Social, economic and geographic factors influencing health equity among LGBTQ+ populations: A scoping review

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Understanding the interplay between these disparities and social factors is crucial for promoting health equity. Addressing intersecting identities and improving resource access are vital for enhancing the well-being of the LGBTQ+ population. Methods Using the JBI methodology for scoping reviews, a comprehensive search was conducted across MEDLINE (PubMed) and Google Scholar. Two independent reviewers screened titles and abstracts for relevance, followed by full-text reviews for inclusion based on eligibility criteria. Discrepancies were resolved by a third reviewer. Data extraction captured details on study objectives, methodology, and the influence of social norms, culture, religion on SRH outcomes. The synthesis highlighted how these factors shape SRH in diverse LMIC settings. Results From a total of 3207 studies, 48 relevant articles were included after screening 30 full text articles. The study revealed that health inequity among LGBTQ+ populations was significantly influenced by the interrelated factors of stigma, discrimination, income disparities, leading to increased mental and physical health issues and barriers to healthcare. Conclusion This review outlined the socioeconomic and geographical factors that contribute to health inequities within the LGBTQ+ population. The available evidence highlights the need for a comprehensive policy to address health inequities among LGBTQ individuals and enhance healthcare access. Health Policy Socioeconomic factors geographical factors health inequities LGBTQ+. Figures Figure 1 Figure 2 Figure 3 Introduction Health inequities, marked by disparities in health experiences and outcomes rooted in social inequities and the effectiveness of support systems, represent a critical issue in global public health. These inequities are particularly pronounced among Gender, Sexual, and Romantic Minority (GSRM) individuals, a group that includes, but is not limited to, LGBTQ+ (lesbian, gay, bisexual, transgender, queer) persons with intersecting identities, such as caste, age, occupation, disability, race, ethnicity, language, region, religion, and community. 1 While extensive research has been conducted on the health and healthcare experiences of GSRM populations, most of this work originates from the global north, with limited focus on India and South Asia. GSRM individuals face health disparities driven by social, economic, cultural, and political factors, with high rates of mental health conditions. Barriers to healthcare, especially for those open about their SOGIESC, significantly impact their quality of life. The social determinants of health (SDOH) are non-medical factors that influence health outcomes. These include the conditions in which people are born, grow, live, work, and age, as well as the broader forces shaping daily life. 2 GSRM individuals who are open about their SOGIESC often face challenges related to housing, employment, and access to nutritious food. These determinants are closely tied to their health concerns. The GSRM population experiences higher rates of tobacco use and often lives in overcrowded, unsanitary conditions with inadequate ventilation and limited access to safe drinking water. The lack of a supportive educational environment during formative years also hinders future employment opportunities, making it difficult for them to secure adequate housing, nutritious food, and quality healthcare. The broader environment surrounding LGBTQI + youth play a crucial role in their mental health, well-being, and sense of social connectedness. Feeling supported by adults provides sexual and gender minority youth with resilience when facing challenges, particularly during the vulnerable phase of personal identity formation. 3 Socioeconomically marginalized, elderly, disabled GSRM individuals, or those with chronic illnesses, often face limited healthcare access, further widening the health outcome gap compared to heterosexual counterparts. 4 LGBTQ+ health needs vary by life stage. Adolescents face higher risks of bullying, risky sexual behavior, suicide, and homelessness. Adults report higher substance use, while older adults often experience social isolation and lack culturally competent care. Discriminatory attitudes in healthcare lead many LGBTQ + individuals to avoid seeking care due to fear of inadequate treatment. 5 This scoping review aims to map the social, economic, and geographic factors contributing to health inequities among GSRM individuals, including LGBTQ + persons. By systematically exploring these determinants, the review seeks to promote health equity, enhance well-being, and challenge the pathologization of GSRM individuals. Methods The review followed the JBI methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. 6 , 7 Inclusion criteria Participants The review will include GSRM persons. There will be no restriction on population, demographic variables (e.g. SOGIESC, ethnicity, caste, class, race, language, geography, religion, disabilities, age et al), or sampling techniques. Concepts This review will systematically explore the social, economic, and geographic factors influencing health equity among GSRM persons. It will map existing literature to identify how stigma, discrimination, economic status, employment, poverty, and access to GSRM-affirming services contribute to health disparities. Focus will be on how social attitudes, financial instability, and geographic location affect mental health, access to care, and well-being, particularly highlighting disparities between urban and rural areas. 8 , 9 Context The context of health inequity among GSRM populations is addressed across various urban, semi urban, and rural areas throughout different regions of India, without being limited to any specific geographical location or health issue Search strategy A 3-step search strategy will be adopted to locate published and unpublished papers. A preliminary limited search of MEDLINE (PubMed), and Google Scholar (first 10 pages) was performed. It was followed by an analysis of the text words and index terms used to describe the search strategy will be developed and tailored for each database. The full search strategy was piloted on June 24, 2024, in MEDLINE (PubMed) (Annexure 1). Study selection After conducting the search across various databases, the identified citations were consolidated and imported into Rayyan software. Out of 3207 studies, 535 duplicate studies were identified and removed. Subsequently, 2 reviewers screened and assessed the titles and abstracts of the articles based on the inclusion criteria. Following initial screening, the selected articles underwent a comprehensive full-text assessment, which were independently performed by the same 2 reviewers. Articles that did not meet inclusion criteria were excluded. In case of any discrepancies between the reviewers at the title/abstract or full-texting screening stage, discussions were held to reach a consensus, or if necessary, a third reviewer was consulted. Reasons for the exclusion of full-text papers that do not meet the inclusion criteria. The results of the search process and research selection will be compiled in the final scoping review and presented using a PRISMA flow diagram. 