.png)
The Lavender Lounge
Welcome to the Lavender Lounge: a podcast community discussing the latest in LGBTQ+ health and wellness. Hosted by Spectrum Medical Community Health Advocate Anna Kova, Lavender Lounge amplifies voices in conversations around LGBTQ+ health, identity, and resilience. Featuring care providers, local advocates, and individuals with lived experience in this space, we share real insights to empower you wherever you’re at in your health journey.
The Lavender Lounge
Nothing About Us Without us: Queer Healthcare in Rural America
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Dr. Kyle Gresenz is a queer theorist and rural healthcare scholar working to expose how systems fail LGBTQ+ communities. We dig into the four domains of healthcare, structural urbanism, and why geography and policy still dictate who gets care and who doesn't. Kyle also breaks down how finances, location, and discriminatory policies block access and what it actually takes to push past learned helplessness toward real, structural change. Listen, share, and follow to hear more!
Spectrum Medical Care Centre
Maricopa County Community Resources
LGBTQ+ Healthcare Directory
Vitalyst Health Foundation
Mental health resources:
Crisis & Suicide Prevention
- 988 Suicide & Crisis Lifeline — Call or text 988, available 24/7. LGBTQ+ individuals can still call 988 and receive caring, confidential support, though the specialized "Press 3" option is no longer available. EveryMind
- The Trevor Project (LGBTQ+ youth ages 24 and under) — TrevorLifeline: 1-866-488-7386 (24/7) | TrevorText: Text START to 678-678 (24/7) | TrevorChat available at thetrevorproject.org/get-help AFSP
- Trans Lifeline (by and for trans people) — 1-877-565-8860 (US), available 24/7 AFSP
- Crisis Text Line — Text HOME to 741741, available 24/7 Human Rights Campaign
- RAINN National Sexual Assault ...
And I think that's such a core thing is that people should be a part of the decisions that are being made about them. And there's this phrase from the disability justice movement that says nothing about us without us. And I think that's so powerful. Where absolutely, if it's about queer people, queer people should be at the table making those decisions.
SPEAKER_00Exactly.
SPEAKER_02And we just don't see that reflected, right? And the decisions that are being made in the state legislature or in the federal government. Queer people are not being considered and it's apparent.
SPEAKER_00And here we are today.
SPEAKER_02Exactly. Here we are today. Exactly.
SPEAKER_00Yeah. Hello and welcome to the Lavender Lounge. Today I am with Dr. Kyle Grezens. We're so happy to have you on the podcast today. How are you doing?
SPEAKER_02I'm doing great. Great to be here. Thank you.
SPEAKER_00So you come from a background in researching queer healthcare in rural spaces. So I am super excited to learn about that today and all of the amazing work that you're doing and helping the community with.
SPEAKER_02Thanks so much for having me. It's great to be here. As you mentioned, I study queer rural healthcare, which is a part of healthcare that I thought would be really interesting to explore for a few reasons. And so when I started out in public health about gosh, eight plus years ago, we were really pushed toward finding a health condition that we wanted to learn more about and how we could prevent that in the community. And so I thought to myself, hmm, I don't know if that's really how I'm want to approach this topic. And so a lot of times with queer health, we look at things like HIV prevention and other sexually transmitted infections, or we look at mental health. And I think those are really important outcomes that we need to look at. But I was interested more in the policy of how do institutions affect people's health and their access to health services. And so that's kind of what led me down this path of studying this population.
SPEAKER_00That is really cool. And I think that's an angle that honestly I haven't really heard that much about. So when you say policy, and do you mean the more big picture stuff, like all these processes and the systems that guide all of the research that we see in like academic spaces? Or do you want to expand a little on that?
SPEAKER_02Yeah, for sure. That's a great question. And so I see it both as big P policy. So this is stuff that's happening coming out of Washington, DC and state legislatures that is affecting the lives of queer and trans people all across the United States, but also that little pea policy, too, which is happening within healthcare institutions. And so it's not always just that there are policies coming out of the federal government or state governments that are affecting people's health and healthcare access, but it's also what those institutions are doing who are delivering that. This varies, though, of course, across geography. So we see now, I think, in a very interesting time when there's a large national debate about healthcare, especially around queer and trans healthcare happening. You know, we just recently had the Supreme Court decision on trans affirming healthcare. And there's this ongoing debate about how will health systems implement this guidance from the Supreme Court, and if they're truly leaving it up to the states as they say they want to do, what does that look like? And we've seen where large hospital systems have changed their policies of how they're caring for queer and trans people.
