The relationship between sexual and gender stigma and difficulty accessing primary and mental healthcare services among LGBTQI+ populations in Thailand: Findings from a national survey

Abstract

Sexual and gender stigma is a known contributor to population health inequities; however, its impact on healthcare access among sexual and gender minorities (SGM) in Thailand is understudied. Therefore, we sought to examine the level of SGM stigma and its impact on self-reported difficulty accessing primary and mental healthcare services among a nationally recruited sample of lesbian, gay, bisexual, transgender, queer, intersex, and other gender and sexually diverse (LGBTQI+) people in Thailand. A previously validated sexual stigma scale was adapted to ascertain perceived and enacted SGM stigma. Between January and March 2018, 1,350 LGBTQI+ participants completed the online survey, and the median age was 27 (Quartile 1, 3: 23, 33) years. In total, 169 (12.5%) and 269 (19.9%) reported difficulty accessing primary and mental healthcare and 365 (27.0%) reported actively concealing their gender expression to access care. In multivariable logistic regression analyses, experiences of enacted stigma were independently associated with difficulty accessing primary healthcare (adjusted odds ratio [AOR] = 1.35; 95% Confidence Interval [CI]: 1.11 – 1.63) and mental healthcare (AOR = 1.26; 95% CI: 1.07 – 1.48), while experiences of perceived stigma were independently associated with difficulty accessing mental healthcare only (AOR = 1.20; 95% CI: 1.07 – 1.34). Our findings call for multi-level interventions to decrease SGM stigma and improve healthcare access among SGM in Thailand.