2024 WNC LGBTIQA2S+ Health Equity Survey
Top Disparities and Recommendations
Special Thanks to:
Lead Investigator: Amy Upham
Health Equity Committee Members:
Adrian Parra, Michael Harney, Allison Hody, Luna Britt, Rohini Townsend, Des Brotak, Heather Compton, Daniel J. Downer, Vance Goodman, and Amanda Wray
Graphic Designer: Des Brotak
This survey was conducted online from April 3-June 17, 2024 and collected 351 eligible responses from 18+ LGBTQIA+ individuals from Buncombe and contiguous counties, along with Mitchell, Yancey and Jackson. Full Spanish translation and Low Vision mode were enabled.
Where would you feel the most comfortable receiving mental health therapy or counseling?
Mental Health
Findings
67%
of respondents have had feelings of “depression or hopelessness” in the last year
When asked where they would prefer to receive mental health services, 70.1% said an independent therapist and 55.7% through an LGBTQIA2S+ organization. For trans people, that was 67.8% from an LGBTQIA2S+ organization, and for nonbinary 74.7%.
65%
of respondents have had frequent or prolonged anxiety
18%
of respondents have had thoughts of harming themselves
Top types of discrimination reported within mental health services:
1. Physical health concerns dismissed (38.9%)
2. Underdiagnosed (38.9%)
3. Mental health concerns dismissed (34.1%)
4. Misdiagnosed (33.3%)
5. Overmedicated (22.2%)
Intersectional Disparities
%
Thoughts of harming themselves
A fifth of those 18-30 (20%), 29 % of trans people, 32% of nonbinary individuals and 34% of people with disabilities have contemplated hurting themselves in the last year.
Latine individuals had higher rates of experiencing flashbacks (61% compared to 37% overall.)
Nonbinary people and people with disabilities had higher rates on nearly every symptom.
Response
Blue Ridge Pride’s Action:
Began Mental Health Counseling program October of 2024
Recommendations for Community Partners:
Consider how to boost mental health and social supports for your queer clients/participants, whether that be peer support groups, referral systems, a counselor-led support group, or if an LGBTQIA2S+ org, offering mental health services
Provide staff with flexible and ample time-off to tend to their mental health
Recommendations for Funders:
Prioritize mental health funding to LGBTQIA2S+ organizations as a means of suicide prevention
Food Insecurity
Findings & Intersectional Disparities
20%_
of those who sought basic needs services faced discrimination at a food bank or with food stamps; 24% of trans+ people and 30% of POC
2x_._
as likely for Queer BIPOC to live over 20 minutes away from nearest grocery store (26.8%) compared to Queer White respondents (13.7%)
“Sometimes” or “Often” ran out of food and had no money to buy more:
Trans+ Community: 40%
Queer People with Disabilities: 38%
BIPOC Queer Community: 36%
Queer Community: 28%
NC Average: 10.9%
Response
Blue Ridge Pride’s Action:
Opened a food and hygiene supply pantry in our office; networked with Loving Food Resources to ensure LGBTQIA2S+ people could also access food there, and set up referral system
Recommendations for Community Partners:
Let your colleagues know this information via trainings, bulletin boards, org emails, etc. so that when working with queer individuals, especially BIPOC queer folks, staff are aware they may need assistance with food.
Refer queer clients/participants to Blue Ridge Pride, Tranzmission and/or Loving Food Resources.
Ensure food pantries are accessible to people with disabilities; consider delivery services.
Recommendations for Funders:
Earmark funds and resources for LGBTQIA2S+ organizations for food insecurity given the high rates of food insecurity as well as experiences of discrimination at local food banks (which are often faith-based) and Departments of Social Services.
Fund inclusivity trainings specific to LGBTQIA2S+ at local Departments of Social Services.
Support and Preserve BIPOC and Queer agricultural and food production/service, such as Southside Community Farms.
Have you ever had a negative experience from a regional healthcare provider once they learned that you identify as LGBTQIA+?
