








































EDITORIAL 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 4 – Issue 3 – November 2021 
 

Past, Present, and Future of LGBTQ Health Care 
Emma Nye, DAT, LAT, ATC 
Grand View University, Des Moines, IA 
 

 
Key Phrases 
Patient-centered care; inclusion 
 
Correspondence 
Dr. Emma Nye, Select Medical, Grand View University, 3164 
SW Arlan Lane, Ankeny IA, 500023. 
E-mail: enye@grandview.edu  
Twitter: @EANye15  
 
 
Full Citation 
Nye E. Past, present, and future of LGBTQ health care. Clin 
Pract Athl Train. 2021;4(3):1-4. 
https://doi.org/10.31622/2021/0004.3.1.      
 
 
EDITORIAL 

Lesbian, Gay, Bisexual, Transgender, Queer, 
Intersex, and Asexual (LGBTQIA+) individuals 
have largely faced bias, stigma, and victimization 
in health care settings.1 Factors such as lack of 
knowledgeable providers and access to inclusive 
facilities have led to reduced utilization of the 
healthcare system, and therefore, negative long 
term health outcomes.1 Although the LGBTQIA+ 
community is most often tied together as one 
population, each letter may represent an 
individual of diverse socioeconomic status, race, 
ethnicity, abilities, and identities. In recent years, 
the athletic training profession has largely focused 
on how to create inclusive spaces for LGBTQIA+ 
patients and have worked towards a more 
culturally competent membership. Now that 
athletic trainers (ATs) have a foundational level of 
knowledge, we must move to considering how 
intersectionality, or an approach which considers 
the interaction of different factors or social 
categories, rather than each in isolation,2 impacts 
patient outcomes.  

The concept of intersectionality was first 
introduced to highlight the connections between 
race and gender and has gained interest by 
healthcare providers looking to better serve 
patients. Intersectionality recognizes the 

multidimensionality of each individual and argues 
the social oppression they may experience is 
caused from the intersection of different social 
inequalities, rather than one marginalized 
identity.3 ATs must recognize the patients we treat 
are comprised of multiple identities, have varying 
values and beliefs, and should not be categorized 
into one group. Although we are bound by the 
Board of Certification’s Standards of Professional 
Practice, and specifically to render quality patient 
care regardless of the patient’s race, religion, 
age, sex, ethnic or national origin, disability, 
health status, socioeconomic status, sexual 
orientation, or gender identity,4 now is the time to 
begin considering how each of these 
demographics connect to one another.  

Patterns of discrimination and substandard care 
have been well documented across health care 
settings, particularly for those who identify as 
LGBT.1 Healthcare providers’ refusal of care, 
refusing to touch patients or use additional 
precautions, the use of harsh or abusive language, 
or being rough or abusive was reported by more 
than half of respondents in one of the largest 
studies on LGBT health care.5 Staggeringly, 
respondents of color experience even higher rates 
of discrimination and substandard care, and were 
twice as likely as White people to report 
experiencing physically rough or abusive 
treatment by medical providers.5 In a 2020 study, 
researchers found gender minority blacks were 
more likely to report experiencing severe mental 
distress, longer periods of being physically or 
mentally unwell, longer periods of activity 
limitations due to poor health, than cisgender 
blacks, as well as cisgender Whites.6  

Additionally, the US Transgender Survey, a 2015 
nationwide survey with 27,715 transgender 
respondents, revealed that Black transgender 
women reported higher HIV prevalence rates 

mailto:enye@grandview.edu
https://doi.org/10.31622/2021/0004.3.1


Past, Present, and Future of LGBTQ Health Care 

 

 
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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188         Volume 4 – Issue 3 – November 2021 
 

compared with the overall transgender sample, 
and that transgender people of color reported 
higher rates of attempted suicide and lack of 
health insurance.7 In an effort to reduce these poor 
health outcomes, ATs must not only continue to seek 
out educational resources to become more 
culturally agile, but also go beyond seeing our 
patients through single identifiers.  

