Healthcare access for two-spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) communities varies across the country depending on a number of factors, including the availability of services in each region, the level of healthcare practitioner knowledge, and the level of support from family, friends, and community. A 2019 federal health report indicates 2SLGBTQ communities experience disproportionately higher rates of arthritis, and many 2SLGBTQ individuals face a number of barriers when it comes to receiving healthcare, all of which can make caring for their arthritis more difficult.
Some of the main issues preventing supportive healthcare for 2SLGBTQ communities include: being refused care, stereotypes and discrimination against 2SLGBTQ individuals, care providers being unaware of specific healthcare needs, patients’ previous negative experiences within the healthcare system, and the use of language on forms or during appointments that excludes 2SLGBTQ experiences. While there are many other concerns 2SLGBTQ communities face in accessing healthcare, these additional barriers tend to be greatly reduced when people feel supported by their healthcare team and their family and friends.
When Gilles Fournier, who lives with arthritis, thinks back on his return home to Canada from a trip abroad at the start of the COVID-19 pandemic, he recalls how his family and friends offered a great deal of support for him and his husband. “[Family and friends] were all offering to do the shopping for us, asking ‘what do you need?’, and stuff like that.”
As a gay man living in Alberta, Gilles has had many positive experiences in navigating his healthcare. He points to a good support system as part of this experience. Gilles and his husband have the support of good family doctors and additional practitioners, though unfortunately not everyone in the 2SLGBTQ community has access to the same level of care.
Inclusive, appropriate healthcare for 2SLGBTQ communities can make a big difference in improving health outcomes for people living with arthritis. Early detection and treatment can play a large role in limiting damage and disability caused by arthritis. However, for individuals who have experienced stereotypes, discrimination, or a lack of understanding from healthcare professionals, they may be hesitant to seek a diagnosis until the disease has progressed.
While many positive changes have been happening within the medical field for 2SLGBTQ communities, there are still a number of concerns when it comes to accessing healthcare and arthritis-specific care. Some of the many questions people in 2SLGBTQ communities ask themselves before accessing care may include:
- Will the specialist I have been referred to help me, or will they blame my gender identity or sexual orientation for my health concerns?
- Will my healthcare provider make assumptions about me or my health because of my gender identity or sexual orientation?
- If I go to the hospital, will they dig up a chart from an old visit and use the wrong name or pronouns, or turn me away from care?
- After I have surgery, who will I share a hospital room with? Will my partner be able to visit me without having to lie about how we are related?
- Is it worth going to this physiotherapy appointment and risk being judged, or can I try to manage on my own?
- Will a personal support worker assigned to my care be inclusive and knowledgeable? Will I feel safe in my own home?
In addition to these concerns, some 2SLGBTQ communities face specific barriers to care, such as the trans community. Doctors may be hesitant to prescribe pain medication to trans patients or have a lack of knowledge about how arthritis medications may interact with estrogen or testosterone that some trans people may be taking to affirm their gender. These barriers can lead to a host of additional health gaps and problems. Many people may avoid care altogether or go long periods of time with undermanaged pain. These additional stressors can lead to greater impacts from chronic pain and take a greater toll on mental health, contributing to depression and in some cases, increased suicidality.
Though navigating arthritis can be a challenge at the best of times, when these additional barriers are minimized or don’t exist, as in the case with Gilles Fournier, suddenly the experience of navigating arthritis becomes less difficult.
Rainbow Health Ontario suggests the following steps to help members of 2SLGBTQ communities feel welcome in healthcare spaces:
Use of appropriate language;
- Not assuming someone has a “husband,” “wife,” “boyfriend” or “girlfriend”
- Use of proper pronouns (the words used to describe people in conversation for example: she/her, they/them, he/him, ey/em, zie/zir)
- Asking what language and terms feel best to describe someone’s body (i.e., breast feeding or chest feeding)
Sensitivity about trans people’s bodies;
- Not asking or making assumptions about the appearance or parts of a person’s body
- Not making assumptions about who requires what type of healthcare based on appearances or gender expression
Intake forms that are inclusive and allow trans and non-binary patients to self-identify their name, pronouns and gender with open-ended questions
- Leave a blank line for people to write in their gender i.e., Gender: _________,
- List body parts that may require care on intake forms instead of asking about sex assignment at birth.
Fostering supportive environments for exercise and mobility programs such as physiotherapy, pool access, and recreational spaces.
- Providing access to all-gender change rooms and bathrooms
When supportive environments are in place 2SLGBTQ communities are better able to focus on addressing their health needs. Although Gilles reflects his future care needs are not without concern, he states “when you have a support system like [my family and friends], arthritis is less of a burden… much less of a burden”.