From the Perspectives of Black lgbts in the US Medical Providers’ Comfort with Patients’ Sexuality

Abstract

For lesbian, gay, bisexual, and transgender (lgbt) people, being comfortable with medical professionals is important. A nation-wide sample of 1,374 Black lgbt people is used to examine the importance of identity, health, and demographics on the belief/perception that medical providers are comfortable with sexual identity issues. Logistic regression models reveal that respondents who were “out,” had family support, had regular healthcare provider, received their medical information primarily from their healthcare provider, had “happier” dispositions, and were male have more positive belief perceptions; that is, they are more likely to perceive that their medical professional seemed comfortable with their sexual identity.

Introduction

Scholars have shown that sexual expression is an important part of a person’s health and well-being (Kinsey, Pomeroy, Martin, & Gebhard, 1953; Mayer et al., 2008). At the same time, having trust in medical professionals is equally as important; and this is especially so for people who live intersectional lives, where such social markers as race, gender, and sexual identity are each stigmatized. More specifically, trust in medical professionals is not based solely on a practitioner’s level of intelligence or technical skills, but extends to a provider’s capacity to deal adequately with the totality of the human experience (Imber, 2004). Black¹ lesbian, gay, bisexual, and transgender (lgbt) patients’ perceptions of medical professionals are rooted in a history of abuse from practitioners perpetuated against lgbt persons, members of the Black community, and the intersection of the two identities (Feinberg, 2001; Lewin & Meyer, 2002). Given this historical and social context, what are the factors that contribute to positive relationships between Black lgbt people and their medical providers?

To better understand the encounters of lgbt people with medical professionals in clinical spaces, this paper examines the following research questions: What is the relationship between Black lgbts’ identity salience and the perceptions that their medical providers will be comfortable with their sexual identity? Additionally, how is this relationship mediated by health-related and demographic variables? Employing a sample of Black lgbt people from the 2010 Social Justice Sexuality (sjs) Project,² logistic regression modeling is used to explore these relationships.

Literature Review

An examination of the public health literature offers explanations of how lgbt people interact with medical professionals (Institute of Medicine, 2011; Scout & Fields, 2001). This literature is less elucidatory about the perceptions that Black lgbts use to navigate these interactions. Therefore to better understand these issues, we present a review of literature around three major themes: (1) lgbt identity salience, (2) lgbt engagement with medical professionals, and (3) trust in the medical professions.

lgbt Identity Salience

By occupying intersecting categories of race, gender, and sexual identity, Black lgbt people inhabit a very specific location of identity (Battle & Lemelle, 2002; Collins, 2004; Crenshaw, 1991). As it applies to individuals who are both racial and sexual minorities, researchers have raised concerns when a disconnect exists between how people are identified or labeled by others and how they behave or might label themselves (Meyer, 2001; Young & Meyer, 2005). For example, some have argued that Black lgbt people may have primary allegiance to either the Black community or the lgbt community. By definition, the power to name a group or an experience is biased by one’s cultural context (Gergen, 2001). Further, self-identity labels vary across time, geography, age, race, gender, and other demographic variables (Battle, Cohen, Warren, Ferguson, & Audam, 2002). Therefore, assuming how, when, or even if racial-or sexual-minority status is more salient than other identifiers can be problematic (Collins 2004; Crenshaw 1991) and often goes against how people define themselves.

Ilan Meyer (2001) theorized that Black gay and bisexual men, for example, may share more attitudes, beliefs, and norms with fellow African American church members than with lesbians and gay men in Chicago’s White gay community. Thus, the social discourse is that there is complexity in the degree to which an lgbt identity is salient to each member within this group. In terms of feeling connected to one’s local lgbt community, some researchers argue that sometimes having an openly-gay identity is a luxury afforded primarily to White men and women (Meyer, 2001). This dismisses the existence of thriving lgbt networks in the Black community.

In an exploratory study about the importance of a patient’s sexual identity in medical encounters, Bjorkman and Malterud (2007) concluded that lesbians may disclose their sexual orientation when they believe that it is medically relevant. The authors examined the implications of outing oneself to a medical professional, which they found was also related to whether or not they were already out to their family and immediate social networks. The in-depth interviews with lesbians between 28 and 59 years of age showed that they would consider disclosing their sexuality if they were depressive, had gynecological issues at the time of the visit, or if they found it necessary for the medical professionals to understand them as whole persons. Finally, the authors showed that these lesbian patients felt most comfortable with general practitioners who did not take a heterosexual identity for granted.