23.6%
41.7%
of Latine respondents
of all respondents
Discrimination in Healthcare Settings
Findings and Intersectional Disparities
Have you or someone in your household had to go out of state in the past 12 months to receive gender-affirming healthcare?
4.2%
of all respondents
15.4%
of trans+ respondents
19.1%
of POC respondents
23.6% of respondents experienced discrimination from a local healthcare provider. More trans+ (46%), Latine (41.7%), and POC (33.3%) individuals felt discriminated against by a healthcare provider for being LGBTQIA+.
Was there a time during the past 12 months when you needed medical care, but could not get it?
Top sources of healthcare discrimination
1. Physical care (56.2%)
2. ObGyn (31.5%)
3. Mental health (21.9%)
28.1%
of all respondents
33.3%
of POC respondents
45.2%
of POC respondents
46%
of trans+ respondents
50%
of trans+ respondents
The top 3 reasons cited were: Deductible/Copay too high (45.7%), No insurance (37.2%) and Fear of Discrimination for LGBTQIA+ status (27.7%). For BIPOC, fear of discrimination for being LGBTQIA+ was #1.
Response
Blue Ridge Pride’s Action:
Outreach to healthcare providers for our Welcoming Spaces training
Placing our training online, on-demand in 2025 for larger entities, like hospitals, EMS, and clinics.
Recommendations for Community Partners:
If you are a healthcare provider, connect with Blue Ridge Pride for our Welcoming Spaces training and Campaign for Southern Equality for their Trans 101 training.
Require training for healthcare and health administration staff on racial equity
Recommendations for Funders:
Require that entities funded to provide primary, OBGYN or mental health services incorporate training on considerations and disparities for LGBTQIA2S+, BIPOC and Latine individuals.
Asthma
Findings & Intersectional Disparities
21%_
of respondents have been diagnosed with asthma compared to 8.7% of the general public
36.8%
reported using tobacco now or in the past; 25.9% of those people still smoke
26.2%
of those who use tobacco use e-cigarettes
Where would you like to receive tobacco cessation services?
1. LGBTQIA2S+ Organization (48.3%)
2. Personal Doctor (31%)
2. Text/Online Counseling (31%)
Of those who currently smoke or vape:
67% are interested in quitting
38.6% are interested in quitting within the next 12 months
BIPOC and non-binary people reported significantly higher rates of asthma while those over 50 years old reported significantly lower.
Trans individuals were the most likely to select “Not interested in quitting”, at 42.9% and most who would consider quitting saw this as happening more than 12 months from now.
Response
Blue Ridge Pride’s Action:
In communication with North Carolina Department of Health and Human Services Tobacco Division to get info on our website and in our offices, including NC Quitline.
Given the desire to receive cessation services from an LGBTQIA+ organization, Blue Ridge Pride will discuss with the NC and County health departments funding potentials for hosting cessation groups, rolling out health education, and/or having cessation supplies available.
Blue Ridge Pride sits on Buncombe County’s Community Health Improvement Plan committee.
Recommendations for Community Partners:
If you serve the LGBTQIA2S+ community, please consider posting the NC Quitline number, and resourcing cessation supplies.
Consider crafting specific health education messaging for trans and nonbinary individuals, and people of color.
Recommendations for Funders:
Target tobacco cessation funding to LGBTQIA2S+ organizations as a direct or passthrough of Health departments
Eating Disorders
Findings and Intersectional Disparities
15%
of respondents have been diagnosed with an eating disorder compared to 9% of the general public
27%
of non-binary respondents reported having an eating disorder
48%_
of Latine and 38% of BIPOC respondents reported symptoms of disordered eating
Response
Blue Ridge Pride’s Action:
None yet. Plan to network with local eating disorder clinic Tapestry and support groups to start conversations on serving the LGBTQIA2S+ community, including utilizing our Welcoming Spaces trainings, upholding identity-specific support groups with space or marketing support, creating/sharing health education materials, etc.