SPEAKER_00Wow. Even though if that doesn't align with the current research and what doctors are saying about that, is that correct?
SPEAKER_02Yeah, absolutely. And I think it's also interesting to study this area of health policy and trying to understand what are all those sort of barriers and facilitators for healthcare for different populations, because these institutions have also played a role throughout history in shaping whether or not people are pathologized by these institutions. And so a little fun history fact here. So when the New England Journal of Medicine was first established around 200 years ago, they started out very in pathologizing queer and trans people way back then, even. And this was something that persisted up until maybe about 20 years ago or so.
SPEAKER_00Oh wow, that's really recent. Yes, very recent.
SPEAKER_02And a lot of this stuff is very recently changed. And so, you know, you had where homosexuality was by the medical establishment viewed as a mental health condition that can be treated. And we've seen the effects of things like conversion therapy, which is harmful and doesn't, you know, you can't change that part of who you are, right? And so I think in many ways, healthcare institutions are a reflection of the broader society that really prioritizes heterosexual people or for queer people.
SPEAKER_00That makes me think of when people say, oh, the gay agenda. Yeah, right. Because you are a researcher in this space who is wanting to promote uh better health equity for the queer community. And we're seeing the impacts of the current policy changes in clinics. So, for example, I'm from the sexual health care space and we're seeing uh cuts in funding at a national level. For the work that you're doing, are you trying to educate about the importance of resource access for people in queer communities? So when you were using the word pathologize, I would love to hear what your definition of that is in like a healthcare setting.
SPEAKER_02I think in the context of research and also the delivery of healthcare services, the way that providers treat patients, right, there's interpersonal prejudice that people may have as providers based on the backgrounds that they have. And there's also those institutional prejudices. And so hospital systems or other healthcare facilities may have policies in place that are maybe preventing same gender couples from receiving reproductive care, for example. There could be gender-affirming care restrictions in some facilities. And what's interesting is that when we look at there's these four domains of healthcare that I'm particularly interested in, which is healthcare access, which is whether or not you can actually go to a doctor when you need to. There's healthcare utilization, which is your ability to access different types of services and how frequently you're able to go. And so, you know, for chronic conditions like diabetes management, you might have to go more frequently, versus if you get an injury or the common cold, maybe you go once and you don't have to go again. And the other two things that are really important to understand are facilitators and barriers. And so, in the context of queer rural people, there are these really pronounced barriers of distance. And so we see this in rural communities, and obviously this varies by region, where in some parts of the United States there's greater distances. So, for example, in the western United States, where there's just larger land masses between towns and cities, that plays a key role in whether or not someone can go to the doctor. If you have to drive an hour, two hours, three hours just to go for a checkup, that's a really big barrier that also has a cost associated with it. Because unfortunately, gasoline's not free. And so you if you got to fuel up your car just to go to the doctor. And the other key part there when we talk about facilitators is usually driven by resources in the terms of both income that people have, so having money to afford co-pays to go to the doctor, and also health insurance is another really big facilitator. And so in the United States context, often this is tied to our employment. And so for people who are living in rural communities where their employment maybe they're self-employed, they may not have health insurance. And so that really makes a really tricky situation to go to the doctor for a simple cold.
SPEAKER_00And anyone listening to this, I've had personal experience with that. I know a lot of people that I know have had personal experience. And then this is just kind of the reality that we're living in in healthcare in America, is that we have all these barriers. So I can't even imagine also living in a rural area of how much more that would impact your ability to get care. So with rural healthcare, people are geographically isolated, right? And which is a huge impact on their ability to get health care. But do you feel like we see reflections of these rural healthcare situations, even in areas where there is a lot of hospitals and there is so, what are the intersections with all those factors? I know there's a lot of them, but how do you kind of break those down in your research?