The sexual orientation of either the medical professional or the patient can also serve as an impediment to communication, especially when the patient openly identifies as lgbt and the medical professional does not. For example, Hinchliff, Gott, and Galena (2005) concluded that lgbt people can feel the hesitancy that medical professionals may have in interacting with “out” gay and lesbian patients. In their qualitative study of general practitioners in England, the researchers observed that (non-hetero) sexual orientation formed a barrier to talking about sexual health matters for almost half of the doctors in the sample.

The current literature does not make an explicit connection between one’s salient sexual orientation and perceiving one’s medical provider as respectful of one’s sexual orientation, and this is especially so for Black lgbt people. Still unexplored are the ways in which Black lgbt people perceive a medical provider’s attitude about sexuality, race, and the intersection of the two. However, as the next section summarizes, research has revealed that sexuality often complicates the delivery of care for lgbt people.

lgbt Engagement with Medical Professionals

Mutual trust and respect are key in the relationship between patients and their healthcare providers (Hall, Camacho, Dugan, & Balkrishnan, 2002; Imber, 2004); and some have argued that this is amplified for racial minorities (Cochran & Mays, 1988). However, the results concerning race are mixed. Some found racial minorities to be less trusting of the medical establishment than their White counterparts (Ahern & Hendryx, 2003), while others found no racial differences at all (Bonds, Foley, Dugan, Hall & Extrom, 2004; Hall et al., 2002). With regard to lgbt communities, the medical profession has a long and, for the most part, dishonorable history. For example, medical professionals have often been the voice of authority in legitimizing and subjecting gay men to anal examinations that were invasive, abusive, and a form of torture (Long, 2004); and scholars have documented that transgender people are often refused care during medical emergencies (Feinberg 2001). In fact, researchers have found that transgender patients are often denied medical care or experience transphobia within medical settings (Marksamer & Vade, 2003; Reed, Cohen-Ketteris, Reed, & Spack, 2008; Riordan, 2004). For example, Tyra Hunter, a Black transgender man, died after a car accident in Washington dc because emergency medical treatment (emt) personnel argued that his body was inconsistent with his assumed gender (Feinberg, 2001). Although many of the documented cases of medical torture placed upon the bodies of lgbt people are currently perpetuated outside of the United States, mistreatment can happen in hospitals and clinics here in the United States in more subtle forms (Lewin & Meyer, 2002; Long, 2004).

There are certain health needs specific to lgbt patients (Harrison & Silenzio, 1996), yet a 2011 report published by the Institute of Medicine reveals that these health needs may not be receiving much attention due to a lack of understanding, and training, on the part of medical professionals whose knowledge about lgbt populations is limited. Still, researchers have found that homosexual patients are less likely to access healthcare than are their heterosexual counterparts (Wadsworth & McCann, 1992) and are more likely to avoid treatment and prevention services (O’Neill & Shalit, 1992). This context has led to community-based activism, where lgbt professionals create autonomous clinics that can provide culturally sensitive care (Mayer et al., 2008).

Researchers have consistently underscored the need for more information about treatment needs of lgbt patients in general (Mayer et al., 2008). As a result, many have suggested not only gathering data specifically from this vulnerable and understudied group (Buttaro & Battle 2012), but also adding questions to state-wide and national surveys that would allow for easier identification of lgbt people within medical settings (Dilley, Simmons, Boysun, Pizacani, & Stark, 2010). The need for basic demographic data on lgbt populations is critical to helping to understand how the medical profession can increase the health and wellbeing of this group. At the same time, though the literature reveals that lgbt people are engaging with medical professionals, little is known about the types of relationships that are being fostered. The next section describes the importance of trust and respect with regard to relationships with medical providers. What are some of the factors that contribute to a greater level of trust and respect between a patient and her/his medical provider?

Trust in the Medical Professions

Trust in the medical professions is sometimes linked to how well medical knowledge is shared from physician to patient, to having an active relationship with one’s primary care physician, and to having health insurance. These experiences are also affected by a patient’s sexual orientation, race, and age. The medical care discourse seems to affirm that medical professionals who share healthcare information with their patients readily are usually perceived as more trustworthy (Fiscella et al., 2004). In one study, lesbian informants described how physicians refrained from offering them the knowledge they needed in language they could understand, and so they felt misinformed about their overall health (Stevens, 1996). Researchers also found that lesbian patients may need to be more forceful (than their usual patient disposition), and intentional, in navigating the vulnerable power dynamics between physician and patient (Stevens, 1996; Brown & Tracy, 2008). Similarly, healthcare providers require sensitivity training in order to deal professionally with women-who-partner-with-women when they come into their care (Scout & Fields, 2001). Underscoring this need, The Maunter Project for Lesbians with Cancer in partnership with the Centers for Disease Control and Prevention conducted a training project for healthcare providers to address sensitivity and equity with regards to women’s sexual orientation. This project—titled Removing Barriers—also found that some healthcare providers did not know where to find resources that could help them enhance their services to women-who-partner-with-women (Scout & Fields, 2001).