10 Data extraction Two reviewers were independently extracted data from the included papers, capturing information such as author, title, year of publication, place, objectives, methodology, and reported outcome measures (Annexure 2). Any disagreements that arise between the reviewers were resolved through discussion or with a third reviewer. A draft data extraction tool. Three reviewers were independently pilot test the data extraction tool, as recommended by the JBI Manual for Evidence Synthesis. The data extraction table were adjusted and refined as needed while extracting data from each paper. Results The database search identified 3207 records (Annexure 1). After removing duplicates, 2672 records remained. Following title and abstract screening, 30 studies were reviewed in full, with 1 excluded for not meeting inclusion criteria. Ultimately, 18 studies were included in the final analysis. These studies examined key factors affecting LGBTQ + health equity, including social exclusion, economic disparities, and geographic barriers to healthcare. Figure 1 outlines the study search and selection process. The included articles were quantitative studies (n = 8), 11, 12 , 13 , 14 , 15 , 16 , 17 , 18 , non-RCT (n = 2) , 19 , 11 mixed method (n = 1), , 20 cross-sectional (n = 1) , 21 qualitative (n = 1), 22 , 1 synthesis study focusing on the health challenges and barriers faced by LGBTQ + individuals 23 and 1 descriptive study highlighted the historical and ongoing struggles experienced by the LGBTQ + . 1 Study Country and Population Table 1 shows the number of studies by country and their key focus areas. The USA had the most studies (11) 19 , 23 , 8 , primarily addressing social exclusion, mental health, employment discrimination, and geographic healthcare barriers. Studies from India, Kenya, Sweden, the Netherlands, Chile, Colombia, and Mexico focused on social exclusion, stigma, discrimination, financial instability, and healthcare barriers, with factors like caste, gender, violence, and geographic disparities worsening LGBTQ + marginalization. Table 1 Number of studies per country with key focus Country No of studies Key focus areas Social Economic Geographic USA 19 , 23 , 8 11 High levels of stigma, discrimination, and violence. Social exclusion and non-acceptance of LGBTQ + individuals. Increased rates of mental health issues (depression, anxiety). 19 Employment discrimination and higher rates of poverty. Lack of health insurance coverage and financial barriers to accessing care. Housing instability, especially for LGBTQ + youth. Where LGBTQ + individuals live affects how comfortable they feel identifying as such and seeking healthcare, as states with protective laws tend to offer better access to services, while those without these laws create barriers that negatively impact their healthcare experiences. 13 Rural LGBT populations face greater anticipated, internalized, and enacted stigma compared to urban populations. This stigma can lead to reluctance in seeking healthcare services due to fears of discrimination, and rural areas often lack providers knowledgeable in LGBT health. India 17 , 1 , 24 3 Social exclusion due to intersectionality (caste, class, gender). Stigma and discrimination, especially against transgender individuals. Employment discrimination leading to financial instability and poverty, Limited access to gender-affirming care due to economic hardship, especially for marginalized communities. Transgender individuals often reside in overcrowded accommodations that lack basic facilities, exacerbating their health issues due to poor living conditions. 24 Kenya 15 1 Widespread stigma and violence against LGBTQ + individuals. - Peer pressure and harassment in both rural and urban settings. 1 5 Economic instability due to joblessness and discrimination. - Exploitation and blackmail, particularly of LGBTQ + individuals in rural regions. isolation limits access to LGBTQ+-friendly healthcare, especially in rural areas. Sweden and Netherlands 14 1 LGBT individuals face stigma, discrimination, and exclusion, which significantly impact mental and physical health outcomes Disparities in access to healthcare and funding for research on LGBT health persist. acceptance and legal rights for LGBT individuals vary across Europe, with more progressive countries like Sweden and the Netherlands contrasted by restrictive environments in Eastern Europe and Russia Chile, Colombia, Mexico 25 1 internalized stigma and societal discrimination challenge LGBT individuals' perceptions of themselves as parents and their ability to form families limited access to healthcare services, particularly assisted reproductive technologies, creates barriers disparities in healthcare access are prevalent, especially in Latin American countries where inclusive health services for LGBT individuals are inconsistent 25 Annexure 1: Search results from various databases Search conducted: PubMed (MEDLINE) June 4, 2025 Search number, query, sort by, filter, search details, results Publication Trend The search and selection process (Fig. 2 ) identified studies from 2015 to 2023 examining social, economic, and geographic factors affecting LGBTQ + populations. There has been a clear increase in published studies, with most articles appearing in 2016 or later. Only one study was published in 2015, followed by four in 2016, while 2023 saw the highest number of studies (5). Study setting Out of 18 studies, 6 were carried out in urban areas, 23 13 8 15 25 with only 1 study conducted in rural location. 19 Three studies encompassed both urban and rural settings, 24 20 while the specific locations for 7 studies were not clearly indicated. 1 26 ,27 14 11 Social factors The review emphasizes that societal structures, combined with external and internalized homonegativity, significantly influence the physical 13 and mental well-being of gender minority groups. The anxiety and psychological impact of being HIV-positive often compel individuals to conceal their status in order to avoid the physical, emotional, and financial consequences of social exclusion. 28 Even when women desire to get tested, challenges such as locating testing centers and finding LGBTQ-friendly healthcare providers create significant barriers that prevent them from accessing testing, much like the fear of social exclusion leads some HIV-positive individuals to hide their status. 