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Experience of creating LGBTQ Welcoming Space across various HIV health care systems

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BACKGROUND: Creating a safe environment is key to engaging individuals into health care. For PWH who is also a member of a sexual or gender minority (SGM) (ie Lesbian, Gay Bisexual Transgender Queer/Questioning /LGBTQ), prior health care system alienation must be countered via a welcoming health care environment. Via HRSA's SPNS funding, the STI SPNS Project tested the capacity and effect of creating an LGBTQ Welcoming Space in various HIV health care systems. The capacity of each site was measured based on the implementation of 12 LGBTQ Welcoming Space Indicators while the effect was measured via patient and provider anonymous survey.
METHODS: Over 18 months, 3 RWHAP Part C Louisiana clinics were tasked to implement 12 specific interventions to maximize its welcoming capacity for SGM PWH. Each site represented a unique healthcare organization eligible to receive Part C funds: an FQHC, an academic medical center, and an independent nonprofit community health clinic. Ongoing monitoring documented when a specific intervention was implemented. Via an ACASI Client Satisfaction Survey (CSS), consented patients reported the impact of interventions on their clinical experience. Providers from each clinic reported their impression of the environmental and system changes on patient care. A qualitative analysis explored the process of implementation while a Kruskal-Wallis test determined the differences in effect at the different sites as measured via the CCS and providers report.
RESULTS: One site was able to implement all 12 LGBTQ Welcoming Space Indicators. The remaining sites experienced implementation barriers at higher organizational level. 075 CSS were completed by 566 PWH (40% female, 3% transgender, 37% SGM). Regarding environment and system changes, <1% of the CSS respondents described any as 'I noticed and I did not like it" while the clinical providers reported the interventions as having a positive on patient care.
CONCLUSIONS: Despite higher-level organizational barriers, all health care systems were able to implement environmental and system changes to maximize their welcoming capacity for SGM PWH while maintaining or improving patients'' over satisfaction and providers'' acceptability. Though specific sites may experience unique barriers, it is within the capacity of all health care organizations to engage SGM populations into care.