LGBT access to health care was at the forefront of the same-sex marriage debates. Scholars questioned how lack of access to legal marriage impacted the mental health of same-sex couples (Wight et al., 2013) as well as same-sex couples’ access to health insurance (Buchmueller & Carpenter, 2010), and found that the passage of state laws in favor of same-sex marriage decreased health care utilization for gay men (Hatzenbuehler et al., 2012). Taken together, findings on the importance of marriage for the health and health care access of lesbian and gay couples played a vital role in the argument in favor of legalizing same-sex marriage. Less studied, however, are the ways in which the deeply gendered and heterosexist institution of medicine in the U.S. work to bar queer, trans, genderqueer, bisexual as well as lesbian and gay identifying individuals from accessing health care (Herek, 2007). In 2011, the Institute of Medicine called for increased attention to barriers to care for LGBT individuals using intersectional and minority stress frameworks (Grant et al., 2011). This report emphasized that alarmingly little is known about the health and wellbeing of LGBTQ individuals who are multiply marginalized—namely, those who are not only sexual identity minorities but also people of color, women, transgender, or genderqueer.
In this paper, I present findings from a qualitative study examining the health care experiences of a racially diverse sample of sexual and gender identity minority individuals across health care contexts in New York City. In the U.S., LGBTQ activists have prioritized the creation of health care organizations (HCOs) and clinics purposed for the LGBT community. These HCOs aim to ameliorate barriers to care for LGBTQ individuals by offering affordable access to current best care practices delivered by health care providers familiar with LGBT identities and unique health concerns. Whereas legal marriage as a pathway to health care access for same-sex couples benefits couples wherein one member’s obtains spousal benefits from their employer, LGBT HCOs largely target individuals as well as those without any access to health insurance and who may be most in need of care, including people living with HIV and individuals seeking gender confirming or affirming care. However, the creation of LGBT HCOs to attenuate LGBT experiences of minority stress, or discrimination related to their sexual and gender identities (Meyer, 2003; Lick et al., 2013), remains under examined—especially considering the dearth of options available to diverse LGBTQ individuals seeking culturally comprehensive care.
I examine how LGBT HCOs intervene into heterosexist health paradigms through the perspectives of patients. Specifically, I analyze experiences of participants across care contexts: within an LGBT HCO and within traditional health settings. I find that although LGBT HCOs are making necessary and life-saving interventions into access to care for LGBTQ individuals, the reach of such HCOs end at the door: patients are frequently referred elsewhere for specialized care with traditional providers. Furthermore, within LGBT HCOs, some multiply-marginalized individuals experience minority stress during health care interactions that they perceive to acutely diminish their likelihood of seeking future care. These encounters result in part from the unintended consequences related to the institutionalization of efforts to improve LGBT health care access. Finally, and unsurprisingly, I find that patients and providers perceive demands for care within LGBT HCOs to far outweigh their caring capacity. All together, LGBT HCOs are unable to fundamentally shift the foundational gendered and heterosexist paradigms that structure the social institution of health care. I argue that the gendered and raced nature of health makes health settings a place of violence for multiply marginalized sexual and gender identity minorities, and I do so through the examination of the experiences of my participants across multiple health care contexts.
In a post-marriage era where funding for LGBTQ research in the U.S. is being slashed, important questions remain about the health and wellbeing of LGBTQ individuals, particularly related to access to health care. I argue the importance of furthering research and debate related to the health and wellbeing of LGBTQ individuals in general and multiply-marginalized individuals in particular.