An etic view of LGBTQ healthcare: Barriers to access according to healthcare providers and researchers

For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.

Sexual orientation typically describes people's sexual attractions or desires based on their sex relative to that of a target. Despite its utility, it has been critiqued in part because it fails to account for non-biological gender-related factors, partnered sexualities unrelated to gender or sex, or potential divergences between love and lust. In this article, I propose Sexual Configurations Theory (SCT) as a testable, empirically grounded framework for understanding diverse partnered sexualities, separate from solitary sexualities. I focus on and provide models of two parameters of partnered sexuality--gender/sex and partner number. SCT also delineates individual gender/sex. I discuss a sexual diversity lens as a way to study the particularities and generalities of diverse sexualities without privileging either. I also discuss how sexual identities, orientations, and statuses that are typically seen as misaligned or aligned are more meaningfully conceptualized as branched or co-incident. I map out some existing identities using SCT and detail its applied implications for health and counseling work. I highlight its importance for sexuality in terms of measurement and social neuroendocrinology, and the ways it may be useful for self-knowledge and feminist and queer empowerment and alliance building. I also make a case that SCT changes existing understandings and conceptualizations of sexuality in constructive and generative ways informed by both biology and culture, and that it is a potential starting point for sexual diversity studies and research.