Report on Telemedicine’s Role in Advancing Sustainable Development Goals for LGBTQIA+ Populations

Executive Summary

This report synthesizes findings from a scoping review on the utilization of telemedicine to address the healthcare needs of the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) community. The analysis places significant emphasis on how telemedicine initiatives contribute to the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). The review of 38 studies, involving 21,774 participants, demonstrates that telemedicine is a critical tool for improving access to gender-affirming care, mental health services, and HIV/STI testing. While telemedicine shows high satisfaction rates and improves health outcomes, challenges related to digital equity (SDG 9), privacy, and cultural competence must be addressed to ensure its sustainable and equitable implementation. The findings advocate for the development of inclusive telehealth policies and provider training to build resilient and equitable healthcare systems (SDG 16) that leave no one behind.

1.0 Introduction: Aligning Telemedicine with Sustainable Development Goals

The 2030 Agenda for Sustainable Development is founded on the principle of “leaving no one behind.” However, LGBTQIA+ populations globally face significant health disparities rooted in stigma, discrimination, and systemic barriers to care. These challenges directly contravene several SDGs:

• SDG 3 (Good Health and Well-being): This community experiences higher rates of mental health conditions, HIV, and STIs, and faces obstacles in accessing essential services, undermining the goal of ensuring healthy lives for all.
• SDG 5 (Gender Equality): Transgender and gender-diverse individuals face profound barriers to gender-affirming care (GAC), a critical component of health and well-being that aligns with the broader goal of achieving equality and empowerment for all genders.
• SDG 10 (Reduced Inequalities): Healthcare disparities are a stark manifestation of the inequalities faced by LGBTQIA+ individuals. Addressing these gaps is essential for promoting social inclusion and ensuring equal opportunity.

Telemedicine, an innovation in digital health infrastructure (SDG 9), has emerged as a powerful strategy to overcome these barriers. This report examines the evidence on telemedicine’s effectiveness in delivering culturally competent care to LGBTQIA+ communities, thereby advancing the global commitment to sustainable and equitable development.

2.0 Methodology

This report is based on a scoping review following PRISMA-ScR guidelines. A systematic search of MEDLINE, Embase, Web of Science, and Scopus databases up to March 2024 identified 38 relevant studies (37 observational, one randomized controlled trial). The review focused on telemedicine interventions for LGBTQIA+ individuals in the areas of gender-affirming care, mental health, and HIV/STI services. Data on study characteristics, telemedicine applications, and satisfaction levels were extracted and synthesized to map current knowledge and its implications for achieving the SDGs.

3.0 Key Findings and SDG Impact Analysis

The review categorized findings into key healthcare domains, revealing significant contributions toward multiple SDGs.

3.1 Gender-Affirming Care (GAC) and its Contribution to SDG 3, 5, and 10

Twenty-four studies examined the role of telemedicine in providing GAC. The findings demonstrate a clear positive impact on several SDG targets:

1. Improved Access and Reduced Disparities (SDG 3 & SDG 10): Telemedicine significantly improved access to GAC, particularly for rural and underserved populations. This was evidenced by increased appointment completion rates and lower no-show rates, directly addressing geographic and transportation barriers that perpetuate health inequalities.
2. Continuity of Care and Well-being (SDG 3): During the COVID-19 pandemic, telemedicine was instrumental in preventing delays in GAC, including hormone therapy and pre-surgical consultations. This continuity was vital for mitigating the negative mental health impacts associated with care interruptions, thus promoting well-being (SDG 3.4).
3. Empowerment and Equality (SDG 5): By providing a more accessible and private pathway to GAC, telemedicine empowers transgender and gender-diverse individuals to live authentically, a fundamental aspect of gender equality.

3.2 Mental Health Services and the Pursuit of SDG 3.4

The review highlights telemedicine’s critical role in addressing the high burden of mental health challenges within the LGBTQIA+ community, directly supporting SDG 3.4 (promote mental health and well-being).

