How Anti-LGBTQIA+ Legislation Affects Culturally Sensitive Care

The year 2021 historically broke the record for the most anti-LGBTQIA+ laws passed. Then, in 2025, 867 bills were filed in the United States against LGBTQIA+ individuals, ultimately eclipsing that record. The Human Rights Campaign notes a substantial uptick in anti-LGBTQIA+ legislation year over year in the United States.

In 2026, bills impacting the LGBTQIA+ community continue to be introduced across the country. The majority of them impact transgender folks especially. There are currently 771 bills under review nationwide. 

This type of movement has a significant impact on the culture, safety and healthcare of LGBTQIA+ Americans. In this deep dive, we explore a brief history, community members’ experiences, the unique challenges this community faces and its overall impact on those who also have diabetes.

Quick History: The SAFE Act + other laws passed in 2021

In April of 2021, Arkansas passed the Save Adolescents From Experimentation (SAFE) Act. This law bans gender-confirming surgery for those under the age of 18 and prohibits doctors from providing transgender youth puberty blockers or hormone therapy. As of August 2025, this law remains in effect.

Arkansas is one of many states that passed or introduced anti-trans laws in 2021. These laws added more obstacles for LGBTQIA+ people to get healthcare, especially culturally sensitive diabetes care.

According to the Human Rights Campaign, 17 anti-LGBTQIA+ bills were passed into law by May 2021, including:

• 7 anti-trans sports bans in Arkansas, Alabama, Tennessee, Mississippi, Montana, and West Virginia
• 4 religious refusal bills, including in Arkansas, Montana, and South Dakota
• 2 anti-LGBTQIA+ education bills in Tennessee and Montana
• 1 anti-trans medical care ban bill in Arkansas
• 1 sham “hate crimes” bill in Arkansas
• 1 anti-all-comers bill in North Dakota
• 1 anti-trans birth certificate bill in Montana

LGBTQIA+ diabetes community member experiences

Kyle Banks, founder and CEO of Kyler Cares—a nonprofit foundation that provides funding for technology for kids and adults with type 1 diabetes (T1D)—shared with Beyond Type 1 that although he has had mostly positive experiences with the healthcare system, his friends have not. 

“So many friends that identify as LGBTQIA+ are not feeling they’re being heard, feeling their healthcare providers are not seeing them as full human beings,” Banks said.

According to a study published in 2024, 26% of transgender study participants “reported being deadnamed or misgendered, often intentionally, by medical providers and staff” in a healthcare setting. Members of the LGBTQIA+ community report that healthcare staff sometimes make demeaning comments, withhold information and make inappropriate jokes.

Insurance and income struggles for LGBTQIA+ community members

Experiencing stigma, discrimination, violence and rejection from family and community can also have long-lasting impacts on LGBTQIA+ people. A study found that even two years after a child comes out as lesbian, gay or bisexual, many parents still struggle to accept them. 

This rejection can make it harder for LGBTQIA+ individuals to access essential resources like insurance and income support. Understanding these challenges is key to creating a supportive and inclusive environment. 

Another study showed that nearly 8% of almost 10,000 sexual minority participants were unemployed, and about 5% were uninsured. These rates are roughly twice as high as those among heterosexual people. The main reasons for unemployment were illness or disability, while the reasons for lack of insurance remain unknown.

LGBTQIA+ bias in healthcare

According to a 2017 nationwide survey, LGBTQIA+ individuals who saw a doctor over the past year reported some concerning experiences:

• 8% said a healthcare provider refused to see them because of their actual or perceived sexual orientation. 
• 6% experienced healthcare providers refused to give care. 
• 9% reported that a doctor or healthcare worker used harsh or abusive language during their treatment.

• For transgender respondents, 29% said a doctor or other healthcare professional refused to see them because of their actual or perceived gender identity.
• 12% refused to give transgender individuals gender transition-related care.
• 23% intentionally misgendered transgender individuals.
• As a result of these experiences, 6.7% of LGBTQIA+ respondents reported avoiding doctors’ offices out of fear of discrimination.

Lack of awareness in healthcare

Many healthcare providers don’t realize that some of their patients identify as LGBTQIA+. Research shows that a main reason patients avoid sharing this part of their identity is that providers often don’t ask or aren’t sure how to. While some patients face discrimination after coming out, those who feel comfortable sharing their gender or sexuality tend to be more satisfied with their care.

Supporting LGBTQIA+ patients helps build trust and confidence. It also improves their chances of getting the care they need. Being open about LGBTQIA+ issues also encourages more regular health screenings, which are important for catching problems early. This can’t be underscored in life with diabetes. 

