• Posted March 11, 2025

LGBTQ+-Affirming Care Lacking in U.S. Primary Care Clinics

There’s a woeful lack of training for LGBTQ+-affirming care among primary care practices in the United States, a new study suggests.

Only 35% of primary care practices have provided training for doctors on care that affirms sexual orientation and gender identity, researchers reported in a study published March 10 in JAMA Network Open.

Likewise, only 39% of primary care staff have received such training, results show.

These low rates are occurring even though 3 out of 4 practices (76%) are collecting data on patients’ sexual orientation and gender identity, results show.

“Affirming care activities seek to create a safe and inclusive environment for LGBTQ+ patients, which can have positive associations with their health outcomes, mental -well-being, and patient-clinician communication,” the research team led by Ellesse-Roselee Akré, an assistant professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, wrote.

Primary care clinics in the Midwest rated highest in terms of affirming care for LGBTQ+ people, while those in the South ranked the lowest, results show.

Practices in rural areas also were less likely to provide appropriate referrals for LGBTQ+ patients or to train doctors and staff, researchers said.

“The finding that the South and rural areas had the lowest probability of having higher performing practices is troubling when considering that many LGBTQ+ people in rural areas may experience limited access to necessary health services and experience health disparities,” researchers said.

For the study, researchers used national data on 1,245 practices across the United States to compare their engagement in activities that affirm sexual orientation and gender identity.

Results showed that practices that care for poor or underinsured people, as well as those that care for Medicaid patients, were more likely to train staff to provide sensitive care to LGBTQ+ patients.

State-level policies related to LGBTQ+ people also had a direct impact on clinics’ activities related to gender-affirming care.

States that scored higher in policies that protect LGBTQ+ equality had primary care practices that were better prepared to care for those patients, researchers said.

The study “underscores the need for national policies mandating LGBTQ+-inclusive training in medical and nursing education to reduce barriers and improve access to safe, appropriate care for millions of U.S. patients,” researchers concluded.

It’s not clear that such policies will be forthcoming, however, given that President Donald Trump has expressed opposition to gender-affirming care and has ordered federal websites scrubbed of information regarding the LGBTQ+ community.

More information

Rush University Medical Center has more on LGBTQ+ health care.

SOURCE: JAMA Network Open, March 10, 2025