• Reduced Stigma and Increased Utilization: LGBTQIA+ individuals were more likely to use telehealth for mental and behavioral health concerns compared to heterosexual counterparts, suggesting that the remote format reduces stigma-related barriers.
• Mitigating Negative Outcomes: Access to tele-mental health services, especially when combined with GAC, was associated with reduced rates of depression and suicidal ideation.
• Youth-Friendly Platforms: Youth reported that virtual visits were less stressful, indicating that telemedicine can create a more comfortable and effective environment for mental health support.

3.3 HIV/STI Prevention and Treatment: Targeting SDG 3.3

Telemedicine has proven to be a vital tool in the fight against HIV and other STIs, contributing directly to SDG 3.3 (end the epidemics of AIDS and other communicable diseases).

1. Increased Testing Uptake: Telehealth platforms saw a high number of first-time HIV testers, particularly among transgender youth and men who have sex with men (MSM), who may avoid in-person clinics due to fear of judgment.
2. Remote PrEP Initiation and Management: Telemedicine successfully facilitated the remote initiation and management of pre-exposure prophylaxis (PrEP) for HIV, a cornerstone of modern prevention strategies. This overcomes significant logistical barriers for at-risk individuals.
3. Enhanced Counseling and Confidentiality: Patients reported that the privacy of telemedicine consultations allowed for more comprehensive and honest discussions about sexual health, improving the quality of care and counseling.

3.4 Provider Training and Building Stronger Institutions (SDG 16)

Four studies highlighted the use of telemedicine for interdisciplinary consultations and provider training. This application is crucial for building the capacity of healthcare systems to provide inclusive care, aligning with SDG 16 (Peace, Justice and Strong Institutions).

• Interdisciplinary teleconsultations improved healthcare providers’ confidence and competence in treating transgender patients.
• Virtual training programs on topics like hormone therapy and primary care for transgender veterans were effective in enhancing clinical skills and promoting better teamwork.

4.0 Challenges and Barriers to Sustainable Implementation

Despite its potential, the sustainable and equitable scale-up of telemedicine faces several challenges that could hinder progress toward the SDGs.

• The Digital Divide (Barrier to SDG 9 & 10): Lack of reliable internet access, affordable devices, and digital literacy disproportionately affects low-income and rural individuals, creating a new layer of inequality in healthcare access.
• Privacy and Safety Concerns (Barrier to SDG 10 & 16): Patients expressed concerns about digital privacy breaches and the potential for misgendering in virtual settings. Transgender youth, in particular, noted issues with body dysphoria triggered by video calls and the need for a private, safe space for consultations.
• Cultural Competence Gap (Barrier to SDG 3 & 5): The effectiveness of telemedicine is contingent on the provider’s ability to deliver culturally competent and affirming care. A lack of training can undermine patient trust and lead to poor health outcomes.
• Systemic and Policy Constraints: Limitations in insurance coverage, inconsistent cross-state licensing laws, and restrictive policies on virtual care can limit the reach and sustainability of telehealth programs.

5.0 Recommendations and Future Outlook

To fully leverage telemedicine to advance the SDGs for the LGBTQIA+ community, a multi-faceted approach is required:

1. Promote Digital Equity (SDG 9 & 10): Policymakers must invest in public digital infrastructure and programs to ensure that all individuals, regardless of socioeconomic status or location, can access telehealth services.
2. Strengthen Provider Capacity (SDG 3 & 16): Healthcare institutions should implement mandatory, ongoing training for providers on LGBTQIA+-affirming care delivered via telemedicine, including modules on privacy, consent, and cultural sensitivity.
3. Develop Inclusive Telehealth Models (SDG 3, 5, 10): Telehealth platforms should be co-designed with LGBTQIA+ community members to ensure they are user-friendly, secure, and affirming. This includes features like options to disable video, use preferred names and pronouns, and access peer support networks.
4. Advocate for Supportive Policies (SDG 10 & 16): There is a need for sustained advocacy for policies that ensure comprehensive insurance coverage for telehealth, streamline provider licensing, and protect patient data, creating an enabling environment for equitable healthcare delivery.