29 Similarly, gay and bisexual men have a higher prevalence of cardiovascular disease compared to heterosexual men. 30 The experience of stigma, social isolation, marginalization, feelings of worthlessness, and rejection by parents and siblings are deeply traumatic and hinder the normal growth and advancement of LGBT individuals. Economic factors Economic factors play a crucial role in shaping the lives and well-being of LGBTQ + individuals. Discriminatory practices in employment, wage gaps, barriers to healthcare, and limited access to financial resources often exacerbate economic disparities, leading to negative outcomes that affect their overall quality of life. 31 These economic inequalities not only reinforce social marginalization but also hinder progress in achieving equity for LGBTQ + populations. Research has shown that GSRM individuals who are open about their SOGIEC often face obstacles in securing housing and endure financial strain linked to homelessness. 32 Geographic factors Rural societies differ from urban societies in several important ways that affect health outcomes for LGBTQ individuals. People in rural areas are often more supportive of conservative values and display less tolerance toward diverse populations, including LGBTQ individuals. Strong religious beliefs significantly shape the values, attitudes, and social norms within rural communities, which can further impact the acceptance and support for LGBTQ individuals. 33 Many rural men who have sex with men (MSM) form hidden gay networks, making support hard to access. Organizing informal networks is vital in these communities, as existing reference groups can facilitate prevention programs, enhance support, and reduce internalized homophobia, helping to combat stigma from dominant groups. 34 Studies reveal that many LGBTQ + individuals report delayed or denied healthcare due to discriminatory attitudes among healthcare providers. For instance a study has found that healthcare workers often lack training on LGBTQ + health issues, leading to improper care. 23 High levels of psychiatric morbidity, including depression and anxiety, are observed in LGBTQ + populations, exacerbated by social exclusion, bullying, and harassment in everyday life, as highlighted. 24 Research shows that LGBTQ + individuals with disabilities face significant challenges. A study in Victoria, Australia, used focus groups with peer researchers to explore the experiences of disabled LGBTIQA + individuals accessing support services. Two key themes emerged: difficulties in accessing health services as disabled LGBTIQA + individuals and challenges in managing multiple identities. 35 The research indicates that inclusive practices may require changes in policy and practice to address the specific needs of LGBTIQA + individuals with disabilities, as well as LGBTIQA + education for disability services and disability education strategies tailored to LGBTIQA + focused services. 20 The challenges faced by LGBTQ + individuals are compounded by other social categorizations such as race, caste, and gender. LGBTQ + youth, particularly those from conservative families, are often subjected to family rejection, leading to homelessness and isolation, which are major predictors of poor mental health. Discrimination in the labor market often leads to high unemployment rates among LGBTQ + individuals, particularly transgender people. This economic exclusion leads to poverty, housing instability, and a lack of access to healthcare, further exacerbating health disparities. Additionally, many LGBTQ + individuals experience job discrimination, where employers refuse to hire or retain them due to their gender identity or sexual orientation. Economic hardship limits access to health insurance, necessary medications such as hormone therapies, HIV treatment, mental health services, and other essential healthcare like gender-affirming surgeries and treatments for sexually transmitted infections (STIs). This often leads to delayed diagnoses and inadequate management of serious health conditions. LGBTQ + individuals in vulnerable professions, such as sex work, face further risks, including exposure to violence, sexually transmitted infections (STIs), and criminalization, which limit their access to healthcare. One of the findings from this report suggests that transgender individuals, like Ms. XX, face significant challenges such as homelessness, substance use, and difficulties accessing healthcare, contributing to their heightened vulnerability to mental health issues. 13 Those living in rural or semi-urban areas face greater challenges than their urban counterparts due to limited healthcare infrastructure, cultural conservatism, and a lack of GSRM-affirmative healthcare services. A study has found that transgender individuals in rural India are significantly more likely to experience poor health outcomes due to inadequate healthcare access. 19 In both urban and rural settings, a lack of culturally competent healthcare providers those trained in LGBTQ + health needs pose a significant barrier, especially in preventive services like gynecology, oncology, and mental health care. LGBTQ + individuals assigned female at birth (AFAB) and intersex individuals face a lack of access to appropriate preventive healthcare. Rural areas have fewer healthcare facilities and providers that are trained in or sensitive to LGBTQ + issues, which may result in lower utilization of primary healthcare services by LGBTQ + individuals. Travel times to LGBTQ + friendly providers can be longer, making it more difficult to access care. 26 The intersection of geographic location, economic status, and social discrimination exacerbates the health inequities experienced by LGBTQ + individuals. Even where legal reforms have been implemented, such as the 2018 decriminalization of homosexuality in India, there is often a gap between policy and practice, especially in more conservative or rural regions. This geographic inconsistency in legal protections and healthcare access contributes to health inequities for LGBTQ + individuals living outside of major urban centers. This overlapping web of social, economic, and geographic factors continues to drive health inequities among LGBTQ + populations, highlighting the urgent need for inclusive policies and healthcare reforms that address their unique challenges. Discussion This scoping review highlights the impact of social, economic, and geographic factors on health equity in the LGBTQ + community, particularly for Gender, Sexual, and Romantic Minority (GSRM) individuals. Systemic discrimination and intersecting identities create barriers to quality healthcare, exacerbating physical and mental health disparities. Surveys show LGB individuals face higher rates of discrimination and violence compared to heterosexuals. 36 Controlling for other personal and interpersonal stigma and other risk factors such as being depressed, living in stigmatizing social environments is associated with approximately 20% more suicide attempts in LGBT youth. 27 Additionally, studies of gender minorities have shown extremely high rates of suicidal ideation,38 with suicidal ideation as high as 51% and attempted suicide rates as high as 30% among transgender youth,39 compared to the national average of 4.6% for cisgender heterosexuals. 