How to Support Diverse SGM Patients

Paying attention to the complexity of SGM identities underscores the importance of an individual’s social history and environment in determining their health, access to care, and ability to engage in interactions with providers. Providers and staff should assess these social determinants or structural vulnerabilities for all patients, including SGM patients. Structural vulnerabilities arise from an individual’s or a population group’s condition of being at risk for adverse health outcomes because of social forces that are economic, racialized, political, and cultural. Patients are structurally vulnerable when these social forces combine with their institutional and policy-level status (e.g., immigration status, employment status), compromising their abilities to access health care and pursue healthy lifestyles.62

Bourgois and colleagues62 have identified seven often intersecting domains of structural vulnerability that providers can focus on to improve patient care:

  1. Financial security, such as the ability to pay rent, buy food, or afford medical care;
  2. Residence (i.e., having a safe, stable place to live);
  3. Risk environments, including daily exposure to harassment, discrimination, violence, injury, or illness;
  4. Food access;
  5. Social network, meaning the presence of supportive family or friends, as well as access to a trustworthy healthcare provider;
  6. Legal status, including eligibility for public services; and
  7. Education, including literacy and the ability to understand documents.

Bourgois and colleagues suggest that these assessments may help improve patient care and can be used as a teaching tool for new staff and providers to reflect on their possible reactions of discomfort or judgment that may negatively influence patient care.

Finally, in planning for organizational change, providers and staff may want to consider additional education and training to meet the unique needs of SGM people, particularly those facing multiple oppressions that can engender vulnerabilities in healthcare contexts. Such educational opportunities may involve: cultural competency/humility training; workshops on pre- and post-exposure prophylaxis for HIV (PrEP/PEP); hormone replacement therapies for gender affirmation; and conducting safe, gender-affirming physical exams with transgender patients.63

More information about these topics can be found in Chapter 9.