In addition, research has found that having a regular primary care physician contributes to higher levels of trust, and this is so among Black patients (Do et al., 2010). Broadly, however, Black (and other non-White Hispanic) patients may be less trusting of medical professionals than are White patients (Stepanikova, Mollborn, Cook, Thom, & Kramer, 2006). Based on a stratified sample of 59,725 patients, researchers showed that Black patients scored higher on indirect measures of mistrust of their doctors than did White patients (Stepanikova et al., 2006). Being misunderstood by a physician or feeling like a medical professional does not know about lgbt issues may also contribute to a lack of trust. In a survey of 529 Black lesbians and 65 Black bisexual women, Cochran and Mays (1988) concluded that patients did not trust their medical providers. This study’s participants felt that had they disclosed their sexual orientation, they would be further alienated by their doctors, and they also reported that they feared that their doctors would not recognize differences in lifestyle between White and Black lesbians, thus receiving inadequate care (Cochran & Mays, 1988). However, recent research has failed to find any relationship between physician trust and race and ethnicity (Hall et al., 2002).

Age has also been found to be a factor influencing a person’s comfort with a medical provider. A 2011 Institute of Medicine report stated that many lgbt people, particularly older people, have problems maintaining a relationship with a regular general practitioner or healthcare professional possibly because of historical stigma attached to non-heterosexual orientations. Still, the existing literature demonstrates that patient trust of doctors is positively associated with patient age (Hall et al., 2002). According to Fiscella and colleagues (2004), older patients are more likely to trust their primary care physicians. However, Balkrishnan and colleagues (2003) found that age was only a marginal predictor of physician trust and trust in the medical profession and that patients who have changed their primary care physician in the recent past, report stronger trust in their current physician (Balkrishnan et al., 2003). The authors go on to say that trust may be an even more pivotal measure of the medical professional-patient relationship than even satisfaction.

Previous research also shows that having health insurance matters in perceiving one’s physician as trustworthy. Do and colleagues (2010) posit that this is so because not having insurance coverage can be seen as an access barrier to a regular physician. Alternatively, DeVoe and colleagues (2007) argued that the perceived constraints of insurance plans do not result in a negative measure of physician trust from patients. In other words, though having health insurance may be a factor contributing to a greater trust in the medical profession, there are a variety of ways that trust can be established in the absence of regular health insurance. For example, it is possible to imagine that a medically uninsured person who receives care from a clinic or community health center may actually have a trusting relationship with her/his provider.

The discourse around lgbt people’s interaction with the healthcare community also indicates that there is a relationship between positive mental health, operationalized as happiness, and whether an individual perceives that medical professionals treat them unfairly because of their sexual orientation (Ryan & Rivers, 2003). In a review of the Amnesty International investigation of the human rights of lgbt people, Lewin and Meyer (2002) observed that the harmful effect of bigotry emanating from medical professionals can cause significant mental stress to the patient. While the report focused primarily on abuses internationally, the authors also noted that there is a human rights dilemma in the United States, which can impact the mental health and happiness of lgbt people. Still, empirical studies on medical trust and the lgbt community are limited (Riordan, 2004), and this is compounded by a lack of demographic data collected on a consistent basis for lgbt populations.

As delineated above, previous research has addressed the importance of (1) lgbt identity salience, (2) lgbt engagement with medical professionals, and (3) patient trust in the medical professions. Throughout, scholars have identified how race and sexuality—studied separately or in tandem—can ultimately affect comfort levels between patients and their medical providers. This manuscript seeks to expand on some of that knowledge by exploring the specific belief/perceptions of Black lgbt people in their interactions with medical professionals. Regarding sexual identity issues, what are some of the factors that contribute to a more comfortable relationship with medical professionals? More specifically, this paper seeks to understand the relative importance of three sets of variables—identity salience, health, and demographic characteristics—on the belief that a doctor or medical professional seems comfortable with a patient’s sexual identity.