37 The findings highlight the urgent need for culturally competent policies and healthcare interventions that address the unique needs of GSRM individuals. Transgender women have historically been the focus of healthcare research, which may explain the relatively lower rates of denial or lower-quality care in this group, as many interventions have been tailored to their needs. 8 Implications for research Ensuring equal access to health and healthcare is a core objective in both public health research and practice. 14 Many LGBTQ + people continue to experience high levels of discrimination, stigma, abuse and marginalization in many aspects of their lives. Significant social, economic and health disparities for LGBTQ + communities continue to exist. High rates of suicidal ideation, depression, and anxiety are prevalent among trans and gender-diverse individuals in India, who often face harassment and abuse due to their identity. Trans populations experience high levels of homelessness, and substance misuse, such as alcohol and drug difficulties, is common. Intimate partner and family violence are widespread, with low reporting and inadequate support services. India lacks comprehensive national data on LGBTQ + health due to limited inclusion of relevant questions in major studies, leading to inaccurate health service reporting. Community-driven surveys highlight the urgent need for targeted policy interventions to address these health disparities. Conclusion The review concludes that socioeconomic and geographic factors, including stigma, discrimination, and income disparities, significantly contribute to health inequities within the LGBTQ + population. These factors lead to heightened mental and physical health challenges, as well as barriers to healthcare access. The findings underscore the need for comprehensive policies to address these inequities and ensure that healthcare systems are more inclusive and responsive to the unique needs of LGBTQ + individuals. 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John","email":"data:image/png;base64,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","orcid":"","institution":"M S Ramaiah university of applied sciences","correspondingAuthor":true,"prefix":"","firstName":"Denny","middleName":"","lastName":"John","suffix":""}],"badges":[],"createdAt":"2025-06-15 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process\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6896994/v1/69c39efe80d0881514eb6ae4.png"},{"id":84753471,"identity":"1e7abbe6-1aae-4843-bd6f-344073631192","added_by":"auto","created_at":"2025-06-17 03:38:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10786,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIncluded studies by year of publication\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6896994/v1/d1659b03bfed37ddf5ef6690.png"},{"id":84753482,"identity":"fc477537-1fa7-42b3-b7f9-94c8fdfbf10d","added_by":"auto","created_at":"2025-06-17 03:38:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":167923,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCountries with published studies\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6896994/v1/7c05e8ec747e1e3a0af8f378.png"},{"id":84754497,"identity":"89f3d0fd-3707-43e0-871d-39bc07a56ce4","added_by":"auto","created_at":"2025-06-17 03:54:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":861837,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6896994/v1/fab27cbd-94f3-4249-8935-6e537f3bae8e.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSocial, economic and geographic factors influencing health equity among LGBTQ+ populations: A scoping review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth inequities, marked by disparities in health experiences and outcomes rooted in social inequities and the effectiveness of support systems, represent a critical issue in global public health. These inequities are particularly pronounced among Gender, Sexual, and Romantic Minority (GSRM) individuals, a group that includes, but is not limited to, LGBTQ+ (lesbian, gay, bisexual, transgender, queer) persons with intersecting identities, such as caste, age, occupation, disability, race, ethnicity, language, region, religion, and community. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eWhile extensive research has been conducted on the health and healthcare experiences of GSRM populations, most of this work originates from the global north, with limited focus on India and South Asia.\u003c/p\u003e \u003cp\u003eGSRM individuals face health disparities driven by social, economic, cultural, and political factors, with high rates of mental health conditions. Barriers to healthcare, especially for those open about their SOGIESC, significantly impact their quality of life.\u003c/p\u003e \u003cp\u003eThe social determinants of health (SDOH) are non-medical factors that influence health outcomes. These include the conditions in which people are born, grow, live, work, and age, as well as the broader forces shaping daily life.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e GSRM individuals who are open about their SOGIESC often face challenges related to housing, employment, and access to nutritious food. These determinants are closely tied to their health concerns. The GSRM population experiences higher rates of tobacco use and often lives in overcrowded, unsanitary conditions with inadequate ventilation and limited access to safe drinking water. The lack of a supportive educational environment during formative years also hinders future employment opportunities, making it difficult for them to secure adequate housing, nutritious food, and quality healthcare.\u003c/p\u003e \u003cp\u003eThe broader environment surrounding LGBTQI\u0026thinsp;+\u0026thinsp;youth play a crucial role in their mental health, well-being, and sense of social connectedness. Feeling supported by adults provides sexual and gender minority youth with resilience when facing challenges, particularly during the vulnerable phase of personal identity formation.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003eSocioeconomically marginalized, elderly, disabled GSRM individuals, or those with chronic illnesses, often face limited healthcare access, further widening the health outcome gap compared to heterosexual counterparts.\u003csup\u003e4\u003c/sup\u003eLGBTQ+ health needs vary by life stage. Adolescents face higher risks of bullying, risky sexual behavior, suicide, and homelessness. Adults report higher substance use, while older adults often experience social isolation and lack culturally competent care. Discriminatory attitudes in healthcare lead many LGBTQ\u0026thinsp;+\u0026thinsp;individuals to avoid seeking care due to fear of inadequate treatment. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis scoping review aims to map the social, economic, and geographic factors contributing to health inequities among GSRM individuals, including LGBTQ\u0026thinsp;+\u0026thinsp;persons. By systematically exploring these determinants, the review seeks to promote health equity, enhance well-being, and challenge the pathologization of GSRM individuals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe review followed the JBI methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e ,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThe review will include GSRM persons. There will be no restriction on population, demographic variables (e.g. SOGIESC, ethnicity, caste, class, race, language, geography, religion, disabilities, age et al), or sampling techniques.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConcepts\u003c/h3\u003e\n\u003cp\u003eThis review will systematically explore the social, economic, and geographic factors influencing health equity among GSRM persons. It will map existing literature to identify how stigma, discrimination, economic status, employment, poverty, and access to GSRM-affirming services contribute to health disparities. Focus will be on how social attitudes, financial instability, and geographic location affect mental health, access to care, and well-being, particularly highlighting disparities between urban and rural areas.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eContext\u003c/h3\u003e\n\u003cp\u003eThe context of health inequity among GSRM populations is addressed across various urban, semi urban, and rural areas throughout different regions of India, without being limited to any specific geographical location or health issue\u003c/p\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eA 3-step search strategy will be adopted to locate published and unpublished papers. A preliminary limited search of MEDLINE (PubMed), and Google Scholar (first 10 pages) was performed. It was followed by an analysis of the text words and index terms used to describe the search strategy will be developed and tailored for each database. The full search strategy was piloted on June 24, 2024, in MEDLINE (PubMed) (Annexure 1).\u003c/p\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eAfter conducting the search across various databases, the identified citations were consolidated and imported into Rayyan software. Out of 3207 studies, 535 duplicate studies were identified and removed. Subsequently, 2 reviewers screened and assessed the titles and abstracts of the articles based on the inclusion criteria.\u003c/p\u003e \u003cp\u003eFollowing initial screening, the selected articles underwent a comprehensive full-text assessment, which were independently performed by the same 2 reviewers. Articles that did not meet inclusion criteria were excluded. In case of any discrepancies between the reviewers at the title/abstract or full-texting screening stage, discussions were held to reach a consensus, or if necessary, a third reviewer was consulted. Reasons for the exclusion of full-text papers that do not meet the inclusion criteria. The results of the search process and research selection will be compiled in the final scoping review and presented using a PRISMA flow diagram.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData extraction\u003c/h2\u003e \u003cp\u003eTwo reviewers were independently extracted data from the included papers, capturing information such as author, title, year of publication, place, objectives, methodology, and reported outcome measures (Annexure 2). Any disagreements that arise between the reviewers were resolved through discussion or with a third reviewer. A draft data extraction tool. Three reviewers were independently pilot test the data extraction tool, as recommended by the JBI Manual for Evidence Synthesis. The data extraction table were adjusted and refined as needed while extracting data from each paper.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe database search identified 3207 records (Annexure 1). After removing duplicates, 2672 records remained. Following title and abstract screening, 30 studies were reviewed in full, with 1 excluded for not meeting inclusion criteria. Ultimately, 18 studies were included in the final analysis. These studies examined key factors affecting LGBTQ\u0026thinsp;+\u0026thinsp;health equity, including social exclusion, economic disparities, and geographic barriers to healthcare. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e outlines the study search and selection process.\u003c/p\u003e\n\u003cp\u003eThe included articles were quantitative studies (n\u0026thinsp;=\u0026thinsp;8),\u003csup\u003e11, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e ,\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e ,\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, non-RCT (n\u0026thinsp;=\u0026thinsp;2) ,\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003emixed method (n\u0026thinsp;=\u0026thinsp;1), ,\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e cross-sectional (n\u0026thinsp;=\u0026thinsp;1) ,\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e qualitative (n\u0026thinsp;=\u0026thinsp;1), \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, 1 synthesis study focusing on the health challenges and barriers faced by LGBTQ\u0026thinsp;+\u0026thinsp;individuals\u003csup\u003e23\u003c/sup\u003e and 1 descriptive study highlighted the historical and ongoing struggles experienced by the LGBTQ\u0026thinsp;+\u0026thinsp;.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Country and Population\u003c/h3\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the number of studies by country and their key focus areas. The USA had the most studies (11)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, primarily addressing social exclusion, mental health, employment discrimination, and geographic healthcare barriers. Studies from India, Kenya, Sweden, the Netherlands, Chile, Colombia, and Mexico focused on social exclusion, stigma, discrimination, financial instability, and healthcare barriers, with factors like caste, gender, violence, and geographic disparities worsening LGBTQ\u0026thinsp;+\u0026thinsp;marginalization.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eNumber of studies per country with key focus\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo of studies\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eKey focus areas\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSocial\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEconomic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGeographic\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUSA\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e ,\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e ,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh levels of stigma, discrimination, and violence.\u003c/p\u003e\n \u003cp\u003eSocial exclusion and non-acceptance of LGBTQ\u0026thinsp;+\u0026thinsp;individuals.