6.0 Conclusion

Telemedicine is more than a tool for convenience; it is a critical enabler of health equity and a powerful instrument for achieving the Sustainable Development Goals. By bridging gaps in access, reducing stigma, and delivering specialized care, telehealth interventions are helping to ensure that the health and well-being of LGBTQIA+ populations are not left behind. Realizing this full potential requires a concerted effort from policymakers, healthcare systems, and technology developers to address the challenges of digital inequality, privacy, and cultural competence, thereby building a truly inclusive and sustainable future for all.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s primary focus is on healthcare for the LGBTQIA+ community. It extensively discusses improving access to gender-affirming care (GAC), mental health services, and prevention and testing for HIV and STIs, all of which are central to ensuring healthy lives and promoting well-being.

SDG 5: Gender Equality

• While SDG 5 primarily focuses on women and girls, its broader aim of achieving gender equality and empowering all is highly relevant. The article addresses the specific healthcare needs and discrimination faced by individuals based on their gender identity and sexual orientation (transgender, gender-diverse, non-binary individuals), linking directly to the principles of eliminating discrimination and ensuring equal access to health.

SDG 10: Reduced Inequalities

• The article directly addresses the healthcare disparities and inequalities faced by the LGBTQIA+ community, a marginalized group. It highlights how factors like stigma, discrimination, and lack of culturally competent providers create barriers to care, and it examines how telemedicine can be a tool to reduce these inequalities, particularly for those in rural and underserved areas.

SDG 9: Industry, Innovation, and Infrastructure

• The article explores the use of telemedicine and digital health technologies as an innovative solution to bridge gaps in healthcare access. This connects to building resilient infrastructure and fostering innovation, specifically by leveraging information and communications technology (ICT) to provide essential services, thereby addressing Target 9.c on increasing access to technology.

SDG 4: Quality Education

• The review points out that a “lack of provider education and cultural competence contributes to healthcare inequalities.” It also discusses the use of telemedicine for “transgender health education for providers” and “training and interdisciplinary consultation services” to enhance the quality of care and boost provider confidence. This aligns with the goal of ensuring inclusive and equitable quality education and promoting lifelong learning opportunities, in this case, for healthcare professionals.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

1. Target 3.3: By 2030, end the epidemics of AIDS… and other communicable diseases.
   • The article extensively discusses the use of telemedicine for “testing for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs),” “remote initiation of pre-exposure prophylaxis for HIV (PrEP),” and supporting “HIV prevention and care.” This directly contributes to ending the HIV epidemic.
2. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article highlights significant mental health challenges in the LGBTQIA+ community, including high rates of depression and anxiety. It states that telemedicine helps to “reduce mental health disparities” and offers “mental health support through virtual counseling,” noting that access to care via telemedicine led to “reduced rates of depression and suicidal ideation.”
3. Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services…
   • The review addresses “sexual health/reproductive Health-Related problems” and the need for tailored prevention and screening. The focus on HIV/STI testing and counseling for various LGBTQIA+ subgroups falls under the umbrella of sexual healthcare services.
4. Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services… for all.
   • The core theme of the article is using telemedicine to “improve healthcare access and outcomes for LGBTQIA+ populations,” especially in “rural and underserved areas.” It discusses overcoming barriers like transportation and distance to provide essential services like gender-affirming care, mental health support, and medication management, which is a direct effort toward achieving universal health coverage for a marginalized community.