For example, the American Cancer Society notes that bisexual and lesbian women have a higher risk of breast cancer. When healthcare providers understand these risks, they can help find health issues sooner and ensure proper treatment.

Unique challenges for young LGBTQIA+ adults

Many young adults say doctors often do not react when they tell them about their LGBTQIA+ identity. This can be a missed chance for doctors to connect and help their patients. It also shows that more work is needed to create welcoming environments for LGBTQIA+ people. 

Providing gender-affirming healthcare can lower the chances of transgender people thinking about or attempting suicide. According to the Trevor Project, LGBTQIA+ youth are four times more likely to try to take their own lives than heterosexual youth.

The LGBTQIA+ awareness gap in modern medicine

LGBTQIA+ people also have a hard time finding doctors who understand their needs and can provide respectful care. One reason is that medical schools do not always teach about transgender treatment, so many doctors lack the training and knowledge needed. Because of this, some LGBTQIA+ people may delay or avoid seeking care.

While this report was initially published in 2018, the same concerns remain true today. In 2026, families with transgender youth reported the fears and struggles that came when blue states dropped gender-affirming care.

LGBTQIA+ community: prevalence of smoking and diabetes

LGBTQIA+ people face unique health challenges that can increase their risk of developing diabetes. For instance, smoking raises the chance of insulin resistance, making it harder to manage diabetes or leading to type 2 diabetes (T2D).

• Among LGBTQIA+ youth, smoking rates range from 38 to 59%.
• Among adults, rates range from 11 to 50%.
• One study shows that LGBTQIA+ adults use menthol cigarettes more often (36.3%) than heterosexual adults (29.3%).

High smoking rates may be caused by stress and discrimination during the coming-out process.

LGBTQIA+ community: risk of obesity

Being obese also raises the risk of diabetes. It can cause insulin resistance in all types of diabetes and increase the chances of developing T2D if it hasn’t already.  Lesbian women, for example, tend to have higher rates of overweight and obesity because of eating disorders, less concern about body image when dating women and lower levels of exercise.

Other factors that increase diabetes risk in LGBTQIA+ individuals include:

• Stress
• Substance use
• Depression
• Delays in filling prescriptions

These barriers highlight the need for culturally sensitive diabetes care that respects and understands the unique experiences of LGBTQIA+ people.

How healthcare providers can support culturally sensitive LGBTQIA+ diabetes care

In 2010, Theresa L. Garnero, an assistant clinical professor and director of a diabetes care program at the University of the Pacific, shared tips for providing sensitive care to LGBTQIA+ people with diabetes. Her article was titled “Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender (LGBTQIA+) Community.” 

Even though it was written over 15 years ago, her advice is still useful today. Garnero says that caring for LGBTQIA+ patients begins with understanding and addressing personal biases.

• Health insurance: LGBTQIA+ people often face stigma, discrimination and trouble getting health insurance. This can delay getting the right diabetes care. When diabetes is involved, it’s important to get treatment without delay because managing it requires regular check-ins. Providing culturally aware care helps people with diabetes (PWD) stay healthy.
• Fostering trust: Culturally sensitive diabetes care for LGBTQIA+ individuals can build trust between patients and doctors. It can also encourage greater participation in healthcare, reduce disparities in health outcomes and decrease missed medical appointments.
• Creating a welcoming environment: To offer better diabetes care for LGBTQIA+ patients, providers can make their clinics more welcoming. For example, they can place LGBTQIA+-friendly magazines in the waiting room or display symbols such as the rainbow flag, as Garnero suggests.

Small steps make a meaningful difference for LGBTQIA+ people with diabetes

Garnero explained that providing culturally aware diabetes care includes asking about sexual orientation and gender identity on intake forms. Including LGBTQIA+ options in electronic medical records can help reduce the need for patients to share this information with different healthcare providers repeatedly. 

“It’s our job as healthcare workers to show that our practices welcome everyone,” said Garnero.

Because the majority of office settings operate under the subtext of a heteronormative culture, many diabetes support materials often assume heterosexuality.

 “Intake forms usually ask about marital status. But what about people who don’t want to marry due to fear of backlash?” Garnero asked. 

She suggests that offering choices like “prefer not to answer” can be more inclusive and encourage better conversations between patients and providers.

“Allowing people to select ‘prefer not to answer’ or opening up a dialogue helps the provider understand that whatever the situation, they are there to help,” she added.

Banks, a Black gay man with T1D, said that culturally sensitive care helps him manage his diabetes better. “Respecting different cultural backgrounds is very important,” Banks explained. “Creating care plans that consider these differences can really improve health outcomes and make a big difference.”

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