\u003c/p\u003e\n \u003cp\u003eIncreased rates of mental health issues (depression, anxiety). \u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment discrimination and higher rates of poverty.\u003c/p\u003e\n \u003cp\u003eLack of health insurance coverage and financial barriers to accessing care.\u003c/p\u003e\n \u003cp\u003eHousing instability, especially for LGBTQ\u0026thinsp;+\u0026thinsp;youth.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhere LGBTQ\u0026thinsp;+\u0026thinsp;individuals live affects how comfortable they feel identifying as such and seeking healthcare, as states with protective laws tend to offer better access to services, while those without these laws create barriers that negatively impact their healthcare experiences. \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eRural LGBT populations face greater anticipated, internalized, and enacted stigma compared to urban populations. This stigma can lead to reluctance in seeking healthcare services due to fears of discrimination, and rural areas often lack providers knowledgeable in LGBT health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndia \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial exclusion due to intersectionality (caste, class, gender).\u003c/p\u003e\n \u003cp\u003eStigma and discrimination, especially against transgender individuals.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment discrimination leading to financial instability and poverty, Limited access to gender-affirming care due to economic hardship, especially for marginalized communities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTransgender individuals often reside in overcrowded accommodations that lack basic facilities, exacerbating their health issues due to poor living conditions.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKenya\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidespread stigma and violence against LGBTQ\u0026thinsp;+\u0026thinsp;individuals.\u003c/p\u003e\n \u003cp\u003e- Peer pressure and harassment in both rural and urban settings.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEconomic instability due to joblessness and discrimination.\u003c/p\u003e\n \u003cp\u003e- Exploitation and blackmail, particularly of LGBTQ\u0026thinsp;+\u0026thinsp;individuals in rural regions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eisolation limits access to LGBTQ+-friendly healthcare, especially in rural areas.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSweden and Netherlands\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLGBT individuals face stigma, discrimination, and exclusion, which significantly impact mental and physical health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisparities\u003c/p\u003e\n \u003cp\u003ein access to healthcare and funding for research on LGBT health persist.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eacceptance and legal rights for LGBT individuals vary across Europe, with more progressive countries like Sweden and the Netherlands contrasted by restrictive environments in Eastern Europe and Russia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChile, Colombia, Mexico\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003einternalized stigma and societal discrimination challenge LGBT individuals\u0026apos; perceptions of themselves as parents and their ability to form families\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003elimited access to healthcare services, particularly assisted reproductive technologies, creates barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edisparities in healthcare access are prevalent, especially in Latin American countries where inclusive health services for LGBT individuals are inconsistent\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eAnnexure 1: Search results from various databases\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eSearch conducted: PubMed (MEDLINE) June 4, 2025\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eSearch number, query, sort by, filter, search details, results\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePublication Trend\u003c/h2\u003e\n \u003cp\u003eThe search and selection process (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) identified studies from 2015 to 2023 examining social, economic, and geographic factors affecting LGBTQ\u0026thinsp;+\u0026thinsp;populations. There has been a clear increase in published studies, with most articles appearing in 2016 or later. Only one study was published in 2015, followed by four in 2016, while 2023 saw the highest number of studies (5).\u003c/p\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003eStudy setting\u003c/h2\u003e\n \u003cp\u003eOut of 18 studies, 6 were carried out in urban areas,\u003csup\u003e23 13 8 15 25\u003c/sup\u003e with only 1 study conducted in rural location.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Three studies encompassed both urban and rural settings,\u003csup\u003e24 20\u003c/sup\u003e while the specific locations for 7 studies were not clearly indicated.\u003csup\u003e1 26 ,27 14 11\u003c/sup\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSocial factors\u003c/h2\u003e\n \u003cp\u003eThe review emphasizes that societal structures, combined with external and internalized homonegativity, significantly influence the physical \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and mental well-being of gender minority groups. The anxiety and psychological impact of being HIV-positive often compel individuals to conceal their status in order to avoid the physical, emotional, and financial consequences of social exclusion.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Even when women desire to get tested, challenges such as locating testing centers and finding LGBTQ-friendly healthcare providers create significant barriers that prevent them from accessing testing, much like the fear of social exclusion leads some HIV-positive individuals to hide their status.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Similarly, gay and bisexual men have a higher prevalence of cardiovascular disease compared to heterosexual men.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The experience of stigma, social isolation, marginalization, feelings of worthlessness, and rejection by parents and siblings are deeply traumatic and hinder the normal growth and advancement of LGBT individuals.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eEconomic factors\u003c/h2\u003e\n \u003cp\u003eEconomic factors play a crucial role in shaping the lives and well-being of LGBTQ\u0026thinsp;+\u0026thinsp;individuals. Discriminatory practices in employment, wage gaps, barriers to healthcare, and limited access to financial resources often exacerbate economic disparities, leading to negative outcomes that affect their overall quality of life.