The Role of Online Spaces in Navigating LGBTQ+ Healthcare Access

Ashley Lacombe-Duncan, PhD, joins Michigan Minds to share insight on her research, which focuses on healthcare access and health equity, with a particular focus on healthcare access for people who experience multiple forms of intersecting oppressions. Lacombe-Duncan is an Assistant Professor at the U-M School of Social Work and core faculty of the U-M Center for Sexuality and Health Disparities.

Her community-based interdisciplinary research agenda advances two overarching areas: sexual and reproductive healthcare access among lesbian, gay, bisexual, transgender (trans), queer, and other sexuality and gender diverse (LGBTQ+) people and women living with HIV; and social ecological, intersectionality, and multi-level stigma theoretical approaches applied to understand and address LGBTQ+ and women living with HIV’s health in local and global contexts. 

As a graduate student, Lacombe-Duncan volunteered at the Casey House—North America’s oldest standalone hospice for people living with HIV—where her interest in this area began. 

“When I started in that role, I really harbored many of the stigmatizing assumptions about what it means to be a person living with HIV that are pervasive in society today. I learned through my experience how stigma can be challenged through knowledge, and as my relationship grew with the organization and with the clients, I became really passionate about reducing HIV stigma—particularly that I saw being perpetrated by people in rolls similar to mine, such as social workers, doctors, and other allied health care providers,” she says. 

Her recent work, titled, “LGBTQ Persons’ Use of Online Spaces to Navigate Conception, Pregnancy, and Pregnancy Loss,” was a collaboration with faculty from the U-M School of Information and U-M School of Nursing. The study investigated how pregnancy loss stigma, trans stigma, and sexual stigma impacted participants experiences and what kind of access to resources they had.

“What we found was that participants showed really immense resilience through their use of online LGBTQ-specific spaces. So, primarily Facebook groups—and these were spaces where participants often felt seen, heard, valued, and received practical support that was really getting at the LGBTQ-specific experiences. At the same time, these spaces were still excluding those facing multiple stigmas such as LGBTQ people of color and those without partners.”

Lacombe-Duncan explains key findings from a paper she co-authored that explores how TikTok can be used by community members, researchers and healthcare providers to share trans-specific health information. This work demonstrated TikTok’s unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities. 

“The analytics really speak to the power of this medium for sharing information, as just one single TikTok received 70,000 views at the time we published the paper and almost 9,000 positive endorsements. Overall the 13 videos were viewed over 380,000 times… The reach is really phenomenal. That said, there are limitations, such as limited access to those without stable Internet. So, this should really be seen as just one way for researchers to share their information.”

June celebrates LGBTQ+ Pride Month, a celebration that aims to raise awareness and reduce stigma. As a intersectional stigma and discrimination researcher, Lacombe-Duncan says recongizing Pride Month and its history is important. 

“It’s both a time to celebrate who we are and our many strengths, but I think most importantly, it’s a time to acknowledge those who have come before us and fought so hard for the rights that we have today. It’s also a time for us to come together and mobilize to fight against the onslaught of anti-LGBTQ+ legislation that’s being passed within the US and globally.”

Lacombe-Duncan describes how community involvement and education on the challenges that LGBTQ+ people face can create change—both from an LGBTQ+ specific research perspective and from an HIV research perspective. She explains how listening to the lived experiences of communities is a powerful way to transform and expand narratives. 

“As an LGBTQ+ person, we see very limited—at least, historically and still to this day—ways in which LGBTQ+ people are represented in the media. Having community members share whole and real lives, I think can be really transformative.” 

Lacombe-Duncan offers various ways in which community members can get involved and learn more about LGBTQ+ research. She suggests reading from sources that are specifically written by LGBTQ+ people about the history of pride, and supporting LGBGT+ organizations by attending events and sharing media that they create. Lacombe-Duncan also shares resources from the U-M Spectrum Center, where community members can learn more about LGBTQ+ research.