Two-Spirit, Lesbian, Gay, Bisexual, Transgender and Queer (2SLGBTQ+) Blac, Indigenous, People of Colour (BIPOC) are a multiply marginalized population subject to multiple social stressors tied to their gender, race/ethnicity and sexual orientation. Research has found that 2SLGBTQ+ BIPOC are at an increased risk of both mental and physical health problems because of the additive impact of oppressive structures on their intersecting identities1. Furthermore, many 2SLGBTQ+ BIPOC face obstacles when seeking mental and physical healthcare services. They may be unable to find services in their area, encounter discrimination or refusals of service in healthcare settings, or delay seeking treatment over fears of mistreatment2.
This article has been developed to help health care staff provide an inclusive and respectful practice for 2SLGBTQ+ BIPOC individuals. Ensuring these individuals feel safe and included is imperative to addressing their unique health care needs and can lead to greater trust in the healthcare system.
5 Points to change your practice
1. Be educated on cultural competency and the intersectionality of queer and racial/ethnic identities
The centre for American Progress found that a lack of cultural competency in the health care system is one of three main factors that contributes to significant negative outcomes for 2SLGBTQ+ BIPOC2. It is important to understand that certain health disparities, such as a higher incidence of diabetes in 2SLGBTQ+ African-American adults, are a result of multiple co-existing psychosocial factors1. Patients should never be blamed for their health disparities because these are the outcomes of systemic structures of oppression, a lack of culturally safe care, and policies that further marginalize these groups.
2. Create a physical environment (posters, intake forms, etc.) that is welcoming for 2SLGBTQ+ BIPOC patients
Given the longstanding history of discrimination, 2SLGBTQ+ BIPOC folx may “scan” a healthcare environment to determine if it is a safe place before continuing to seek care3. It is important to show these individuals that your space is safe through posters with diverse images and inclusive language, unisex restrooms, a copy of your organization’s non-discrimination policy, symbols of inclusiveness and intake forms in multiple languages that account for gender & sexual diversity. It is also important to have education materials on 2SLGBTQ+ health in multiple languages for individuals who have never spoken about their queer identity in their native language. Note that creating a welcoming physical environment should be accompanied by an inclusive space, well-trained staff, and an open attitude.
3. Be aware of financial support and resources in the community
… And share them with patients!
For some 2SLGBTQ+ BIPOC folx, barriers to health care include not only lack of culturally competent service providers, but also lack of affordable ones. For instance, the centre for America Progress showed that certain subgroups within the community, such as the LGB Latinx2, seems to have reduced access to employer-provided health insurance compared to the rest of the population. Being aware of the (culturally sensitive) community resources that could provide support to patients without adequate financial means or comprehensive health insurance, can ultimately make a huge difference in their health outcome.
4. Be ready to talk about identities and how it affects health outcomes.
Sexual & gender identities should be addressed when relevant to a patient’s case, but remember: Not every medical condition or concern is related to a person’s sexual or gender identity! Trying to be conscious of our biases, receptive, and non-judgemental is already a good start to provide a safe space for patients and ultimately, promote their wellbeing. Those principles should be applied for everyone, but could make an even greater difference for 2SLGBTQ+ BIPOC patients as they are historically more often deterred from seeking health care due to past negative experiences.
5. Going a step beyond: Connecting patients to a queer community within their own culture
Many people’s identities revolve around their sexual orientation and gender, but also by their race and ethnicity. Unfortunately, it is sometimes hard to reconciliate those identities, especially when stigmas, homophobia, transphobia and discrimination are still very prevalent in many cultures. Indeed, a lot of 2SLGBTQ+ BIPOC folx find themselves disconnected from their communities4, feeling as if they have to choose one identity over the other, when they should not have to. Finding people they can relate to and strengthening psychosocial support can make a big difference for their well-being. If you are able to & if the patient prefers, try to connect them to a queer community within their culture.
Authors | Claire Fine, Sherry Cui, Dan-Ha Huynh (2SLGBTQ+ Health Portfolio)
- Molina Y, Lehavot K, Beadnell B, Simoni J. Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma. LGBT Health. 2014;1(2):131-139. doi:10.1089/lgbt.2013.0007
- Krehely, J. (2009). How to close the LGBT Health Disparities Gap. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2009/12/pdf/lgbt_health_disparities_race.pdf?_ga=2.161606844.146503896.1611637829-1138717366.1611637829
- Clow, B. (2013). Rethinking LGBTQ Health. Retrieved from https://cdn.dal.ca/content/dam/dalhousie/pdf/diff/ace-women-health/3/ACEWH_rethinking_LGBTQ_health.pdf
- Ghabrial, Monica. “ “Trying to Figure Out Where We Belong”: Narratives of Racialized Sexual Minorities on Community, Identity, Discrimination, and Health.” Master’s thesis, Department of Psychology University of Toronto, 2014. Retrieved from https://tspace.library.utoronto.ca/bitstream/1807/98370/3/Ghabrial_Monica_A_201411_MA_thesis.pdf