.

Historical analysis published in the American Journal of Public Health details how this stigma translated into discrimination at every level of society. People with AIDS were evicted by landlords, refused treatment by medical professionals, and fired from jobs. Obituaries omitted AIDS as a cause of death. Same-sex partners were denied access to hospitals, funerals, and the homes they had shared. The political response was equally negligent: as documented by the British Academy, US President Reagan notoriously avoided any public mention of AIDS until 1985, as conservative forces labeled those living with HIV as “immoral.” By then, tens of thousands had already died.

Community organizing in the face of government failure 🔗

Faced with government silence and medical indifference, LGBTQI+ communities organized themselves. NBC News’ historical account of the crisis describes how the Gay Men’s Health Crisis was founded in New York City in 1982 – today the oldest HIV/AIDS service organization in the world – and how the AIDS Coalition to Unleash Power (ACT UP) was formed in 1987 to push back against government inaction. Their activism directly accelerated FDA approval of HIV treatments, changed how clinical research was conducted, and drew public attention to the lethal consequences of homophobic public health policy.

The legacy of AIDS stigma persists. The Human Rights Campaign notes that HIV criminalization statutes – which 37 US states still maintain – disproportionately affect LGBTQI+ people and run counter to effective public health by perpetuating stigma and discouraging testing and treatment. A qualitative study on HIV testing among gay and bisexual men found that fear of being stereotyped as promiscuous, fear of social rejection, and distrust of providers all acted as stigma-related barriers to getting tested – meaning that discrimination does not just harm those who seek care, it prevents people from seeking care in the first place.

Towards compassionate, equitable healthcare 🔗

The path toward healthcare that genuinely serves LGBTQI+ people requires changes at multiple levels: legal, institutional, and educational. The discrimination, pathologization, and stigma described above are not inevitable – they are products of specific policies, training gaps, and institutional cultures, all of which can be changed.

De-medicalization and the shift to affirming care 🔗

A key demand of LGBTQI+ health advocates is the de-medicalization of queer identities – meaning the removal of LGBTQI+ identities themselves from frameworks of disorder and pathology. A peer-reviewed essay calling for the demedicalization of queer bodies argues that while medicalization was historically used as a political tool to gain some rights, it has increasingly become an obstacle – embedding queer experiences within heteronormative clinical frameworks that treat difference as dysfunction. The World Health Organization took a significant step in this direction when it removed gender incongruence from the chapter on mental disorders in ICD-11, reclassifying it under sexual health – an acknowledgment that being transgender is not a mental illness.

For transgender individuals specifically, the shift toward affirming care means treating patients’ own understanding of their gender as authoritative, not as a symptom requiring extensive psychiatric gatekeeping before treatment is provided. Research on trans healthcare from a human rights perspective argues for models based on information, counseling, and informed consent – prioritizing patient autonomy rather than medical authority over queer bodies.

Education and structural change in healthcare systems 🔗

Provider education is non-negotiable. Structural competency research on LGBTQ+ older adults highlights that upstream social and policy factors – not just individual provider attitudes – drive health disparities, and that meaningful change requires identifying and addressing these structural barriers. At the clinical level, this means normalizing the collection of sexual orientation and gender identity data in patient intake, with appropriate training on how to use that data to deliver better care rather than expose patients to further risk. It means using correct pronouns, creating physically inclusive intake forms, and ensuring that medical records reflect patients’ identities rather than erasing them.

KFF survey findings make clear that discrimination in healthcare is not just a personal affront – it has measurable consequences for health outcomes. LGBT adults who face discrimination are more likely to experience worsening health, more likely to change providers, and less likely to seek care at all. Creating healthcare environments where LGBTQI+ patients can be open about who they are – without fear – is not just a matter of dignity. It is a basic condition for effective medical care.

What do you think? Given that much of the discrimination LGBTQI+ people face in healthcare is rooted in provider ignorance rather than explicit hostility, do you think mandatory LGBTQI+ health education in medical training would be sufficient to close this gap – or are deeper structural changes needed? And when we consider that communities most harmed by inadequate public health responses, like those most affected by the AIDS crisis, have historically had to organize and advocate for themselves to receive care, what does that reveal about who our healthcare systems were designed to serve?

References

1. https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/
2. https://psnet.ahrq.gov/perspective/patient-safety-concerns-and-lgbtq-population
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC12145487/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC9642061/
5. https://news.cuanschutz.edu/medicine/lgbt-adults-face-discrimination-in-health-care
6. https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/
7. https://courses.lumenlearning.com/suny-lgbtq-studies/chapter/history-and-culture-of-medicine-and-lgbtq-people/
8. https://digitalhistory.hsp.org/anonymous-was-no-more/essay/medicalization-and-demedicalization-homosexuality
9. https://en.wikipedia.org/wiki/Conversion_therapy
10. https://www.oas.org/en/iachr/media_center/PReleases/2016/064.asp
11. https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-020-0118-y
12. https://www.un.org/en/chronicle/article/hivaids-and-education-lessons-1980s-and-gay-male-community-united-states
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC8493181/
14. https://www.thebritishacademy.ac.uk/blog/aids-epidemic-lasting-impact-gay-men/
15. https://www.nbcnews.com/feature/nbc-out/lgbtq-history-month-early-days-america-s-aids-crisis-n919701
16. https://www.hrc.org/resources/hrc-issue-brief-hiv-aids-and-the-lgbt-community
17. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12761-5
18. https://pmc.ncbi.nlm.nih.gov/articles/PMC4918872/
19. https://pmc.ncbi.nlm.nih.gov/articles/PMC10598237/
20. https://www.kff.org/racial-equity-and-health-policy/lgbt-adults-experiences-with-discrimination-and-health-care-disparities-findings-from-the-kff-survey-of-racism-discrimination-and-health/