Health of two-spirit, lesbian, gay, bisexual and transgender people experiencing poverty in Canada: a review

Abstract

Lay Summary Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people experience poverty much more than the general population. 2SLGBTQ+ people and people experiencing poverty face poorer health and greater difficulty accessing healthcare. Studies focussing on the impacts of 2SLGBTQ+ status and poverty on health can help inform policy. We sought to find out what is known about the health of 2SLGBTQ+ people in Canada experiencing poverty. Following systematic guidelines, we searched and summarized literature on 2SLGBTQ+ poverty from a variety of online databases. 2SLGBTQ+ poverty research remains sparse but is growing, demonstrated by most studies being published in the past decade. Half the studies explicitly focussed on poverty and the other half did not. Intersectionality helped to understand the health-related themes identified—healthcare access, physical health and mental health and substance use—as these outcomes are shaped by unique forms of oppression. 2SLGBTQ+ people experiencing poverty face poorer health than other 2SLGBTQ+ people in Canada. Discrimination was an overarching finding that explained consistent connections between 2SLGBTQ+ status, poverty and health. Research that directly questioned the experiences of 2SLGBTQ+ people experiencing poverty was limited. Research is needed on underrepresented 2SLGBTQ+ sub-groups who face higher rates of poverty, including transgender, bisexual and two-spirit populations.