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e These economic inequalities not only reinforce social marginalization but also hinder progress in achieving equity for LGBTQ\u0026thinsp;+\u0026thinsp;populations. Research has shown that GSRM individuals who are open about their SOGIEC often face obstacles in securing housing and endure financial strain linked to homelessness.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eGeographic factors\u003c/h2\u003e\n \u003cp\u003eRural societies differ from urban societies in several important ways that affect health outcomes for LGBTQ individuals. People in rural areas are often more supportive of conservative values and display less tolerance toward diverse populations, including LGBTQ individuals. Strong religious beliefs significantly shape the values, attitudes, and social norms within rural communities, which can further impact the acceptance and support for LGBTQ individuals.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Many rural men who have sex with men (MSM) form hidden gay networks, making support hard to access. Organizing informal networks is vital in these communities, as existing reference groups can facilitate prevention programs, enhance support, and reduce internalized homophobia, helping to combat stigma from dominant groups.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eStudies reveal that many LGBTQ\u0026thinsp;+\u0026thinsp;individuals report delayed or denied healthcare due to discriminatory attitudes among healthcare providers. For instance a study has found that healthcare workers often lack training on LGBTQ\u0026thinsp;+\u0026thinsp;health issues, leading to improper care. \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e High levels of psychiatric morbidity, including depression and anxiety, are observed in LGBTQ\u0026thinsp;+\u0026thinsp;populations, exacerbated by social exclusion, bullying, and harassment in everyday life, as highlighted.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eResearch shows that LGBTQ\u0026thinsp;+\u0026thinsp;individuals with disabilities face significant challenges. A study in Victoria, Australia, used focus groups with peer researchers to explore the experiences of disabled LGBTIQA\u0026thinsp;+\u0026thinsp;individuals accessing support services. Two key themes emerged: difficulties in accessing health services as disabled LGBTIQA\u0026thinsp;+\u0026thinsp;individuals and challenges in managing multiple identities.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e The research indicates that inclusive practices may require changes in policy and practice to address the specific needs of LGBTIQA\u0026thinsp;+\u0026thinsp;individuals with disabilities, as well as LGBTIQA\u0026thinsp;+\u0026thinsp;education for disability services and disability education strategies tailored to LGBTIQA\u0026thinsp;+\u0026thinsp;focused services.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThe challenges faced by LGBTQ\u0026thinsp;+\u0026thinsp;individuals are compounded by other social categorizations such as race, caste, and gender. LGBTQ\u0026thinsp;+\u0026thinsp;youth, particularly those from conservative families, are often subjected to family rejection, leading to homelessness and isolation, which are major predictors of poor mental health. Discrimination in the labor market often leads to high unemployment rates among LGBTQ\u0026thinsp;+\u0026thinsp;individuals, particularly transgender people. This economic exclusion leads to poverty, housing instability, and a lack of access to healthcare, further exacerbating health disparities. Additionally, many LGBTQ\u0026thinsp;+\u0026thinsp;individuals experience job discrimination, where employers refuse to hire or retain them due to their gender identity or sexual orientation. Economic hardship limits access to health insurance, necessary medications such as hormone therapies, HIV treatment, mental health services, and other essential healthcare like gender-affirming surgeries and treatments for sexually transmitted infections (STIs). This often leads to delayed diagnoses and inadequate management of serious health conditions. LGBTQ\u0026thinsp;+\u0026thinsp;individuals in vulnerable professions, such as sex work, face further risks, including exposure to violence, sexually transmitted infections (STIs), and criminalization, which limit their access to healthcare. One of the findings from this report suggests that transgender individuals, like Ms. XX, face significant challenges such as homelessness, substance use, and difficulties accessing healthcare, contributing to their heightened vulnerability to mental health issues.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThose living in rural or semi-urban areas face greater challenges than their urban counterparts due to limited healthcare infrastructure, cultural conservatism, and a lack of GSRM-affirmative healthcare services. A study has found that transgender individuals in rural India are significantly more likely to experience poor health outcomes due to inadequate healthcare access.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e In both urban and rural settings, a lack of culturally competent healthcare providers those trained in LGBTQ\u0026thinsp;+\u0026thinsp;health needs pose a significant barrier, especially in preventive services like gynecology, oncology, and mental health care. LGBTQ\u0026thinsp;+\u0026thinsp;individuals assigned female at birth (AFAB) and intersex individuals face a lack of access to appropriate preventive healthcare. Rural areas have fewer healthcare facilities and providers that are trained in or sensitive to LGBTQ\u0026thinsp;+\u0026thinsp;issues, which may result in lower utilization of primary healthcare services by LGBTQ\u0026thinsp;+\u0026thinsp;individuals. Travel times to LGBTQ\u0026thinsp;+\u0026thinsp;friendly providers can be longer, making it more difficult to access care.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eThe intersection of geographic location, economic status, and social discrimination exacerbates the health inequities experienced by LGBTQ\u0026thinsp;+\u0026thinsp;individuals. Even where legal reforms have been implemented, such as the 2018 decriminalization of homosexuality in India, there is often a gap between policy and practice, especially in more conservative or rural regions. This geographic inconsistency in legal protections and healthcare access contributes to health inequities for LGBTQ\u0026thinsp;+\u0026thinsp;individuals living outside of major urban centers. This overlapping web of social, economic, and geographic factors continues to drive health inequities among LGBTQ\u0026thinsp;+\u0026thinsp;populations, highlighting the urgent need for inclusive policies and healthcare reforms that address their unique challenges.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review highlights the impact of social, economic, and geographic factors on health equity in the LGBTQ\u0026thinsp;+\u0026thinsp;community, particularly for Gender, Sexual, and Romantic Minority (GSRM) individuals. Systemic discrimination and intersecting identities create barriers to quality healthcare, exacerbating physical and mental health disparities.