A comparative assessment of access to healthcare between homeless bisexual young adult men and homeless gay young adult men in New York City

Background: In recent years, attention to homeless lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth has grown. Studies show that they are disproportionately homeless when compared to non-LGBTQ youth. As a result of homelessness, they face unprecedented health disparities. However, few studies have examined access to and utilization of healthcare by the LGBTQ youth, particularly among subgroups like homeless bisexual and gay youth. Purpose: The purpose of the study was to conduct a comparative assessment of access to healthcare and to compare access between homeless bisexual and homeless gay young adult men in New York City. Methods: The purposive sample of 30 subjects aged 18 and older was asked to answer a brief survey questionnaire and undergo semi-structured interviews. Subjects were recruited from a drop-in homeless youth center in New York City. Content analysis methods and Andersen’s Behavioral Model of Health Services (of vulnerable population) theory were employed to critically analyze and investigate access to healthcare in this community. Verbal informed consent was obtained. Findings: Of the 30 participants, 56.6 % (17) were bisexual and 43.3% (13) gay. Homeless bisexual young adult men had more physical and mental health problems than homeless young adult gay men. Additionally, bisexual young adult men were disproportionately affected by barriers to healthcare than gay men. Bisexuals used hospital emergency departments more frequently than gays alongside using fewer LGBTQ-specific healthcare services than gays. The underlying structural barriers to healthcare between the two groups included the fragmentation of healthcare, interruptions in government benefits, lack of access to transportation, geographic concentration of healthcare services, and limitation in LGBTQ-homeless shelters. Facilitators of healthcare included comprehensive medical care, provision of incentives (like food and transportation fare), rapport with healthcare providers, and social support. Conclusion: Accessing hospital ERs were found to be more frequent among bisexual men than gay men. Conversely, more gay men accessed LGBTQ-specific healthcare services than bisexual men. Bisexual men described more physical and mental/behavioral health disease burdens than their counterparts. More largescale research is needed to examine the behavioral characteristics between the two groups, especially to investigate why they access healthcare services differently.Ph.D.Includes bibliographical referencesby Harlem J. Gunnes