LGBT Women Veterans Report Missing Needed Health Care Due to Concerns about Interacting with Other Veterans
Research suggests that the stress of concealment, discrimination, and stigma contribute to poorer health and earlier deaths among LGBT people. Women Veterans who identify as LGBT may be more susceptible to the impact of minority stress, given their dual minority status in VA (female and LGBT). Sexual minority Veteran women have worse outcomes compared with both sexual minority non-Veterans and heterosexual Veteran women. LGBT women, in general, report experiencing discrimination, rejection, and/or poor care following disclosure of their sexuality or gender identity in healthcare settings, and LGBT women Veterans are no different. Harassment may affect behavior, with the potential to lead LGBT women Veterans to miss or delay needed treatment. This study sought to examine LGBT women Veterans' experiences within the VA healthcare system, and whether their experiences impact use of VA care. Investigators surveyed 1,391 women Veterans (86% non-LGBT, 14% LGBT) by phone from 1/15 to 3/15 who had at least three primary care visits in the past year at 12 VA facilities across 9 states. Participants were asked both about feeling welcome and about feeling unsafe at VA, as well as about harassment experiences and delayed/missed care.
The majority of women Veterans reported feeling welcome at their VA. However, fewer LGBT women reported feeling welcome and safe at VA compared with non-LGBT women Veterans.
After controlling for demographics, health status, and positive trauma screens, LGBT identity was predictive of women Veterans experiencing harassment from male Veterans at VA in the past 12 months, as well as feeling unwelcome or unsafe at VA.
LGBT women Veterans were about 3 times more likely than non-LGBT women Veterans to attribute missing needed care in the previous 12 months to concerns about interacting with other Veterans.
Study participant descriptions of harassment indicated that male Veterans' comments and actions were distressing and influenced LGBT women Veteran's healthcare accessing behavior.
Creating a safe and welcoming environment in VA is important for women Veterans generally, but findings indicate that for LGBT women this is an even more serious concern. Despite VA's ongoing efforts to educate employees and change the culture toward a more inclusive environment, more targeted work addressing the needs of LGBT women Veterans may be needed.
This study relied on cross-sectional telephone survey self-reports about healthcare experiences and utilization and specifically asked participants about harassment and unwanted experiences with male Veterans, but did not ask about interactions with VA support or professional staff, which could also be influencing willingness to seek care.
This study was funded by HSR&D (CRE 12-026). Dr. Shipherd is part of VA's LGBT Health Program, Office of Patient Care Services, and VA's National Center for PTSD, Women's Health Sciences Division, Boston, MA. Drs. Darling, Klap, Rose, and Yano are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA.
Shipherd J, Darling J, Klap R, Rose D, Yano E. Experiences in the Veterans Health Administration and Impact on Healthcare Utilization: Comparisons Between LGBT and Non-LGBT Women Veterans. LGBT Health. July 1, 2018;5(5):303-11.