Methodology

The data analyzed in this paper were taken from the Social Justice Sexuality (sjs) Project. The survey design included an iterative process to ensure validity. For example, several focus groups were conducted prior to the launch of the nation-wide survey to identify concerns that were pertinent to lgbt people of color. Additionally, to assess potential respondents’ comfort with initial versions of the survey instrument, pilot studies were conducted before the final questionnaire was produced.

A number of items in the sjs survey were taken verbatim from preexisting surveys to ensure validity. However, some questions were re-phrased or new items created to reflect the target population—lgbt people of color. Many sources were used to facilitate the creation of the instrument, including some of the following: The Black Pride Survey 2000, which serves as one of the largest survey projects to gather data from Black lgbt people in the US; The Black Youth Project, which collects relevant data on Black youth in the USA today; The General Social Survey from the USA; The Lavender Islands Study on Family; The Living in the Margins Survey based on Asian and Pacific Islander populations; The National Black Lesbian Needs Assessment Survey from the USA; The National Health and Nutrition Examination Survey; Nuestras Voces, based on Latino gay and bisexual men, and The Santa Clara Strength of Religious Faith Survey (Plante et al., 2002), which has continued to measure the importance of religion in this country.

The sjs project was conducted using self-administered questionnaires. The ten-page instrument contained 105 items addressing five areas: Family formations and dynamics; Civic engagement; Spirituality and religion; Sexual, racial, and ethnic identity; and Mental and overall health. In addition to the English version of the survey, a Spanish language version was developed. Via a variety of venue-based locations (for example: gay parades; community center; churches; among others), data was collected from January to December 2010, in all 50 states, Washington dc, and Puerto Rico.

The sjs project was conducted using self-administered questionnaires. The ten-page instrument contained 105 items addressing five thematic areas: Family formations and dynamics; Civic engagement; Spirituality and religion; Sexual, racial, and ethnic identity; and Mental and overall health. In addition to the English version of the survey, a Spanish language version was developed. Via a variety of venue-based locations, data was collected from January to December 2010, in all 50 states, Washington dc, and Puerto Rico. Finally, during the field period, a version of the survey was also available on the project’s website, SocialJusticeSexuality.com. The sampling techniques employed by the sjs project varied, including: venue-based sampling, snowball sampling, the internet, as well as partnerships with community-based organizations, activists and opinion leaders. The sjs team gathered data at places such as Pride marches for lgbt people of color, social outings, religious events, festivals, rodeos, and senior gatherings.

Participants

Ultimately, 4,953 valid surveys were successfully gathered. Almost half (42.12%; n = 1,374) of the respondents identified as Black. Of those Black respondents, 52% were male, 42% were female, and six percent were gender variant. Most of the Black sample (61%) was between 25 and 49 years of age; while 21% of the sample was between 18 and 24, and 18% was over 50 years of age. A little more than a third (36.4%) of the Black participants identified as gay, 22.6% identified as lesbian, 10.7% identified as bisexual, 4% identified as queer, while the remainder had some other sexual orientation identity (e.g., In the Life; Macha/o; among others).

The present analysis is based on the sub-sample of Black Lesbian, Gay, Bisexual and Transgendered men and women (n = 1,374) with valid responses to the appropriate questions. (See Table 1 and the Findings section for further information of the sub-sample used in this article).

Variable Definition

This paper examines the relationship among identity salience variables, health-related variables, demographic variables and a patient’s perception that her/his medical provider seems comfortable with his/her sexual identity. More specifically, this study examines the belief/perceptions Black lgbt respondents have when assessing the comfort levels of medical professionals around sexual identity. The belief/perception variable has its roots in the medical trust literature, based on patients’ expectation that they will be treated respectfully (Do et al. 2010; Hinchliff et al. 2005; Stepanikova et al. 2006). The dependent variable is presented as dichotomous, where one (1) represents respondents for whom the medical professional seemed comfortable with their sexual identity, and zero (0) for those who felt their medical professional was ‘not comfortable’. The values in the original item about perception of the medical professional’s view of the respondent from the questionnaire were “seemed uncomfortable”; “ignored sexual identity” and “did not know your sexual identity” were all recoded as zero (0), or “not comfortable”; and “comfortable with sexual identity” remained coded as one (1). The relationship between this variable and several socio-cultural variables was examined across three explanatory models.

