Lesbian, gay, bisexual, and transgender veterans' experiences in the VA health care system

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) veterans in the Department of Veterans Affairs (VA) healthcare system. To begin to address this issue, we conducted six focus groups with 58 LGBT veterans at two large VA medical centers. We asked about positive and negative experiences with the VA healthcare system, barriers to access, and solutions for making the VA setting more welcoming. Consistent themes emerged across the two hospitals: (1) LGBT issues were rarely raised by VA clinicians. Mental health clinicians were more likely to raise the topic and were generally viewed as supportive compared to other disciplines. (2) Sexuality and sexual behavior were viewed as personal and private. Many believed that clinicians should not ask about sexuality and behavior. Some saw value in tailoring health care based on their sexual behavior and associated unique needs. (3) Barriers to care for LGBT veterans included clinicians who lacked knowledge and sensitivity about LGBT issues, equating the VA with the military where many had had negative experiences, and fear of discrimination. (4) Suggestions for making the VA more welcoming included staff training, signs denoting an inclusive and safe environment, LGBT community resource lists, and an onsite LGBT advocate. The data suggests the need for VA clinician education about the benefits of assessing sexuality and unique health risks. The strategies that emerged for promoting a welcoming environment for LGBT veterans can guide the VA system in creating LGBT-sensitive policy and staff training.