Barriers to accessing healthcare services by the LGBTIQ community: A comparative study from Nepal and India

Abstract

Background: It has been more than a decade since Lesbian, Gay, Bisexual, Transgender, Intersex and Queer (LGBTIQ) rights were first implemented in Nepal and India. However, it is still being reported that LGBTIQ people are deprived of fundamental rights and health due to discrimination and stigma. Sexual and gender minorities are subjected to many challenges while accessing health care. This study investigates the enabling and constraining factors that influence health care access and utilization of people who identify as LGBTIQ in Nepal and India. Methods: A comparative desk-based study used Queen Margaret University (QMU) electronic library resources to search and identify peer-reviewed articles published between 1994 and 2020 in key databases including PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Moreover, Google Scholars advanced was employed for Nepal and India. Online resources like government and various organisational portals were also used to obtain grey literature on the concept of LGBTIQ access and utilization of health care services. The Ryckvier (2018) framework was employed to examine enabling and constraining factors for accessing health care and utilization by LGBTIQ in Nepal and India. A total of 3640 and 18375 articles related to Nepal and India respectively were identified and screened after which 14 articles from Nepal and 17 articles from India were selected for this study. Results: The findings show that access to health care services in both countries is poor due to the negative and discriminating behaviour of health care professionals towards LGBTIQ people. The key barriers were; a lack of LGBTIQ friendly services and admission procedures; physical, financial and distance barriers, and lack of competent staff who understood and identified their reasons for accessing health care services. Additionally, social environment determinants such as the internalised stigma of sexual minorities, rejection by family, society, peers and LGBTIQ communities (Masters), criminalisation, misuse of power by higher authorities and lack of legal support influenced LGBTIQ access to health services and utilisation. Thus, they are more susceptible to health-related problems such as depression, STDs (including HIV), loneliness, and suicidal attempts. Conclusion: To ensure increased access and health service utilisation by LGBTIQ people in Nepal and India, it is essential for individual health care professionals, policymakers and the administrative department (public and health services) to support and understand LGBTIQ health, issues and rights without discrimination. The wider community, as well as the health team, must accept their sexual and gender identity and treat them as human beings with individual’s needs. The government must intervene with specific LGBTIQ oriented laws that protect and address their rights. Key Words: A comparative study, Nepal, India, stigma, discrimination, barriers, health care access, service utilisation health, LGBTIQ