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Sexual and gender stigma is a known contributor to population health inequities; however, its impact on healthcare access among sexual and gender minorities (SGM) in Thailand is understudied. Therefore, we sought to examine the level of SGM stigma and its impact on self-reported difficulty accessing primary and mental healthcare services among a nationally recruited sample of lesbian, gay, bisexual, transgender, queer, intersex, and other gender and sexually diverse (LGBTQI+) people in Thailand. A previously validated sexual stigma scale was adapted to ascertain perceived and enacted SGM stigma. Between January and March 2018, 1,350 LGBTQI+ participants completed the online survey, and the median age was 27 (Quartile 1, 3: 23, 33) years. In total, 169 (12.5%) and 269 (19.9%) reported difficulty accessing primary and mental healthcare and 365 (27.0%) reported actively concealing their gender expression to access care. In multivariable logistic regression analyses, experiences of enacted stigma were independently associated with difficulty accessing primary healthcare (adjusted odds ratio [AOR] = 1.35; 95% Confidence Interval [CI]: 1.11 – 1.63) and mental healthcare (AOR = 1.26; 95% CI: 1.07 – 1.48), while experiences of perceived stigma were independently associated with difficulty accessing mental healthcare only (AOR = 1.20; 95% CI: 1.07 – 1.34). Our findings call for multi-level interventions to decrease SGM stigma and improve healthcare access among SGM in Thailand.

international journal of mental health and addiction

The relationship between sexual and gender stigma and difficulty accessing primary and mental healthcare services among LGBTQI+ populations in Thailand: Findings from a national survey