3022 — Perceived stigma, discrimination, and disclosure of sexual orientation among a sample of lesbian Veterans in the Department of Veterans Affairs

Mattocks KM, VA Central Western Massachusetts Healthcare System; Sullivan JC, VA Central Western Massachusetts Healthcare System; Bertrand C, VA Central Western Massachusetts Healthcare System; Sherman MD, VA Minneapolis Healthcare System; Gustason C, VA Central Western Massachusetts Healthcare System;

Objectives:
Many lesbian women avoid disclosure of their sexual orientation to their healthcare providers for fear of perceived stigma and discrimination. With the increasing number of women Veterans seeking VHA care, including lesbian and bisexual (LB) Veterans, it is important to understand LB Veterans' experiences with disclosure of sexual orientation, perceived stigma and discrimination in VHA care. Our study examines LB Veterans' perspectives on disclosure of sexual orientation to VHA providers, their experiences with perceived stigma and discrimination in VHA healthcare, and their recommendations for improvements in VHA healthcare to create a welcoming environment for LGBT Veterans.

Methods:
We conducted in-depth interviews and a survey with twenty LB Veterans at four VHA facilities nationally.

Results:
A sizeable proportion (50%) of LB Veterans in the study feared that their VA providers would mistreat them if they knew about their sexual orientation, yet only ten percent of LB Veterans had experienced mistreatment from VHA staff or providers. A majority of LB Veterans (70%) believed that VHA providers should never ask about sexual orientation, and only 20% of LB Veterans had disclosed their sexual orientation to their VA providers. One of the biggest problems LB Veterans experienced in their VHA care was that VHA staff often did not invite same-sex partners or spouses to be involved in LB Veterans' medical care or medical decision-making.

Implications:
Though many LB Veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most LB veterans believed the VHA was trying to create a welcoming environment for its LGBT Veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

Impacts:
This is the first qualitative study to explore LB Veterans' experiences and perceptions of VHA care. As a healthcare organization, VHA has instituted non-discriminatory policies stating that sexual orientation shall not serve as a barrier to receiving healthcare. This study has made important contributions to the knowledge of VHA care delivered to LB Veterans that can assist policymakers and leaders in quality improvement decisions for this population.