Health disparities for LGBT military members serving under “don't ask, don't tell”: Quantifying health care utilization and circumvention

Background: This study sought to examine health care utilization for American LGBT military members serving under “Don't Ask, Don't Tell” (DADT) and to investigate any mediating roles involving a servicemember's DADT policy knowledge or pre-repeal sexual orientation disclosure. Methods: Survey data was analyzed from 1,484 self-identified LGBT servicemembers (mean age 32.7; 67.8% White non-Hispanic; 79.0% male; mean years of military service 9.78; 74.6% active duty). Multivariable logistic regression models adjusted for age, sex, ethnicity, and geographic location examined health care utilization for LGBT-related medical issues alongside two tested variables: servicemembers' knowledge of DADT policy changes protecting them from discharge and the presence of a sexual orientation disclosure to a military provider before DADT repeal. Results: Overall, 30.8% of the sample reported underutilizing health care and 14.9% had circumvented military health care for various LGBT health issues. Underutilization was most significant for mental health issues (43.5%, p<0.0001) while non-military health care circumvention was highest for sexually transmitted infections (22.7%, p<0.0001). DADT policy knowledge mitigated military health care underutilization by 20% (p=0.0043, RR 0.70-0.86), while a pre-repeal sexual orientation disclosure decreased underutilization 26% (p=0.0002, RR 0.63-0.84). Conclusions: The DADT policy served as a significant impetus for LGBT servicemembers to either underutilize or circumvent their military health care. Both a servicemember's policy knowledge and pre-repeal sexual orientation disclosure significantly improved health care utilization rates. Therefore, these indicators partially illustrate how both knowledgeability and comfortability factors play an important role in overcoming negative organizational policy, such as DADT, aimed at the LGBT community.