Access to Primary Care and Preventive Health Services of LGBTQ+ Migrants, Refugees, and Asylum Seekers

  • Yudit NamerEmail author
  • Oliver Razum
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)


Gender identity, gender expression, sexual orientation and their conformance to dominant societal norms contribute to the super-diversity of today’s migration patterns. Regardless of whether or not the individual’s gender identity, gender expression and/or sexual orientation is their reason to migrate, or behind their refugee or asylum-seeking status, non-heteronormative identity complicates the experience in the host country. Language and cultural barriers already reduce migrants’, refugees’ and asylum seekers’ access to health care and non-heteronormative identity acts as an additional barrier between individuals’ human right to health care and the access to care. Preventive health services aimed at LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) individuals tend to overly focus on HIV and other sexually transmitted infections at the risk of overlooking other health concerns. Furthermore, these services may not always appreciate the inherent heterogeneity of the LGBTQ+ community, at times failing to differentiate between the healthcare needs of non-heterosexual and non-cisgender individuals. This chapter reviews the literature in advocacy of bridging the research and policy gap between the primary and preventive care required by and the care provided for LGBTQ+ migrants, refugees, and asylum seekers.


LGBTQ+ Refugees Asylum seekers Gender identity Sexual orientation Access barriers 


  1. Alessi, E. J. (2016). Resilience in sexual and gender minority forced migrants: A qualitative exploration. Traumatology, 22, 203–213. CrossRefGoogle Scholar
  2. Alessi, E. J., Martin, J. I., Gyamerah, A., & Meyer, I. H. (2013). Prejudice events and traumatic stress among heterosexuals and lesbians, gay men and bisexuals. Journal of Aggression, Maltreatment & Trauma, 22, 510–526. CrossRefGoogle Scholar
  3. Alessi, E. J., Kahn, S., & van der Horn, R. (2016). A qualitative exploration of the premigration victimization experiences of sexual and gender minority refugees and asylees in the United States and Canada. The Journal of Sex Research, 54, 1–13. CrossRefGoogle Scholar
  4. Balsam, K. F., Huang, B., Fieland, K. C., Simoni, J. M., & Walters, K. L. (2004). Culture, trauma, and wellness: A comparison of heterosexual and lesbian, gay, bisexual, and two-spirit Native Americans. Cutlural Diversity and Ethnic Minority Psychology, 10, 287–301. CrossRefGoogle Scholar
  5. Brooks, V. R. (1981). Minority stress and lesbian women. Lexington, MA: Lexington Books.Google Scholar
  6. Bozorgmehr, K., & Razum, O. (2015). Effect of restricting access to health care on health expenditures among asylum-seekers and refugees: A quasi-experimental study in Germany, 1994–2013. PLoS One, 10, e0131483. CrossRefPubMedPubMedCentralGoogle Scholar
  7. Burkill, S., Copas, A., Couper, M. P., Clifton, S., Prah, P., Datta, J., et al. (2016). Using the web to collect data on sensitive behaviours: A study looking at mode effects on the British national survey of sexual attitudes and lifestyles. PLoS One, 11, e0147983. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Carroll, A., & Mendos, L. R. (2017). State sponsored homophobia 2017. Accessed 24 Jul 2017.
  9. Council of Europe. (2011). Discrimination on grounds of sexual orientation and gender identity in Europe (2nd ed.). Strasbourg: Council of Europe Publishing.Google Scholar
  10. D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167. CrossRefGoogle Scholar
  11. D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21, 1462–1482. CrossRefPubMedGoogle Scholar
  12. Dalia Research. (2016). Counting the LGBT population: 6% of Europeans identify as LGBT. Accessed 13 Sept 2017.
  13. de Vries A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. The Journal of Sexual Medicine, 8, 2276–2283. CrossRefGoogle Scholar
  14. Elliott, M. N., Kanouse, D. E., Burkhart, Q., Abel, G. A., Lyratzopoulos, G., Beckett, M. K., et al. (2015). Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine, 30, 9–16. CrossRefPubMedGoogle Scholar
  15. Emanvel, B. (2016). The difficulties of being an LGBT refugee in Germany. refugee-germany/. Accessed 10 Oct 2016.
  16. European Centre for Disease Prevention and Control. (2009). Migrant health: Epidemiology of HIV and AIDS in migrant communities and ethnic minorities in EU/EEA countries. Stockholm: ECDC.Google Scholar
  17. European Centre for Disease Prevention and Control, & WHO Regional Office for Europe. (2015). HIV/AIDS surveillance in Europe 2014. Stockholm: ECDC.Google Scholar
  18. European Union Agency for Fundamental Rights. (2017). Current migration situation in the EU: Lesbian, gay, bisexual, transgender and intersex asylum seekers. Accessed 21 July 2017.