SPEAKER_02That's a great question. That has a lot to do with a concept in public health called structural urbanism. And so structural urbanism is this idea that we have provided provision of health care where there's the greatest profit motive. Unfortunately, sometimes with that is the case where if people don't have those other resources, I was talking about health insurance, right? That's a big one. Just because you live in an urban area doesn't mean you necessarily have health insurance. The other key facilitator, again, is your income. Are you able to afford to go to the doctor? And what's interesting with the rural and urban comparison for health services is that people who live in urban areas may have greater proximity to healthcare facilities and clinics. That being said, so does everybody else. So if you have a population, say, of two million people living in an urban area and there's three hospitals, well, there's many people who are going to come to those hospital doors. And so you will find that there's almost a greater competition, right? To access those services. And the people who are able to pay for the services are the ones who are going to receive them. And I think a lot of this is a reflection of these core social structures in our society that shapes that, right? We live in a capitalist society, and that plays a big role in everything to do with our healthcare system because it prioritizes profit over equitable care.
SPEAKER_00Right. And that is sad. Yes.
SPEAKER_02Let's just call it what it is. That is tragic. Yes.
SPEAKER_00If only we would care more about the people getting the care. Because, you know, when you think about it, I think it's crazy that this is still a controversial issue because healthcare is the same as access to water or food. It's something that is vital to your life and being able to have a life. And what I'm hearing from you is that there's also this added complexity with access to care for the queer community because of their identity. And I was wondering if you could talk about that relationship some more of this need to access vital resources, but then also having that barrier of one's identity. Do you have any personal experience with that or have you observed that in the systems that you work in?
SPEAKER_02Yeah, absolutely. I think that on a personal level, and this is really kind of what led me down this path of inquiry was going to the doctor as a young 20-something and wanting to understand what my options were for HIV prevention. You know, going to the family clinic, I didn't know if I could talk to that person about HIV prevention. That really shaped me and my health because I was afraid to talk about what my health needs were. And so I think that when we think about social identity in the context of institutions, those identities are in relationship to other identities in society. Yes. They're also in relationship to the institution themselves, and those are in relationship to history. And so I consider myself a queer theorist. And so looking at this problem through a queer theory lens, I think is helpful because we're able to challenge the status quo with queer theory, look at non-normative structures to understand wait, maybe the way that that functions isn't working, it's actually reproducing inequality in people.
SPEAKER_00When you say queer theory, what is that lens? I know it's a very broad question that's tied to a lot of you know historical context. Yes. But for example, in the queer community, like we can't help using that lens, right? Because of our own personal experience. But for other people that might not identify with that, can you just break down what that is?
SPEAKER_02Queer theory, I conceptualize as a very powerful analytical tool to understand how social hierarchy manifests in society. Okay. And so when we think about being queer, there's, I mean, it's such a core thing, right? Of like this is just about who you love, who you want to have sex with.
SPEAKER_01Yeah.
SPEAKER_02And something that pretty much everybody does, right? So it's something that's so fundamentally a part of who we are as humans. But what queer theory does is shows us because we've had to live on the margins, we have had to shrink ourselves, change who we are throughout the life course. It gives us a different understanding of what a normative life looks like. So when we think about the American dream, for example, and sort of what that means, right? Typically, what you're probably going to think about is, you know, the white picket fence, the 2.5 kids, the golden retriever, and it's probably a mom and a dad, right? And so that right there is a good example of how we reinforce what a normative life looks like. And there's a term for this cultural hegemony. Yep. And that means basically that this is what is normal and this is what everyone is expected to do in society. And so when we say, well, that's normal, that's how it's supposed to function, no, actually it's not, right? That there's other experiences that are outside of what's considered quote unquote normal. And those are things for us to explore, understand, and figure out how does it all just fit together? Because at the end of the day, it really doesn't matter if somebody has a mom, dad, 2.5 kids, a golden retriever, or it's a dad and a dad, 2.5 kids, right? It doesn't matter. And so it's this thing that's artificially imposed on us as a society, and it's dangerous.
SPEAKER_00I think that's so key that what you just said, it is artificial. The nuclear family structure, it's not supported by objectivity and data that that is what is the healthiest situation for all people.
SPEAKER_01Right.
SPEAKER_00And I think especially right now in our year 2025, we're seeing this pressure that this is what is healthy and normal when this box that is being imposed onto people is not what is healthy and normal for most people. Right. It doesn't reflect the society that we live in.