Recommendations for Community Partners:
Begin to raise awareness about this little-known disparity. For eating disorder clinics or agencies which treat eating disorders, consider hosting queer-specific support groups and offering LGBTQIA2S+ inclusive health education materials.
Recommendations for Funders:
Fund health education campaign around eating disorders in the queer and BIPOC communities
Cancer Screenings
%
Age-eligible individuals who haven’t been screening for cancer
Findings and Intersectional Disparities
43.8% of age-eligible individuals are not being screened for breast cancer, 36% for cervical cancer, 71% prostate cancer, 49.7% colon cancer and 53.5% skin cancer.
60%_
of eligible trans respondents have not been receiving breast cancer screening
48%_
of eligible trans respondents have not been receiving cervical cancer screening
POC and Latine people had lower rates of screening across the board, as they do in the general population, with statistically significant disparities for breast, colon, and skin cancer screenings.
Response
Blue Ridge Pride’s Action:
Informed the local Health Department and local hospital system, HCA as they both provide cancer screenings. In conversation with Novant to host Breast cancer screening mobile unit at Festival.
Recommendations for Community Partners:
If you are a health or health-adjacent provider, be sure to be proactive with your patients/clients on their cancer screenings. Don’t assume they will make or keep the appointment. For trans and BIPOC patients in particular, make this a priority conversation.
Recommendations for Funders:
Fund LGBTQIA2S+ OBGYN services. This may require using funds to attract a queer-led OBGYN practice to WNC.
25.8% of respondents had experienced homelessness at some point in their life,
compared to 17% of the national LGBT population
and the national average of 6%.
Homelessness and Housing Insecurity was selected in the top 3 priorities the community would like us to work on, along with Depression/Loneliness and Transgender Care.
Homelesssness
32%_
of people who sought basic needs services experienced discrimination by homeless service providers
Findings
7.7%-.
of respondents feared losing their housing within the next 3 months—18% of trans and 25% of POC respondents
49.5%
of respondents are cost-burdened (spend over a third of their income on rent, mortgage payments, or other housing costs) compared to NC average of 28.1%
Intersectional Disparities
Rates of Lifetime Homelessness
Queer People with Disabilities: 39.2% Queer POC: 39%
Non-binary People: 37% Latine Queer People: 34.8%
Queer People: 25.8%
Trans+ People: 24.6%
Percentage that don’t feel safe in their living situation
Queer: 5.2%
Queer People with Disabilities: 8.2%
Queer Latine: 9.1%
Queer POC: 11.6%
Trans: 16.4%
70.5%
of respondents of color are cost-burdened
58.3%
of respondents with disabilities are cost-burdened
19%__
of all trans respondents, and
23.3%_
of all POC respondents have experienced discrimination from a local Basic Needs/Social Service provider, compared to 8.5% of all respondents
Response
Blue Ridge Pride’s Action:
Joined the Asheville’s Continuum of Care as a member.
Applied for a Board position on the CoC to help steer local homeless services to be more queer-friendly, but was not accepted (was not provided reason other than that they had adequate representation in their minds from all groups; we are aware of one LGBTQ+ person on the Board).
Considering long-term strategic priority of creating or co-creating queer homeless shelter.
Recommendations for Community Partners:
Hold local homeless service providers accountable to serving the LGBTQIA2S+ community without discrimination, including where they stay, how they dress, what programs they attend, and allowing same sex couples to stay together (and with their children).
Work with local LGBTQIA2S+ organizations when in planning phases of creating or updating homeless services, including prevention.
Recommendations for Funders:
Find a way to fund a low-barrier shelter in Asheville. Require contractor to be fluent in LGBTQIA2S+ inclusion and equity, including having queer staff on board (possibly as Community Health Workers).
Assess the utility of continuing to give the lion’s share of service dollars to those who discriminate against the most vulnerable to houselessness. Do not be afraid on this issue to give funds to smaller organizations who serve their own communities, especially for prevention; post-Helene the housing crisis in Asheville is an emergency.
