“It’s very difficult to navigate the health care system”: structural barriers and the need for affirming care for LGBTQ+ young adults

LGBTQ+ young adults face significant barriers to healthcare access, including stigma, misgendering, and a lack of provider competence. These experiences contribute to heightened psychological distress and delays in seeking care. Minority Stress Theory offers a framework for understanding how structural and interpersonal discrimination impacts health outcomes in this population. This study qualitatively explores the healthcare experiences of a sample of LGBTQ+ young adults in the United States to identify barriers to affirming care and generate recommendations for inclusive, equitable healthcare delivery. In February 2025, four virtual focus group discussions were conducted with 35 LGBTQ+ individuals between the ages of 18 and 26 years living in the United States. Participants were diverse in terms of sexual orientation, gender identity, and race/ethnicity. A semi-structured focus group guide informed by prior research guided the discussions. All focus group transcripts were analyzed via thematic analysis. Coding was conducted collaboratively using MAXQDA, and intercoder reliability was established. Minority Stress Theory guided the interpretation of themes. Four key themes emerged: (1) Building Trust Through Affirming and Competent Care Practices; (2) Expanding Pathways to LGBTQ+ Healthcare; (3) Provider Education, Training, and Accountability; and (4) Cultivating Safe, Inclusive, and Visibly Affirming Healthcare Spaces. Participants identified multiple interpersonal and structural barriers, while also offering actionable strategies for system improvement. LGBTQ+ young adults require more than inclusive language; they need healthcare systems committed to structural change, accountability, and visibility. Findings underscore the importance of embedding LGBTQ+ competence and affirmation across all levels of care to promote health equity.