Health Service Use, Access, and Challenges for 2S/LGBTQIA+ Individuals with Rheumatic Conditions

Objectives Rheumatic conditions require multidisciplinary care to optimize health and quality of life. 2S/LGBTQIA+ communities (Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and additional sexual and gender-expansive identities) experience higher rates of rheumatic conditions,[1,2] yet remain underrepresented in rheumatology research.[3] This study examined healthcare use, access, and barriers among 2S/LGBTQIA+ individuals with rheumatic conditions.

Methods We analyzed data from the Community-Based Research Centre’s Our Health 2022 Canada-wide survey. This cross-sectional, multilingual (English, French, Spanish) survey was conducted April-September 2022 and recruited 2S/LGBTQIA+ participants aged ≥15 years through social media, community agencies, and paid advertisements. Respondents self-completed an anonymous online questionnaire capturing sociodemographics, healthcare use, access gaps, and sources of support. Those who self-reported a formal diagnosis of ≥1 rheumatic condition(s) were included. Descriptive statistics summarized outcomes.

Results Among 4,037 respondents, 497 (12%) reported ≥1 rheumatic conditions. Reported diagnosed conditions included fibromyalgia (n=169), osteoarthritis (n=152), psoriasis or psoriatic arthritis (n=105), Raynaud’s syndrome (n=88), rheumatoid arthritis (n=55), gout (n=36), ankylosing spondylitis (n=32), lupus (n=11), and Sjögren’s syndrome (n=8). Median age was 40 years; 66% were assigned female at birth, 36% identified as trans, 27% as non-binary, and 2% as intersex. Indigenous participants comprised 9% of the sample, of whom 66% identified as Two-Spirit. Among those who reported needing specific health services to manage their chronic health condition(s), unmet need was most frequent for personal home support (68%), foot care (60%), gender-affirming surgery (48%), home nursing (44%), alternative therapies (40%), gender-affirming care (38%), and physical therapy (34%) (Table 1). Common barriers included wait times (75%), difficulty obtaining appointments (70%), referral challenges (46%), service unavailability (45%), cost (40%), transportation (32%), and lack of gender- or sexuality-affirming providers (15%). Nearly half (49%) stopped, reduced, or delayed filling medications because they could not afford them, and 39% reported experiencing discrimination in healthcare. Despite these challenges, participants described drawing strength and support from friends, family/chosen family, pets, partners, social media communities and, among Indigenous respondents, Elders or Knowledge Keepers. Participants also reported positive impacts of living with a chronic condition, including building community connections, finding pride in their identity/experience, and engaging in activism.

Conclusion Reported challenges reflect entrenched inequities in healthcare that disproportionately affect 2S/LGBTQIA+ communities. Addressing these inequities requires structural change, integrating affirming, inclusive, and community-informed approaches into clinical practice and service delivery. Centering health justice principles in models of care can help ensure 2S/LGBTQIA+ communities receive equitable and affirming rheumatology care.

References [1.] Ward BW. Prev Chronic Dis 2015;12:E192. [2.] Pinnamaneni M. Prev Med Rep 2022;28:101881. [3.] Mathias K. Curr Opin Rheumatol 2023;35:117-27.