Paper long abstract:

Background: Studies show that sexual and gender minorities have unique health care needs and encounter complicated problems to access health services. This paper examines factors that mediate health care seeking behaviour and utilization of health care services among Lesbian Gay and Bisexual (LGB) in Ethiopia, and coping mechanisms they use to navigate these challenges.

Methods: Concurrent mixed method design was used. Participants were selected using purposive and snowball sampling. Ninety-three LGB (64.5% Gays, 17.2% Lesbians, and 18.3% Bisexuals) with an average age of 27 (ranging between the 18 and 42 years) took part in the quantitative wing of the research. In-depth interviews and an FGD were held with 10 and 8 participants, each respectively. The quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed thematically.

Results: The study found sexual health and mental health problems to be main concerns of LGB. LGB live under acute anxiety and fear of being exposed, or bringing shame and humiliation to themselves or their families. Disclosure, wilful or not, was often met with stigma, discrimination, rejection, isolation, verbal and physical abuse. Informants emphasized link between mental health and risky sexual practices. Risk perception to HIV was high among LGB, with two-thirds reporting high risk. Only 37.5% (33/88) stated being always motivated to seek care when sick and the rest cited the following barriers that stifled their health seeking behaviour and utilization of health care services: Stigma and discrimination 84.6% (77/91), shame and embarrassment 84.6% (77/91), fear of being discovered/confidentiality concerns (80.2%, 73/91), lack of LGB friendly services 47.2 (42/89), affordability (18.9%, 17/90), distance (17.8%, 16/90), permission to see doctor 8.8%, 8/91), health care professional refusal (10.6%, 9/85).

Conclusion: This research suggests the need for recognizing the existence of LGB, their unique sexual and mental health needs, and availing appropriate services. Mental health issues in particular need to be given appropriate attention. The study shows that LGB peer networking, face-to-face and virtual, represent key strategies to coping with access barriers to sexual and mental health care services. One of the implications of the research is to strengthen and support the online LGB peer network groups to improve their capacity to provide advice on sexual and mental health issues, and information on where to access LGB friendly services, if and when available