39.8%
of respondents have experienced physical violence from a family member, intimate spouse or partner.
35.6%
have experienced sexual violence
Violence
Findings
52.7% of respondents have “Sometimes” or “Often” been threatened or harassed for being LGBTQIA+.
24%
of respondents have needed family violence or rape crisis services, but did not get it at that time.
Intersectional Disparities
People with disabilities had the highest experiences of family/intimate partner (64%) and sexual violence (61%)%.
Those who identify as Trans, and Nonbinary also had very high rates of intimate partner/family violence (54 and 57% respectively) and sexual violence (46 and 57% respectively)
Those in middle age (31-50) had higher than average rates of family/intimate partner (46%).
Of those who have experienced physical or sexual violence, those who identify as male or trans masculine, and BIPOC people were significantly more likely to experience physical violence from someone who was not a family member, intimate partner, or spouse.
48.5% of respondents with disabilities and 41% of Latine respondents have needed family violence or rape crisis services, but did not get it at that time..
Response
Blue Ridge Pride’s Action:
We refer to LGBTQIA2S+ specific domestic violence services through Southern Queer Survivors Network as needed, and are networked with both Our Voice and Helpmate as well.
Recommendations for Community Partners:
If you serve survivors of violence, offer queer-centered consent and violence prevention/response trainings to your staff (some available through local LGBTQIA2S+ organizations such as Youth OUTright’s consent training).
In general onboarding trainings, share the above disparities and require a general inclusion training for LGBTQIA2S+ (Blue Ridge Pride Welcoming Spaces).
Make sure any family violence information and services are available in Spanish
Consider targeted health education and prevention messaging campaign for people with disabilities, trans and nonbinary, those in middle age
Recommendations for Funders:
Fund LGBTQIA2S+ survivor services in WNC outside of The Family Justice Center. While the resource is helpful to many, being collocated with cops presents problems for our community, who have higher incidences of law enforcement involvement and, within that, high rates of experiences of threats, yelling and physical violence (31.8% of LGBTQIA2S+ individuals with LEO involvement and 57.9% of trans individuals with LEO involvement).
While the LGBTQ Center of Durham has a survivor advocate placed in Asheville for WNC, the need is much higher than can be met by one individual. Consider funding at least one LGBTQIA2S+ survivor advocate in each County within WNC, and several in Asheville. Prioritize funding to LGBTQIA2S+ organizations for these positions
Fund LGBTQIA2S+ inclusivity training at rape crisis and domestic violence service agencies.
Sexual Health
10.2%
of sexually active respondents have not talked to their partner(s) about consent
41.1%
for respondents over 50.
Findings and Intersectional Disparities
51%_
have not been tested for HIV since introducing a new partner.
76.6%
of all respondents would not know how to access an abortion in WNC if they needed one.
Among those sexually active, condoms are the most widely used method of protection at 15% and PreP at 7.6%; Only 2.4% use dental dams.
When asked where individuals would feel most comfortable receiving an HIV test, 65.7% said their personal doctor, followed closely by LGBTQIA2S+ organization at 61.5%.
89.9% of respondents feel abortion access is integral to the health of LGBTQIA2S+ persons.
Response
Blue Ridge Pride’s Action:
We invite WNCAP and Public Health testing vans to our large events.
Preliminary conversations with WNCAP on hosting periodic STI testing at our new office.
To Do: brainstorm with our GenPlus committee possible actions on lack of consent with our elders
Recommendations for Community Partners:
Post STI awareness materials from WNCAP, Health Department, etc. in waiting rooms of doctor offices and nonprofit allied services
For healthcare and allied providers, refer patients/clients to STI testing as a matter of course
Recommendations for Funders:
Invest in a regional LGBTQIA2S+ center which would host a variety of health programs co-located with LGBTQIA2S+ supports