The first model included five independent variables measuring identity salience with regard to a respondent’s connection to lgbt communities; the importance of sexual identity; the belief in family support; and the number of people a respondent is “out” to in her/his life. Connected to Local LGBT Community, Share LGBT Community Problems, Sexual Identity is Important, and Family Support are each 6-point scale variables, where 6 represented ‘more’ of the specific item. The fifth variable—Outness—in Model I is a composite (α = .901) in which six original questions asked how many people in the respondent’s social network (family, friends, religious community, co-workers, etc.) knew about the respondent’s sexuality. The alpha indicates that the use of the composite to create the broader Outness variable is powerful and can statistically represent a concept of Outness better than using the six items independently.

Model II measured the impact of health indicators on perceptions. For this model, there were four dichotomous variables based on whether the respondent had Health Insurance; if s/he had a regular Health Care Provider; if the respondent’s Medical Professional Provides Health-related Info; and a yes/no question about the respondent’s Smoker status. The fifth variable was perceived Overall Health, where the respondent answered the following question: “In general, would you say that your health is . . .” and were able to respond “poor” to “excellent” on a five-point scale. Happiness (or mental well-being) was the final item in Model II. This was a composite (α = .880) of four questions: “Over the past week, how often have you felt (a) that you were just as good as other people, (b) hopeful about the future, (c) happy, and (d) that you enjoyed life.” The composite variable maintains the scaled measurements present in the original items, therefore we present more detailed measures on the mental health of the respondents.

In Model III, several key demographic variables were used to analyze the respondents’ perception of their doctor’s attitude toward their sexuality. These variables included age; gender; and relationship status. Additionally, there were variables measuring education (which ranged from 1 to 7; where 7 = Graduate/Professional degree) and income (which ranged from 1 to 12; where 12 = $100,000 and over).

Results

Even though these were all Black lgbt respondents, there was nevertheless some heterogeneity within the group. The ages of respondents in the sub-sample used in this analysis ranged from 18 to 81, with the average being 36.5 years old. The average household income of this sub-sample was between $20,000 and $29,999, with most of the sample averaging closer to the upper end of the range; and the average educational attainment was an Associate degree. Most of the sample was male (53%), while 43% were female, and 4% were gender variant. Finally, almost half of the sample identified as being single (48.3%).

Sixty-two percent of the sample felt that their medical providers were comfortable with their sexuality. This, therefore, sets the foundation for discussing the relationship between belief/perception and all of the predictors. Ultimately, logistic regression was employed for multivariate analyses, which would allow us to examine the odds or predictability of our indicators.

Three models are presented in Table 2. All three models are statistically significant as the significance level for the Model Chi Square (x²) is < .001. This means that the results from the three models are not simply based on chance. The proposed equations predicted weak to modest proportion of the variance in perception of medical provider’s comfort with sexuality as the Nagelkerke r² ranges from .119 to .239 for the three models. This means that 11.9% to 23.9% of the variation in perception of medical provider’s comfort with sexuality was predicted by the models. The first (and the weakest) model was improved upon with the addition of each set of mediating variables.

Table 1.

Mean, Standard Deviation, Range and Description of Variables for Black LGBTs (n = 1374)

In Model I, as the level of outness increases by one point among Black lgbt respondents, the odds that they perceive their medical professionals as comfortable with their sexuality increase by a factor of 1.347, controlling for variables that measured connections to local lgbt communities, sharing lgbt community’s problems, the importance of sexual identity, and family support. Additionally, as family support increased among this sample, the odds of their belief/perception increased by a factor of 1.295, controlling for the other four identity-related variables.

Model II added a battery of questions measuring health. The results show that, first, all significant relationships found in Model I (outness and family support), held in Model II. Additionally, those with a regular health-care provider had a higher odds-ratio of perceiving their doctors as more comfortable with their lgbt status by a factor of 2.914, while controlling for insurance, information from medical professionals, overall physical health, happiness, smoking, and all five identity salience-related variables from Model I. Likewise, respondents who received health information from medical professionals had more positive belief/perceptions than did their counterparts (when the latter increased by one, the dependent variable increased by a factor of 2.235). Finally, happiness had a positive impact on belief perceptions. A one point increase in happiness increased the odds that respondents perceive their medical professionals as comfortable with their sexuality by a factor of 1.249.

Table 2.