  19. Fakoya, I., Álvarez-del Arco, D., Woode-Owusu, M., Monge, S., Rivero-Montesdeoca, Y., Delpech, V., et al. (2015). A systematic review of post-migration acquisition of HIV among migrants from countries with generalised HIV epidemics living in Europe: Implications for effectively managing HIV prevention programmes and policy. BMC Public Health, 15, 561. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Feldman, R. (2006). Primary health care for refugees and asylum seekers: A review of the literature and a framework for services. Public Health, 120, 809–816. CrossRefPubMedGoogle Scholar
  21. Flowers, P. (2001). Gay men and HIV/AIDS risk management. Health, 5, 50–75.CrossRefGoogle Scholar
  22. Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H.-J., Lehavot, K., Walters, K. L., Yang, J., et al. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84, 653–663. CrossRefPubMedGoogle Scholar
  23. Gates, G. J. (2017). In US, more adults identifying as LGBT. Accessed 21 July 2017.
  24. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730. CrossRefPubMedPubMedCentralGoogle Scholar
  25. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43, 460–467. CrossRefGoogle Scholar
  26. International Lesbian, Gay, Bisexual, Trans and Intersex Association [ILGA]. (2016a). Protecting the rights of LGBTI asylum seekers and refugees in the reform of the common European asylum system. Accessed 21 July 2017.
  27. International Lesbian, Gay, Bisexual, Trans and Intersex Association [ILGA]. (2016b). Seeking refuge without harassment, detention or return to a “safe country”. Accessed 21 July 2017.
  28. Kahn, S., Alessi, E., Woolner, L., Kim, H., & Olivieri, C. (2017). Promoting the wellbeing of lesbian, gay, bisexual and transgender forced migrants in Canada: Providers’ perspectives. Culture, Health & Sexuality, 19, 1165–1179. CrossRefGoogle Scholar
  29. Kara, H., & Çalık, D. (2016). “Tekin olmayi” beklerken: LGBTİ mültecilerin ara duraği Türkiye. Ankara: KAOS GL.Google Scholar
  30. Keygnaert, I., Guieu, A., Ooms, G., Vettenburg, N., Temmerman, M., & Roelens, K. (2014). Sexual and reproductive health of migrants: Does the EU care? Health Policy, 114, 215–225. CrossRefPubMedGoogle Scholar
  31. Lombardi, E. (2007). Public health and trans-people: Barriers to care and strategies to improve treatment. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities (pp. 638–652). Boston: Springer US. CrossRefGoogle Scholar
  32. Majumder, P., O’Reilly, M., Karim, K., & Vostanis, P. (2015). ’This doctor, I not trust him, I’m not safe’: the perceptions of mental health and services by unaccompanied refugee adolescents. The International Journal of Social Psychiatry, 61, 129–136. CrossRefPubMedGoogle Scholar
  33. Matthews, A. K., Hughes, T. L., Johnson, T., Razzano, L. A., & Cassidy, R. (2002). Prediction of depressive distress in a community sample of women: The role of sexual orientation. American Journal of Public Health, 92, 1131–1139. CrossRefPubMedPubMedCentralGoogle Scholar
  34. Meyer, I. H. (2013). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychology of Sexual Orientation and Gender Diversity, 1(S), 3–26. CrossRefGoogle Scholar
  35. Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356. CrossRefPubMedGoogle Scholar
  36. Razum, O., & Bozorgmehr, K. (2016). Restricted entitlements and access to health care for refugees and immigrants: The example of Germany. Global Social Policy, 16, 321–324. CrossRefGoogle Scholar
  37. Sandfort, T. G. M., Bakker, F., Schellevis, F. G., & Vanwesenbeeck, I. (2006). Sexual orientation and mental and physical health status: Findings from a Dutch population survey. American Journal of Public Health, 96, 1119–1125. CrossRefPubMedPubMedCentralGoogle Scholar
  38. Shakhsari, S. (2014). The queer time of death: Temporality, geopolitics, and refugee rights. Sexualities, 17, 998–1015. CrossRefGoogle Scholar
  39. The Lancet. (2016a). Meeting the unique health-care needs of LGBTQ people. The Lancet, 387, 95. CrossRefGoogle Scholar
  40. The Lancet. (2016b). Refugee and migrant crisis: The deficient global response. The Lancet, 388, 633. CrossRefGoogle Scholar
  41. UN High Commissioner for Human Rights. (2011). Discriminatory laws and practices and acts of violence against individuals based on their sexual orientation and gender identity. Accessed 13 Sept 2017.
  42. UN High Commissioner for Refugees (UNHCR). (2015). Protecting persons with diverse sexual orientations and gender identities: A global report on UNHCR's efforts to protect lesbian, gay, bisexual, transgender, and intersex Asylum-Seekers and refugees. Accessed 24 July 2017.
  43. UNAIDS. (2016). Prevention gap report. Geneva: UNAIDS.Google Scholar
  44. Vertovec, S. (2007). Super-diversity and its implications. Ethnic and Racial Studies, 30, 1024–1054. CrossRefGoogle Scholar

Copyright information

© The Author(s), under exclusive licence to Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bielefeld University, School of Public Health, Department of Epidemiology & International Public HealthBielefeldGermany

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