\u003c/p\u003e \u003cp\u003eSurveys show LGB individuals face higher rates of discrimination and violence compared to heterosexuals.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003eControlling for other personal and interpersonal stigma and other risk factors such as being depressed, living in stigmatizing social environments is associated with approximately 20% more suicide attempts in LGBT youth. \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, studies of gender minorities have shown extremely high rates of suicidal ideation,38 with suicidal ideation as high as 51% and attempted suicide rates as high as 30% among transgender youth,39 compared to the national average of 4.6% for cisgender heterosexuals.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e The findings highlight the urgent need for culturally competent policies and healthcare interventions that address the unique needs of GSRM individuals. Transgender women have historically been the focus of healthcare research, which may explain the relatively lower rates of denial or lower-quality care in this group, as many interventions have been tailored to their needs.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplications for research\u003c/h2\u003e \u003cp\u003eEnsuring equal access to health and healthcare is a core objective in both public health research and practice.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Many LGBTQ\u0026thinsp;+\u0026thinsp;people continue to experience high levels of discrimination, stigma, abuse and marginalization in many aspects of their lives. Significant social, economic and health disparities for LGBTQ\u0026thinsp;+\u0026thinsp;communities continue to exist.\u003c/p\u003e \u003cp\u003eHigh rates of suicidal ideation, depression, and anxiety are prevalent among trans and gender-diverse individuals in India, who often face harassment and abuse due to their identity. Trans populations experience high levels of homelessness, and substance misuse, such as alcohol and drug difficulties, is common. Intimate partner and family violence are widespread, with low reporting and inadequate support services. India lacks comprehensive national data on LGBTQ\u0026thinsp;+\u0026thinsp;health due to limited inclusion of relevant questions in major studies, leading to inaccurate health service reporting. Community-driven surveys highlight the urgent need for targeted policy interventions to address these health disparities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe review concludes that socioeconomic and geographic factors, including stigma, discrimination, and income disparities, significantly contribute to health inequities within the LGBTQ\u0026thinsp;+\u0026thinsp;population. These factors lead to heightened mental and physical health challenges, as well as barriers to healthcare access. The findings underscore the need for comprehensive policies to address these inequities and ensure that healthcare systems are more inclusive and responsive to the unique needs of LGBTQ\u0026thinsp;+\u0026thinsp;individuals. Addressing intersecting identities and improving access to essential resources like housing, employment, and education are critical steps toward promoting health equity\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDuha R (2023) The rise of heteronormativity and the Anthropocene\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolar O, Irwin A, World Health Organization (2010). \u003cem\u003eA conceptual framework for action on the social determinants of health\u003c/em\u003e.; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/sites/default/files/2017-06/SDH_conceptual_framework_for_action.pdf\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/sites/default/files/2017-06/SDH_conceptual_framework_for_action.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson C, Cariola LA (2019) Springer Nature. \u003cem\u003eLGBTQI\u0026thinsp;+\u0026thinsp;Youth and Mental Health: A Systematic Review of Qualitative Research\u003c/em\u003e. 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Creighton Law Rev\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"M S Ramaiah University of Applied Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Socioeconomic factors, geographical factors, health inequities, LGBTQ+.","lastPublishedDoi":"10.21203/rs.3.rs-6896994/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6896994/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examined health disparities and social determinants affecting LGBTQ+ individuals, highlighting how stigma and discrimination worsen access to essential resources like employment, income, housing, education, and healthcare. Understanding the interplay between these disparities and social factors is crucial for promoting health equity. Addressing intersecting identities and improving resource access are vital for enhancing the well-being of the LGBTQ+ population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the JBI methodology for scoping reviews, a comprehensive search was conducted across MEDLINE (PubMed) and Google Scholar. Two independent reviewers screened titles and abstracts for relevance, followed by full-text reviews for inclusion based on eligibility criteria. Discrepancies were resolved by a third reviewer. Data extraction captured details on study objectives, methodology, and the influence of social norms, culture, religion on SRH outcomes. The synthesis highlighted how these factors shape SRH in diverse LMIC settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom a total of 3207 studies, 48 relevant articles were included after screening 30 full text articles. The study revealed that health inequity among LGBTQ+ populations was significantly influenced by the interrelated factors of stigma, discrimination, income disparities, leading to increased mental and physical health issues and barriers to healthcare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review outlined the socioeconomic and geographical factors that contribute to health inequities within the LGBTQ+ population. The available evidence highlights the need for a comprehensive policy to address health inequities among LGBTQ individuals and enhance healthcare access.\u003c/p\u003e","manuscriptTitle":"Social, economic and geographic factors influencing health equity among LGBTQ+ populations: A scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 03:38:51","doi":"10.21203/rs.3.rs-6896994/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"600344f4-fe68-4ba0-b625-a6251277cc80","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50063654,"name":"Health Policy"}],"tags":[],"updatedAt":"2025-06-17T03:38:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 03:38:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6896994","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6896994","identity":"rs-6896994","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}