Logistic Regression Coefficients (Odds Ratio in parentheses) Predicting Belief/Perception of Medical Provider’s Comfort with Black LGBT Sexual Identity (n = 1374)^a

The final model of the analysis (Model III), added a battery of questions measuring a variety of demographic variables. All relationships (though not necessarily effects) found in Models I and II were also present in Model III. However, females had more negative belief/perceptions (a factor of 0.742) than did their male counterparts, controlling for age, relationship status, education, income and all of the identity salience and health-related variables.

Discussion

About 40% of the Black lgbt people from this study did not feel that their doctor or medical provider was comfortable with their sexual identity. For this to happen, the respondent had to perceive that the doctor, for whatever reason, knew of their sexual orientation and was not comfortable with it. Whether that was for homophobic or racist reasons, the impact is clear: injurious assumptions are being made about the relationships between patients and their medical providers (Collins 2004; Crenshaw 1991; Meyer 2001). Still, the analysis explored in this study does not fully explain what contributes to the perceived comfort of medical providers when dealing with sexual identity issues for Black lgbt people. For a variety of methodological as well as sociological reasons—like the ability to obtain a representative sample of all Black lgbt people and the fluidity of sexuality—research on the experiences of (Black) lgbt people must continue to be mindful of these realities. However, the analysis in this data produced some significant findings that can be used to justify future research into the relationships that exist between Black lgbt patients and their medical providers.

Findings presented here corroborate the work of other scholars suggesting that the more “out” a patient is to their immediate social network (family, co-workers, etc.), the more likely s/he is to perceive the medical provider as comfortable with sexual identity issues (Bjorkman & Malterud, 2007; Hinchliff et al., 2005). The implied causal effect lends itself to future investigation in order to unpack it. In other words, is it (1) that being out makes the medical provider more comfortable, (2) that having a medical provider who is comfortable around sexual identity issues facilitates a patient’s willingness to be out, or (3) some iterative combination of the two? Interrogating these questions merit longitudinal and/or qualitative information, both of which go beyond the scope of this dataset. Concomitant with this line of reasoning is the impact of family support. This study suggests that as family support increases, so does the likelihood that respondents would perceive their medical providers are comfortable with their sexual identity. The challenge of unpacking causal order is evident. However, with family support, the model for understanding these relationships could become even more complex. Specifically, being out and having more family support could covary such that they iteratively lead to people self-selecting medical providers who are more comfortable with their sexual identity. Longitudinal data and more nuanced path analyses are needed in order to more accurately understand these (possible) relationships.

The positive relationship between belief perceptions and having a regular healthcare provider is poignant indeed. The causal order issue notwithstanding, this research echoes literature arguing that patients are more likely to have a regular healthcare provider if they (the patients) possess positive belief perceptions. Of major concern for women’s health is the fact that they hold more negative belief perceptions, as compared to their male counterparts. Much has been written about unique challenges lesbians face within the healthcare system. Unfortunately, our research further highlights that problems clearly persist for women (Stevens, 1996) and for Black lesbians, in particular.

Conclusion

Interaction with medical professionals is not only necessary for episodic curative experiences, but also for everyday preventative care encounters. Providers should ensure that Black lgbt people do not experience trauma as a result of visiting their healthcare provider. Based on the findings of this research, Black lgbt people should be encouraged to find a regular general practitioner or clinic for continuity of care and to build a respectful, on-going rapport.

Findings from logistic regressions reveal that respondents who were “out,” had family support, had a regular healthcare provider, received their medical information primarily from their healthcare provider, had ‘happier’ dispositions, and were male have more positive belief perceptions. That is, they are more likely to perceive that their medical professional seemed comfortable with their sexual identity. The most poignant findings from the study are evident in Model I. Members of the Black lgbt community will be more trusting of the medical professionals they encounter, if they are supported in other areas of their lives. Support from their close networks, particularly being out to supportive families, can positively impact their interactions in a clinical environment.

Medical professionals also need to be more extensively trained to avoid heteronormative assumptions about their patients. Doing so would create a safe space for patients to disclose their sexual identity and thus receive medical treatment specific to the unique experiences and circumstances of lgbt people. This is consistent with our results, where the provision of health-related information suited to their situation, can only accrue positive outcome for Black lgbt people. Finally, medical providers can also build trust in the relationship between them and their Black lgbt patients, by encouraging the inclusion of supportive family members. This recommendation is based on one of the major findings of the project, where having a supportive family is significantly related to the belief that the doctor is comfortable with the patient’s sexuality. The results from the present study certainly can contribute to the discourse around improving a professional, trusting relationship between medical professionals and the Black lgbt population they serve.