Article Summarizes Issues for Sexual and Gender Minority Veterans Receiving VA Healthcare
It is not known how many sexual and gender minority (SGM) Veterans there are, nor what proportion are using VA healthcare. However, given the size of the population served by the VA healthcare system, VA is likely the largest single provider of healthcare for SGM individuals in the U.S., including lesbian, gay, bisexual, and transgender persons. Population estimates suggest that gay and lesbian service members represent at least 3% of all military personnel, with transgender people adding to this figure. SGM populations have documented disparities in health and healthcare access in the general population, but the number of SGM Veterans, their specific healthcare needs, and experiences with VA care are not well understood. For example, nearly all of the existing studies that examine gay or bisexual male Veterans are focused on some aspect of HIV; however, little is known about the experiences or healthcare needs of non-HIV infected gay or bisexual male Veterans. The literature is also limited for other SGM Veterans. This article summarizes emergent research findings regarding SGM Veterans, and the first initiatives that have been implemented by VA to promote quality care.
- For SGM Veterans, being a member of both Veteran and SGM communities may contribute to a higher level of risk for poor health than membership in just one of these populations. Dual health disparities arising from two identities are clearly demonstrated when observed separately, yet there is limited understanding as to how Veteran and SGM status interact. Elevated health problems and barriers to healthcare access also have been documented within the transgender community, including high rates of discrimination, trauma exposure, and suicidal ideation.
- A recent VA study indicated that only 33% of SGM Veterans reported open communication about their sexual orientation with VA healthcare providers, while 25% reported avoiding certain VA services because of concerns about stigma. In another study of 202 VA providers and 58 SGM Veterans, less than one-third of all participants viewed VA as welcoming to SGM Veterans.
- To address these issues, VA has created new programs, such as the Office of Health Equity LGBT Workgroup, which works to address inequities in the healthcare environment for SGM Veterans. VA also created two new part-time LGBT Program Coordinator positions, through the Office of Patient Care Services, who advise leadership on policy and practice issues related to SGM Veterans.
- In June 2011, VA released the first national policy to describe the services that are available to transgender Veterans. Other recent VA policy changes include "sexual orientation" and "gender identity and expression" now being included in VA non-discrimination and caregiver policies.
- Educational resources and trainings have been developed for VA staff about culturally appropriate care for SGM Veterans.
- Further research is needed to better understand the SGM population, their healthcare needs, and how these needs vary in relation to gender, race/ethnicity, and other factors, as well as in evaluation of provider training and policies.
This study was supported by the VA HSR&D Women's Health Research Network (SDR 10-012). Dr. Kauth is part of HSR&D's Houston Center for Quality of Care and Utilization Studies, and Dr. Shipherd is part of the National Center for PTSD at the VA Boston Healthcare System. Drs. Shipherd and Kauth are the current LGBT Program Coordinators for Patient Care Services.
Mattocks K, Kauth M, Sandfort T, Matza A, Sullivan J, and Shipherd J. Understanding Healthcare Needs of Sexual and Gender Minority Veterans: How Targeted Research and Policy can Improve Health. LGBT Health July 2013;