LGBTQIA+ Populations: A Study Guide for Paramedic Care

Understanding Terminology & Identity

The Genderbread Person: Deconstructing the Binary

It is critical to understand that components of a person's identity are distinct from one another. The "Genderbread Person" model helps visualize these separate concepts, moving beyond rigid binary expectations.

Gender Identity (Brain): A person's internal sense of self as man, woman, non-binary, etc.
Gender Expression (Appearance): How a person outwardly presents their gender (masculine, feminine, androgynous).
Sex Assigned at Birth (Genitals): The sex (male, female, intersex) recorded at birth based on external anatomy.
Attraction (Heart): Who a person is sexually and/or romantically attracted to (e.g., heterosexual, gay, bisexual, asexual).

Key Terminology

Language is powerful and evolves. Using respectful and accurate language is a cornerstone of safe care.

Term	Definition
LGBTQIA+	An acronym for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual. The '+' acknowledges the many other identities not explicitly named.
Cisgender (Cis)	A person whose gender identity aligns with the sex they were assigned at birth.
Transgender (Trans)	An umbrella term for people whose gender identity differs from the sex they were assigned at birth.
Heteronormativity	The worldview that promotes heterosexuality as the normal or preferred sexual orientation and assumes a gender binary.
Pronouns	Words used to refer to someone in the third person (e.g., he/him, she/her, they/them). Always use a person's correct pronouns.
Ally	A heterosexual and cisgender person who actively supports equal rights and social movements for the LGBTQIA+ community.

Health Disparities & Minority Stress

The Minority Stress Model

This model explains how stigma and discrimination lead to poor health outcomes. It's not the identity itself that causes health problems, but the stress of navigating a society that is not affirming or safe.

The Pathway to Poor Health:

Structural Stigma: Societal norms, policies, and institutional practices that constrain the opportunities and well-being of stigmatized individuals.
Minority Stressors:
- Distal Stressors: External events like discrimination, victimization, and rejection.
- Proximal Stressors: Internalized negative societal attitudes, such as internalized homophobia or concealment of one's identity.
Negative Health Consequences: These stressors lead to psychopathological risks (e.g., emotional dysregulation, social isolation) and risky health behaviors (e.g., substance use), culminating in poor mental and physical health.
Healthcare Avoidance: Fear of engaging with healthcare professionals leads to delayed preventative care, creating a cycle of worsening health and increased reliance on acute/emergency services later on.

Barriers to Care & Paramedic Bias

Paramedicine Student Bias: The Thyer et al. (2024) Study

This study surveyed Australasian paramedicine students to assess their attitudes towards the LGBTQIA+ community using the Riddle Scale.

Key Findings:

Positive Attitudes: The majority of students expressed positive attitudes of support, admiration, appreciation, and nurturance.
Concerning Bias: However, a minority (33 responses) showed attitudes of repulsion or pity, suggesting that some future paramedics hold beliefs that can perpetuate stigma and cause harm.
Curriculum Gap: Critically, students reported an overwhelmingly poor opinion of the LGBTQIA+ content within their paramedicine degrees.

This highlights a significant tension: even with good intentions, a lack of formal education can lead to clinicians who are not confident or competent in meeting the needs of LGBTQIA+ patients, reinforcing systems of exclusion.

Providing Culturally Safe & Affirming Care

Creating a Safe Space: What to Do and Say

In unscheduled care, the paramedic sets the tone. Your actions can either build trust or reinforce fear and stigma.

1. Don't Assume - Ask Respectfully:

Introduce yourself with your own pronouns: "Hi, my name is Alex and my pronouns are he/him. How do you prefer to be addressed?"
Use open-ended, inclusive language for relationships: "Who is in your family?" or "Tell me about your partner," instead of assuming a husband or wife.

2. Use 'Warm' Communication:

Acknowledge that past healthcare experiences may have been negative. A welcoming and non-judgmental approach is crucial.
Check for understanding and invite questions: "Was there something you wanted to talk to me about that I didn’t give you an opportunity to?"

3. Ensure Privacy and Consent:

When asking sensitive questions, state your purpose: "I need to ask some questions about your medical history to ensure I give you the safest care. Is it okay to talk about that now?"

Responding to Disclosures of Intimate Partner Violence (LIVES)

LGBTQIA+ people experience high rates of intimate partner violence. If a patient discloses, use the LIVES framework:

Listen closely, with empathy and without judgment.
Inquire about their needs and concerns (emotional, physical, social).
Validate their experience. Show them you understand and believe them. Assure them it is not their fault.
Enhance safety. Discuss a plan to protect them from further harm.
Support by helping connect them to information, services, and social support.

Specific Health Considerations

Area	Key Paramedic Considerations
Transgender Health	Provide gender-affirming care by using correct names and pronouns. Avoid "trans broken arm syndrome": don't assume a patient's medical issue is related to their gender identity. Be aware of anatomical considerations. A trans man may have a cervix and uterus and can present with vaginal bleeding. A trans woman may have a prostate. Hormone therapy can have health implications (e.g., testosterone increases risk factors for cardiovascular disease).
HIV & Co-morbidities	With modern antiretroviral therapy (ART), HIV is a chronic, manageable condition, not a terminal illness. Life expectancy is near-normal. Be aware of a higher incidence of co-morbidities like cardiovascular disease, stroke, and certain cancers. PrEP (Pre-Exposure Prophylaxis) is a highly effective medication used by HIV-negative people to prevent transmission.
Mental Health & Substance Use	LGBTQIA+ people have a significantly higher incidence of mental health disorders (depression, anxiety) and suicidal behaviors due to minority stress and stigma. There is also a higher risk of substance abuse, often as a coping mechanism.