SDG 10: Reduced Inequalities

1. Target 10.2: By 2030, empower and promote the social… inclusion of all, irrespective of… sex… or other status.
   • The article is centered on reducing healthcare access inequalities for the LGBTQIA+ community, a group marginalized based on their “other status” (sexual orientation and gender identity). By examining how telemedicine can “bridge the gap in access to healthcare for LGBTQIA+ populations,” it directly addresses their inclusion in essential services.
2. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… practices…
   • The article identifies “prejudice,” “stigma,” “fear of discrimination,” and a lack of “cultural competence” as key barriers that worsen health outcomes. It proposes telemedicine as a way to provide “LGBTQIA+ affirming care” in a manner that reduces exposure to stigma and discrimination, thereby promoting equal opportunity in healthcare.

SDG 9: Industry, Innovation, and Infrastructure

1. Target 9.c: Significantly increase access to information and communications technology and strive to provide universal and affordable access to the Internet…
   • The entire review is about leveraging a specific information and communications technology—telemedicine—to provide healthcare. It explicitly mentions that telemedicine overcomes “barriers like transportation, distance, and financial limitations” and improves access for those in “rural and underserved areas.” It also acknowledges challenges like “technological accessibility” and the need for “digital equity,” which are central to this target.

SDG 4: Quality Education

1. Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including… human rights, gender equality and promotion of a culture of peace and non-violence.
   • The article identifies a “lack of provider education and cultural competence” as a major problem. It highlights the use of telemedicine for “transgender health education for providers” and “interdisciplinary consultation and training services.” These efforts to enhance provider knowledge, confidence, and cultural competence in treating LGBTQIA+ individuals are a form of specialized education aimed at promoting health equity and human rights.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

For Target 3.3 (End HIV/AIDS)

• HIV diagnosis rates: The article mentions that “HIV diagnosis rates were highest among gay, bisexual, and other men who have sex with men (MSM).”
• HIV/STI testing rates: The article discusses telemedicine’s role in “HIV and STI testing,” including the number of “first-time HIV testers” using online services.
• PrEP uptake and adherence: Progress is measured by the ability to “remotely initiate pre-exposure prophylaxis for HIV (PrEP)” and track “one-month HIV treatment adherence.”

For Target 3.4 (Promote Mental Health)

• Prevalence of mental health conditions: The article provides specific statistics, such as “51.4% of transgender women and 48.3% of transgender men reporting depressive symptoms.”
• Rates of depression and suicidal ideation: Telemedicine’s impact is measured by “reduced rates of depression and suicidal ideation.”
• Mental health scores: The article notes that telemedicine access led to “improved mental health scores.”

For Target 3.8 (Universal Health Coverage)

• Healthcare access and utilization rates: Measured by “appointment completion rates,” “cancellations and no-show rates,” and the “number of new patient visits” through telemedicine.
• Patient and provider satisfaction levels: The article repeatedly mentions that “high satisfaction reported among patients and providers” is a key outcome.
• Reduction in access barriers: Progress is implied by overcoming barriers like “transportation, distance, and financial limitations.”

For Target 10.2 & 10.3 (Reduced Inequalities)

• Disparities in healthcare use: The article compares telemedicine utilization between LGBTQIA+ and heterosexual individuals, noting the former were “more likely to utilize telemedicine services.”
• Patient experience of care: Measured through qualitative data on “stigma,” “fear of discrimination,” and concerns about “misgendering in virtual settings.”
• Availability of inclusive services: The development of “culturally competent telehealth models” and “LGBTQIA+ affirming care” serves as an indicator of progress.

For Target 9.c (Access to ICT)

• Telemedicine adoption rates: The “increased telemedicine adoption for follow-up visits and medication management” is a direct indicator.
• Digital equity barriers: The presence of challenges like “digital privacy concerns” and “technological accessibility” are inverse indicators, highlighting areas needing improvement.

For Target 4.7 (Quality Education)

• Provider confidence levels: The article notes that training programs were effective in “enhancing their confidence in treating transgender veterans.”
• Availability of training programs: The implementation of “interdisciplinary transgender veteran care: development of a core curriculum for VHA providers” is a concrete indicator.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: nature.com