SPEAKER_02Absolutely.
SPEAKER_00So I think that's really interesting how we have these institutions, but they don't actually represent the people that they study, which is why you're studying them, right?
SPEAKER_02Exactly, right, exactly. Yes, that's exactly what led me here is wanting to know how do we disentangle these really complicated ideas and concepts around who we are, just as such a human level of like love and sex. Like, I mean, it's one of the building blocks, I feel like, of civilization is love and sex. You know, so it's like if we can understand all the depth and breadth of what that could possibly be, you know, I intentionally use the term queer in my research. And there's all different ways that people talk about this population. And so, you know, people will say LGBTQ, people will say sexual minority, there's all these different terms that we use. And I like using the term queer because I think it represents pushing the margin even further, right? That there's all these things that we understand about sexuality and gender is always changing. It's something that isn't static. And so the way that we talk about homosexuality today is different from how society talked about it 20 years ago, 50 years ago, 100 years ago. And so I like the term queer to kind of keep our eye on that moving target that this is always in flux, it's always changing, and our understanding of it changes. I mean, there's terms that I've learned in my lifetime that nobody was using 50 years ago. And that's one of the great things is that sexuality and gender is really kind of this infinite institution that is always gonna change along with other structures in society.
SPEAKER_00And that sounds beautiful. The way you describe that as beautiful. Do you feel like this whole spectrum, this whole unknown about because you know, sexuality it really is human identity, right? Which there's a lot of fear and a lot of repression.
SPEAKER_01Yeah.
SPEAKER_00And do you feel like that maybe has relation to what we're seeing right now, where people have this reaction of like, oh, let's be afraid and let's repress that part of ourselves because it's so vast and infinite. Do you feel like that's resonant with what's going on?
SPEAKER_02Yeah, I think that people are uncomfortable with maybe their own sexualities because there's these forces in society, this sort of domination that we have because of cis heteropatriarchy. Oh wow. That's a big word. Yeah, the$5 word thrown out there.
SPEAKER_00So we have patriarchy.
SPEAKER_02Yeah, so we have cis heteropatriarchy, which it reinforces those things we were talking about a moment ago with the cultural hegemony of the 2.5 kids, the man and the woman, the dog, the white picket fence. And so I think that people are because those forces are so strong, right? Like there's such a societal pressure that you're supposed to fit into that and to step outside of those forces of domination can be very scary for people, especially depending on where they are.
SPEAKER_00Because they're systems of control, exactly, right? They're ways of enforcing control, right? Because when a again, correct me if I'm wrong, but I believe historically when societies are more uniform and that term cultural hegemony, hegemony, thank you, that makes a population easier to control, right?
SPEAKER_02Right. Another core part of my work is so we have examining capitalism because of living in a capitalist society, a for-profit healthcare system. There's then on this idea of control, there's these two other core social structures of colonialism, which is the way that we understand borders and land. And then there's also imperialism, which is the way that policy is made to enforce control of those borders in that land. And we see that now, where the current administration is using a militarized police force essentially to harm certain members of the population, right? So I think control over our bodies is a really important part of capitalism, imperialism, and colonialism. And with that, a part of our bodies is our health. And so I think it becomes the perfect lens to understand control over bodies and how that can take the form of both military force, it can take the form of policy making. And I saw a statistic where last year there was 112 legislative legislation put forward across the United States that was anti-LGBTQ healthcare specific. So they're being very productive. I'm sure it's even higher now this year than it was last year. So it's this national debate about who can have healthcare and who can't, what type of healthcare they can have. And I think that that then becomes reflected in other parts of society. So as it becomes normalized, that people say, well, if there's, you know, say a change of like how people feel about trans people, for example, right? There's a concerted effort to further marginalize trans people more than they already are by certain people in Washington and across the United States. You know, we hear this rhetoric around how they're dangerous and they can't be in sports with people, right? And it's like just this outrageous stuff that they're saying.
SPEAKER_00About a minority, right? A minority that is what less than, especially for trans people in sports, like what is it, less than two percent? Yes, one percent of the population.
