Donald, Cameron A. MS; DasGupta, Sayantani MD, MPH; Metzl, Jonathan M. MD, PhD; Eckstrand, Kristen L. MD, PhD. Queer Frontiers in Medicine: A Structural Competency Approach. Academic Medicine 92(3):345-350, March 2017.

Over recent years, the experiences of individuals with diverse sexual orientations, gender identities, and sex developments have received increasing attention. This attention has led to activism, initiative, and change across all realms of society, including health care, to better accommodate and serve these communities. However, health equity is not yet a reality for many people who are lesbian, gay, bisexual, transgender (LGBT); gender nonconforming (GNC); and/or born with differences in sex development (DSD). Significant causes of morbidity—and subsequent mortality—remain disproportionally prevalent among the aforementioned populations.  These health disparities are not inherent to individuals with diverse sexual orientations, gender identities, and sex developments but stem from structural factors including federal and statewide nondiscrimination policies, interpersonal factors such as family and social discrimination, and individual barriers such as internalized homophobia/transphobia. These factors, combined with the challenge of accessing affirming, responsible health care, can lead to a delay in necessary and routine care.