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LGBTQ2S stands for Lesbian, Gay, Bisexual, Transgender, Queer and Questioning, and Two-Spirit. The term Two-Spirit does not simply mean someone who is an American Indian/Alaska Native (AI/AN) and gay. Traditionally, AI/AN Two-Spirit people were male, female, and sometimes intersexed individuals who combined activities and traits of both men and women. 

The LGBTQ2S population has unique healthcare needs – they are at greater risk for multiple health threats, and often experience low quality care due to a variety of factors, such as discrimination, stigma, prejudice, and other social, political, and economic determinants of health.  Lesbian and bisexual women are at increased risk for cardiovascular disease, such as hypertension as well as diabetes, and they also have more risk factors for breast cancer than heterosexual Caucasian women. Transwomen may have more elevated rates of cardiovascular disease and heart attack than their cisgender counterparts. In addition, some of the highest risks of violence affect bisexual women and transwomen, particularly women of color.  There is also increased risk of mental health disparities in LGBTQ2S populations including heightened anxiety, depressive symptoms and greater suicidality among LGBTQ2S people.

Often, culture is prevention and a source of healing in AI/AN communities. Some examples of the healing work being revived in the Two-Spirit community include dance lessons, Two-Spirit gatherings and powwows, Two-Spirit drum groups, and restoring ceremonies such as the Naming Ceremony and Sun Dance.  From the standpoint of western medicine, evidence-based interventions are needed to prevent and address health inequities performed by those who care for them. These interventions need to examine the root causes and multilevel factors driving LGBTQ2S health disparities.

The following documents will help the LGBTQ2S community to learn more about their state of health and what resources are available.  The information will also guide healthcare providers to understand the health and safety needs of LGBTQ2S people and how to take a more effective approach in their healthcare.


Tribal Equity Toolkit

Mending the Rainbow:  Working with the Native
LGBT/Two-Spirit Community

Take Charge Early Pregnancy Pamphlet

Take Charge Sexual Health Pamphlet

Take Charge Nutrition Pamphlet

Take Charge Exercise Pamphlet

Creating Authentic Spaces / Rights

Creating Authentic Spaces / Washroom

Creating Authentic Spaces / Welcoming

Pathways to Parenthood for LGBT People

Emergency Contraception for Transgender and
Nonbinary patients

TSISTA Resource Guide

Learning to Address Implicit Bias Towards
LGBTQ Patients:  Case Scenarios

The Medical Care of
Transgender Persons


Promoting Cervical Cancer Screening
Among Lesbians and Bisexual Women

Suicide Risk and Prevention
for LGBTQ People

Building Patient-Centered Medical Homes for Lesbian, Gay, Bisexual, and Transgender
Patients and Families

Understanding the Well-Being
of LGBTQI+ Populations

U.S. Department of Education Resources for LGBTQI+ Students

National Center for Transgender Equality

TransLine Health



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