Lesbian gay bisexual and transgender health

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The final rule implementing Section 1557 does not explicitly resolve whether discrimination on the basis of sexual orientation alone is prohibited but does state in the preamble that “sex discrimination related to an individual’s sexual orientation where the evidence establishes that the discrimination is based on gender stereotypes” is prohibited.¹⁵⁴ Despite OCR’s capacity to enforce 1557 being stayed, it remains illegal to violate 1557 protections and an entity doing so could be held liable in court.

Since gender identity is internal, one’s gender identity is not necessarily visible to others.”⁶ Additionally, gender expression and gender role conformity further describe the extent to which a person does or does not adhere to expected gender norms and roles. Windsor and subsequent ruling in Obergefell v.

Executive Summary
Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes.
This includes screenings for HIV, STIs, depression, and substance use. It found that in 2015, 8% of high school students identified as LGB and 6.3% had same sex sexual contact. The passage of the ACA in 2010, the Supreme Court’s ruling overturning DOMA in 2013, and subsequent ruling in Obergefell in 2015 (guaranteeing the right to same-sex marriage nationally), have significantly affected access to care and coverage for LGBT individuals and their families, expanded nondiscrimination protections, increased data collection requirements, and supported family caregiving.

While seven in ten gay and bisexual men say they have gotten an HIV test at some point in their lives, just 30 percent say they were tested within the past Three in ten (30%) say they have never been tested for HIV, rising to 44% of those under age 35. The 17-member Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities comprised experts in the fields of mental health, biostatistics, clinical medicine, adolescent health and development, aging, parenting, behavioral sciences, HIV research, demography, racial and ethnic disparities, and health services.

For both men and women, the perpetrators were predominantly male.
Anti-LGBT bias also puts LGBT people at risk for physical violence. Obesity rates are higher among lesbian and bisexual women compared to heterosexual women, but are lowest among gay men. In one survey of transgender individuals, nearly half (48%) of respondents postponed or went without care when they were sick because they could not afford it.⁸⁷ In addition, many health plans include transgender-specific exclusions that deny transgender individuals coverage of services provided to non-transgender individuals, such as surgical treatment related to gender transition, mental health services, and hormone therapy.⁸⁸
An individual’s relationship with providers is another important component of access to care.

More than four in ten heterosexual and lesbian women and the majority (75%) of bisexual women have experienced other forms of sexual violence, such as coercion or harassment. Barriers include gaps in coverage for certain groups, cost-related hurdles, and stigma, including poor treatment from health care providers.
Several recent changes within the legal and policy landscape have served to increase access to care and insurance for LGBT individuals and their families.

The program’s “spousal impoverishment” protections aim to mitigate this by allowing a spouse who remains in the community to retain a certain level of income and assets without affecting eligibility. Another nationwide study found a reported 41% prevalence of suicide attempts among the transgender population.⁵⁵
Research suggests that MSM have higher use of certain substances.

Where do gaps in the research exist? Twelve states (CA, CO, DE, HI, IL, ME, MN, NV, NY, OR, RI, VT, and WA) plus DC prohibit discrimination based on sexual orientation and gender identity in private health insurance.¹³² New Jersey provides protection on the basis of sexual orientation but not gender identity in private health insurance.¹³³ Nineteen states (CA, CT, CO, DE, HI, IL, MA, MD, MI, MN, NJ, NV, NY, OR, PA, RI, VT, and WA) and DC prohibit transgender exclusions in health insurance through legislation or regulation.¹³⁴ Twenty states (CA, CO, CT, DE, HI, IL, IA, ME, MD, MA, MN, NV, NJ, NM, NY, OR, RI, UT, VT, and WA) plus DC prohibit discrimination by private employers on the basis of sexual orientation and gender identity and another two states (NH and WI) prohibit discrimination based only on sexual orientation.¹³⁵
Health Insurance Marketplaces: Windsor also affected eligibility for assistance for same-sex couples in all ACA health insurance marketplaces (whether federally-facilitated or state based).

Other studies have looked beyond self-identification, to include behavior and attraction, and obtained higher estimates, including one that found that 10% of adults reported experience with same-sex partners.¹¹ In addition, a recent analysis indicates that standard survey measures appear to significantly underestimate non-heterosexual identity and same-sex sexual experiences.¹²
Racial and ethnic minorities, young people, and women are more likely than their counterparts to identify as LGBT (Figure 1).¹³
The Youth Risk Behavior Surveillance System (YRBSS), a nationally representative survey of high school students, asks about sexual identity and sex of sexual contacts.