SPEAKER_02Yeah, it's crazy. They're making it sound like there's just this dangerous group of people that many trans people, none of whom are dangerous, right? And it's just like it's so outrageous. But what that does is that it changes people's mental models of how they feel about that population, because being one to two percent of the population, it could be the case that people may never meet a trans person, depending on where they are, who they are, what kind of social circles they're in, or they may never meet an out trans person at the very least, because people may be afraid to be out. But what happens when there's those changes in mental models, it results in people then embracing that. And maybe someone's doctor is a doctor, and they embrace those beliefs, and then that further causes harm and makes it so that trans folks can't access healthcare.
SPEAKER_00Yeah. So by mental models, you mean this stigma that people have towards each other. And that's honestly really the goal of what I really hope this podcast does, and at least maybe one way, or in a small way, is because I feel like when you truly talk to someone just as a person, just like as a human being, it often makes you really question your. Own ideas and perceptions of the world. Even you talking to me right now about rural healthcare in the queer community, you know, an area that I don't know a lot about, that's making me think a lot about everything going on and just like how we can better represent and be there for the community. So a lot of the people that are pushing this hatred and disproportionate fear of a small group of people, oftentimes they haven't even met or spoken with these people that they're talking about. And I saw this video, it was this news article the other day, which was a very anti-LGBTQ man apologizing to the community because he actually spoke to one of the people that were on the other side. And it suddenly made him realize like, hey, these are people just like me. Like these are people that are just advocating for affordable health care. And you know, like I think it's really interesting with all the issues that we're facing. Like, if you really look at it, we are all kind of wanting the same things, like whether on the left or the right. And again, on this podcast, we try to just bring you the most objective knowledge and have you make your own decisions. But whether you identify it on the left or the right, we all agree that we need affordable health care.
SPEAKER_02Right. Absolutely.
SPEAKER_00Like who can argue with that? Affordable health care, clean air, clean water, these are all things that are essential to being alive. So why would we be against our own health and life?
SPEAKER_02Right. It doesn't make any sense. And no, I think what's interesting is that you have a vocal minority of people which are pushing a narrative that queer people and trans people are dangerous when they're not, and that they're trying to dehumanize this population in order to achieve their political objectives. And there's a really interesting organization here in Arizona called the Center for the Future of Arizona, and they do all this wonderful public opinion polling to really understand where is their consensus among people across different political beliefs. And what they find is exactly what you just said that there is a high level of consensus that everybody wants healthcare for themselves and for others. And so there are ways that people agree on many, many issues, and some of these other issues that it would seem like people don't agree on, but there really isn't a whole lot of division there. It's just division that's pushed by a very loud group of people that have political objectives. And so most everyday folks that you encounter, though, view healthcare positively for everybody, including queer people.
SPEAKER_00Right. And maybe more on the darker side, maybe another layer of this issue is that we might all want healthcare and a high quality of life, but there's people that might only want that for themselves and people that are like them, even though there's resources available for everyone to have that. They want it only for themselves, but not for others. Right. Right. Maybe we have to also acknowledge that, you know?
SPEAKER_02Yeah. A lot of that I think is so core to this system in which we're almost in competition for resources always, right? That there's this artificial scarcity around resources because they say they can't build enough healthcare facilities, however, they have money for other things like militarizing the police, you know, and so there's ways in which I think policymaking could be used to provide more health services so people aren't in competition. So I understand that if someone goes to a hospital and they see a big line of people, and it's people that don't look like them, people who are different from them, they may think to themselves, well, all these people are taking up my slice of the health care. But if there was an abundance of healthcare and not so limited in terms of like even in the urban areas, right? Like there's only so many doctors, there's only so many nurses to care for a growing population. So if people are not in competition, I think a lot of that would change.
SPEAKER_00Yeah, absolutely. To circle back around to rural healthcare, would you say that healthcare access, based on everything that we just talked about, do you think this has been used as a tool for oppression and colonialism?
SPEAKER_02Yes, absolutely. And I think what's interesting in the context of rural healthcare is that we see the effects of colonialism that persist to this day. So when we look at rural parts of the state of Arizona, for example, this is where a lot of Native American communities live, right? Some of our largest Native American communities are in rural areas where they have the least access to resources, including healthcare infrastructure. So I think it certainly is reflective of the colonial past and present of the United States. And it's something that until there's major changes in the way that we think about land and the distribution of resources across land, I think uh definitely persists.