A valuable step in bridging the knowledge gap 
of intersectionality is to incorporate not only 
LGBTQIA+ related themes into AT curricula, but 
also to integrate how additional racial and ethnic 
identities impact the patients ATs care for. A 
recent study appearing in the Athletic Training 
Education Journal outlined that 45% of AT 
educators who responded have had athletic 
training-specific diversity or cultural competency 
training. Further, 21% reported being taught 
cultural competence concepts during their 
professional education.8 Formal educational 
training which focuses on best practices for 
treating marginalized patient populations should 
be implemented not only for AT educators, but for 
practicing clinicians as well. The Commission on 
Accreditation of Athletic Training Education 
(CAATE) has proposed accreditation standards 
for diversity, equity, inclusion, and social justice. As 
new cultural competence standards are 
implemented into AT education programs, ATs 
should look to incorporate intersectionality into the 
standard educational content. 

In this issue, the authors address several action 
steps for ATs looking to better serve patients of 
diverse identities. As we continue to provide 
patient-centered care and work towards a more 
culturally competent profession, ATs should seek 
out ways to bridge the knowledge gap, 
demonstrate empathy and understanding, and 
practice patient advocacy.  

 

 

REFERENCES 

1. IOM (Institute of Medicine). The Health of 
Lesbian, Gay, Bisexual, and Transgender 
People: Building a Foundation for a Better 
Understanding. Washington, DC: The National 
Academies Press (US); 2011. 
https://doi.org/10.17226/13128.   

2. Bauer GR. Incorporating intersectionality 
theory into population health research 
methodology: challenges and the potential to 
advance health equity. Soc Sci Med. 
2014.1;110:10-7. 
https://doi.org/10.1016/j.socscimed.2014.0
3.022.  

3. Rai SS, Peters RM, Syurina EV, Irwanto I, 
Naniche D, Zweekhorst MB. Intersectionality 
and health-related stigma: insights from 
experiences of people living with stigmatized 
health conditions in Indonesia. J Equity Health. 
2020 19(1):1-5. 
https://doi.org/10.1186/s12939-020-
01318-w.  

4. National Athletic Trainers Association Code of 
Ethics. Accessed 2.23.2021 
https://www.nata.org/membership/about-
membership/member-resources/code-of-
ethics.  

5. When Health Care Isn’t Caring: Lambda 
Legal’s Survey of Discrimination Against LGBT 
People and People with HIV. New York: 
Lambda Legal, 2010. Accessed 2.23.2021 
www.lambdalegal.org/health-care-report.  

6. Lett E, Dowshen NL, Baker KE. Intersectionality 
and health inequities for gender minority 
Blacks in the US. Am J Prev Med. 
2020.1;59(5):639-47. 
https://doi.org/10.1016/j.amepre.2020.04.
013 .  

7. Howard SD, Lee KL, Nathan AG, Wenger HC, 
Chin MH, Cook SC. Healthcare experiences of 

https://doi.org/10.17226/13128
https://doi.org/10.1016/j.socscimed.2014.03.022
https://doi.org/10.1016/j.socscimed.2014.03.022
https://doi.org/10.1186/s12939-020-01318-w
https://doi.org/10.1186/s12939-020-01318-w
https://www.nata.org/membership/about-membership/member-resources/code-of-ethics
https://www.nata.org/membership/about-membership/member-resources/code-of-ethics
https://www.nata.org/membership/about-membership/member-resources/code-of-ethics
http://www.lambdalegal.org/health-care-report
https://doi.org/10.1016/j.amepre.2020.04.013
https://doi.org/10.1016/j.amepre.2020.04.013


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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188         Volume 4 – Issue 3 – November 2021 
 

transgender people of color. J Gen Intern 
Med. 2019: 34(10):2068-74. 
https://doi.org/10.1007/s11606-019-
05179-0.  

8. Grove DH, Mansell J. Cultural Competence: 
Where Are We as Athletic Training 
Educators?. Athl Train Educ J. 2020;15(1):49-
54. 
http://dx.doi.org/10.4085/150119041.  

 

 

 

 

 

 

  

https://doi.org/10.1007/s11606-019-05179-0
https://doi.org/10.1007/s11606-019-05179-0
http://dx.doi.org/10.4085/150119041


EDITORIAL 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 4 – Issue 3 – November 2021 
 

 


