Purdue HHS researchers address disparities to elevate LGTBQ health

December 16, 2021

Written By: Rebecca Hoffa, rhoffa@purdue.edu

Whether it’s lack of access to affirming care or concerns about if they can trust their providers, sexual and gender minorities face many obstacles within the healthcare system, which can have significant consequences for their overall health.

Stewart Chang Alexander and Randolph Hubach, associate professors in Purdue University’s Department of Public Health, are working to improve healthcare quality and access to reduce health disparities for sexual and gender minority populations. Aligning with HHS’ Developmental Health and Wellness and Healthy Lifestyles and Vital Longevity signature research areas, their work aims to improve outcomes for LGBTQ adolescents who are establishing their relationship with healthcare as well as foster inclusive, supportive healthcare across the life span in both rural and urban communities.

“I think the biggest thing we have a need for is just having these conversations,” Hubach said. “With sexual health and the health of sexual and gender minorities, we don’t live within a vacuum. There are all of these larger cultural, policy-level things that are impacting the needs of us as individuals and the needs of the community.”

Building a trusting healthcare relationship

Chang Alexander’s research in the College of Health and Human Sciences focuses on patient-provider communication, aiming to improve primary care discussions with adolescents about sexual orientation and gender identity. While physicians may be open-minded and strive to use inclusive language, Chang Alexander has discovered that in the fast-paced environment of primary care clinics it can be easy to get in an automatic state with a standard list of questions, which may not devote adequate time to discussing important topics like sexual orientation and gender identity.

“It’s understandable that there’s a fast pace to it, but when it comes to gender identity and sexuality discussions, it can’t be fast-paced,” Chang Alexander said. “It’s not a one-question thing. It’s really about building that rapport with an adolescent.”

While teaching physicians the tools they need to ask adolescents inclusive, holistic questions is a piece of the puzzle, Chang Alexander’s research has shown that trust and confidentiality are the most important factors for adolescents when discussing sexual orientation and gender identity with a provider. Because of this, he noted that it’s important for physicians to ask parents to leave the room to focus on the best interests of the adolescent. If the parent stays in the room, it can hinder the adolescent’s willingness to share information and could have negative outcomes for their health.

“It moves adolescent care from parent-driven needs to adolescent needs,” Chang Alexander said. “When the parent is the consumer, we do things to make mom or dad happy in the room, and when we do that, we’re not thinking about the adolescent and what’s important for the adolescent.”

There can be serious consequences if adolescents do not receive the care and support they need, as Chang Alexander noted that adolescents who are struggling with sexual orientation or gender identity have higher rates of suicide; may engage in riskier sexual behavior; have higher levels of depression; and may engage in smoking, drinking or drug use.

In addition to his work studying what’s happening in the examination room, Chang Alexander noted that there are also things healthcare providers can do outside of their discussions with patients to build a more inclusive environment for LGBTQ adolescents.

“I always say things like posters and magazines in waiting rooms make a big difference,” Chang Alexander said. “Visually, when you start to see that, you think that this might be something safe.”

Making inclusive healthcare accessible

While building a relationship with trusted providers is important from adolescence into adulthood, it can be difficult in rural areas. There may only be one healthcare clinic. Gossip and acceptance could be real concerns. To address these issues, Hubach studies sexual health and access to affirming care in rural populations.

Hubach noted that the solution isn’t simply bringing more doctors into these rural communities but rather introducing affirming providers with whom patients feel comfortable. In the meantime, Hubach has focused on leveraging technology to increase access to healthcare and screening in rural areas through at-home HIV and STI testing, telehealth services and trusted online resources that offer accurate and holistic information.

“Ultimately, we need better care paradigms for both urban and rural communities, but I think rural communities definitely have a unique need that sometimes we just don’t think about,” Hubach said.

Like Chang Alexander’s work, Hubach’s research also investigates LGBTQ patients’ interactions with their providers, focusing on a broader age group. Hubach noted that even beyond adolescence, in rural environments, sexual and gender minority populations may have concerns that their provider will reject them as a patient if they choose to disclose this information.

“We’ve done work with medical students and medical practitioners where we’ve brought in the voices of community members, and they said ‘I never really would have thought about it this way,’” Hubach said. “So there are already providers who are wanting to create a more affirming environment but haven’t really thought about the idea that someone’s going to feel like they could be rejected by their provider.”

Ultimately, Hubach explained that the stigma needs to be removed from sexual health, so when someone makes the decision to understand their sexual health status and make informed decisions, they are encouraged to do so.

“We have to take a more proactive approach to sexual health versus a reactive approach,” Hubach explained.

While strides have been made to advance health for sexual and gender minority populations, Hubach noted that integrating this work into larger public health domains and understanding the many facets of sexual health is key to creating better affirming healthcare related to sexual health and gender identity.

“I think we’ve made a large dent, but we still have further to go,” Hubach said.