SPEAKER_00And even though the rural areas throughout the United States have a lot less access to hospitals, clinics, providers, they have the majority of the burden of disease. Right. Is that right? Yes. Can you explain why that is?
SPEAKER_02I think a lot of it would have to do with those financial factors. And so people who live in rural communities typically have lower levels of educational attainment. They typically have lower income levels and lower rates of health insurance. And so those are really the key facilitators in any context of healthcare that's gonna make it so whether or not you can access services or not. And so because people are not able to access services due to those barriers, it creates where there's a higher likelihood of chronic disease, oftentimes in rural areas too, which is distinct, is that there's more distance between everything, not just between where you live and where your doctor is. And this creates where we're a really car-centered society in the United States, especially in rural areas. It's really the only way to get around, oftentimes. And so things like motor vehicle accidents are higher in rural areas as well, because there's just more of a chance that you would be driving a longer distance.
SPEAKER_00And I did not know that. Yeah, you would think it wouldn't, you would think of even more urban areas, right?
SPEAKER_02Yes.
SPEAKER_00That is really interesting.
SPEAKER_02Yeah, so I think it's it's those factors of that there's these financial factors that prevent people from accessing health services. There's obviously the geographic distance between accessing health services and where you live, and then there's those other factors like being more car-centered, so there's more motor vehicle accidents. People in rural areas also typically will work in professions that maybe are a little more dangerous. So working like in farming or ranching, where you may be run over by a tractor, right? So those kind of effects definitely have an effect on our health. And the last thing I would say is that in terms of resources, it's not just that there's limited healthcare provision in rural areas, that there's also limited access to food. And so when you drive into a rural area and you see that there's a dollar general, well, where's the safeway? Where's a grocery store that has fresh food? And that plays a big role. And so if people don't have access to healthy food, we know that there's a strong association with uh increased chronic disease.
SPEAKER_00Yeah, that's a huge factor. And we even see those food deserts in urban areas, right? So it seems like it's a widespread problem wherever you are. Right.
SPEAKER_02And a lot of this comes down to resources, right? So if there are, I guess they're artificially uh limited, right? That there's so much wealth in the United States, and sometimes that wealth doesn't always find its way to the population in a way that's going to create thriving. So if we don't have grocery stores in urban or rural areas, or we don't have hospitals in rural rural or urban areas, it really just makes it so people can't flourish.
SPEAKER_00In your expertise, and you're soon to be a PhD, that's or you are a PhD candidate, so it's very exciting. So in your expertise, would you say it's impossible to examine health care critically without looking at all of these layers of like cultural hegemony, all these societal, because it seems like when you really, you know, you're you're very eloquent and you have all these terminology, and it seems like you really see everything as this interconnected web with healthcare in there, but it's always, I feel like in your mind, connected to all these other issues. So you would you say it's impossible to examine it without also going into all these complicated issues, right?
SPEAKER_02Yeah, I think it is very complicated to break it out from those. And I think the reason why is because those structures are so core to every aspect of society. No matter the institution, I think you could take the same approach and replicate it. And people do, right? This is work that's rooted in social conflict theory, and that is the predominant sociological theory for understanding inequality in society. And so at the core of it, the way in which resources have been distributed across society, across individuals, across institutions inherently creates a hierarchy. Those with greater number of resources have greater outcomes in life, and those with fewer resources have worse outcomes. And so you could look at that in the context of education and the students who have greater access to resources, the schools that are more well resourced, we see higher levels of academic achievement. And that then translates into whether or not a student will go into post-secondary education. So that relates to educational attainment, and your income level is also positively correlated with higher levels of educational attainment. So I think you could really replicate this across any institution and across any outcome and would see the same thing. So that's why I think it's so important to look at this through the lens of how resources are allocated and why. And a lot of that I think has to do with how we understand our relationship to the land and how we understand other people's relationship to the land and creating borders around certain areas of land and using military and other policy making to determine who gets to be in that land and who doesn't.
