Telehealth and Queer Safety: Exploring Telehealth Utilization and Regional Differences Among Sexual Minorities amidst Rising Anti-LGBTQIA+ Legislation Using a Nationally Representative Dataset

Background and Purpose

Despite the United States’ democratic ideals of being a pluralistic society that provides equal protection under the law, recent years have seen a surge in legislation and violence targeting LGBTQIA+ individuals. Though anti-LGBTQIA+ legislation has proliferated across the country, states in the Midwest and South have implemented more anti-LGBTQIA+ laws than other regions. With the rise of anti-LGBTQIA+ legislation, digital interventions and telehealth have emerged as promising strategies for queer Americans to access care given the increasing need for privacy and safety. To examine the role of telehealth, this study analyzes:

RQ1: Is there a difference in the rate of telehealth utilization between sexual minority status (SMS) and straight respondents? Does this relationship change over time?

RQ2: Does the rate of telehealth utilization vary by region and SMS?

RQ3: To what extent do experiences of medical discrimination and SMS predict telehealth utilization?

Methods

This study analyzed pooled cross-sectional data from the Health Information National Trends Survey (HINTS) 6 (2022) and HINTS 7 (2024), using nationally representative samples of U.S. adults (n=12,516). Chi‑square tests were conducted to analyze differences in telehealth by SMS, region, and year, and multivariable logistic regressions were conducted to analyze telehealth utilization by SMS and medical discrimination history.

Results

Sexual minorities not only utilized telehealth more than straight respondents (χ²=22.0, p< .001) in 2022, but the gap between straight and SMS respondents widened in 2024 (χ²=55.1, p<.001), with 51% of sexual minorities utilizing telehealth versus 34% of straight respondents.

When comparing regional telehealth utilization from 2022 to 2024, while straight respondents in all regions saw a statistically significant decrease, sexual minorities saw non-significant decreases in the West and Northeast, no change in the Midwest, and an 11% increase in the South.

The logistic regression indicates sexual minorities had 1.62 times greater odds of using telehealth than straight respondents (p<.001). Those reporting medical discrimination had 1.73 times greater odds of telehealth utilization (p<.001). There was an interaction effect between medical discrimination history and SMS (OR=1.45, p=.015), indicating that sexual minorities with medical discrimination histories were more likely to use telehealth.

Conclusion and Implications

These results indicate that sexual minorities utilize telehealth at significantly higher rates than their straight counterparts, a gap that grew between 2022 and 2024. This gap appears to be driven by rates of telehealth utilization staying the same in the Midwest and increasing in the South among sexual minorities, a striking finding in the context of increased in‑person services as the COVID‑19 pandemic decreased in salience. The increases in anti‑LGBTQIA+ policies could potentially be contributing to telehealth utilization among sexual minorities. These trends align with previous literature that finds LGBTQIA+ populations utilize digital interventions for an increased sense of safety. At a time when federal funding cuts have eliminated life‑saving LGBTQ‑specific telehealth services, it is imperative that healthcare organizations and policies promote telehealth access for LGBTQIA+ populations, particularly in less affirming areas of the country.