SPEAKER_00Yeah, I feel like that is really key. And just to what you said before, this really does create the system of competition, right? Where it's only this meritocracy where it's like, it's not a question of you should have healthcare. It's oh, do you deserve healthcare? Yes. You know, based on some very small, narrow boxes of if you fit into those boxes and those definitions, because yeah, it's like we have the resources available. It's like it's just a meritocracy the way we the way everything works. And it's like we all operate in this meritocracy where it's like even we're all biased in that sense where there's that constant pressure of just like having to compete for being able to pay rent, being able to afford groceries, you know. And it's like, I mean, from my perspective, I don't really believe in like there's good people and bad people. I just feel like we are all products of our environment, right?
SPEAKER_01Right.
SPEAKER_00And like we can make decisions and transform these environments. But at the end of the day, we're really bound to if we can eat or drink or you know, get care. So there's a lot. There's a lot going on.
SPEAKER_02Yes, there's so much going on. And I think that I think of all these great unknowns in our world. And so there's a great unknown about the ocean, right? There's so much stuff in the ocean that we don't even know that's in there. And oceanographers are doing amazing research to figure out what is in the ocean, and we have people who are exploring space, right? There's this vast solar system that we're a part of, and we have astronauts who are figuring that out. And another great unknown is our social world. And part of that is something I said earlier around how these things are changing. These are not static understandings or static experiences of gender or sexuality or race, ethnicity, right? You could really look at any of these things, and it changes throughout history because of our relationships to each other, our relationships to institutions, and our relationship to history itself. And so, as there's what, eight plus billion people, I don't know what number we're at now. There's a lot of people on this planet. And so, across all of our societies around the globe, there's really an infinite number of experiences that people could have in the social world because there's different cultural understandings of gender and sexuality, for example. Right. And so what we may understand about gender and sexuality in the context of the United States is very different from how they understand it in parts of Asia or parts of Africa or parts of Europe, right? So that place and space plays such a big role in shaping who we are and how we then interface with people around us and society more broadly.
SPEAKER_00That is also beautiful. Thank you. Because honestly, when you say that there's so many infinite possibilities and infinite relationships that we have with the world and with each other, I feel like, especially right now when a lot of people are feeling, you know, despair or hopelessness, right? Things can change. Absolutely. You know, because I feel like the only constant in the universe, honestly, is that things will change and things are changing and things will not be staying the same because it's impossible, you know, because time and space and you know, just all that fun stuff.
SPEAKER_02And I think that we can learn a lot from how things have changed. And that's why I find myself using queer theory as a lens to understand our current situation in healthcare because it's been able to be used to understand other things that have happened throughout history. So thinking about, say, for example, the HIV epidemic of the 80s, when you had really a lot of queer organizing for liberation in the urban cores of New York, Chicago, San Francisco. And this really created a movement for people who were feeling like the government was failing them.
SPEAKER_01Yeah.
SPEAKER_02There was this reluctance at best by the government to talk about what was happening with HIV in the 80s. People were afraid of touching HIV patients, right? There was so much stigma around what they called a gay disease, a gay cancer. Which it's not. Right, exactly. It's not right in the gay community. Exactly. It affects us all. Yeah. And it's through that that there was these organizations like Act Up who started raising awareness that the government is not supporting queer people as they're being disproportionately affected by this virus. And so sending a strong message to lawmakers and to also the American public, changing those mental models that people have about what this quote unquote gay disease really is. And then when people found out, wait a minute, this doesn't just affect gay people, this affects anybody. And that really had a tremendous effect on how people then view HIV. Now, things could still have a long way to go still when it comes to HIV. There's still a lot of stigma there. But I think we've made leaps and bounds since the 80s, right? So I think there's a lot of optimism in seeing that kind of change just happened in the space of HIV.
SPEAKER_01Yeah.
SPEAKER_02And, you know, there's other social movements that then were born out of the HIV epidemic. And so when you had ACT Up, they didn't just stop there. They also were calling attention to the way in which the police were treating LGBTQ people. Yeah. They're calling attention to how LGBTQ people couldn't serve in the military. It called attention to really, again, looking at all these institutions across society and how people were able to interface with it or not. And so I think that it can be a really powerful thing when we have these movements arise out of bad situations, right?
SPEAKER_00And we're seeing that now. Right. People are organizing, people are getting together, you know, to fight for our identities and our freedom.
SPEAKER_02Absolutely. And I think that's really a core of what we need more now than ever is unity. We need community with people. And when people come together, we're really strong together, you know? Yeah. And we live in individualistic society. Through that, there's isolationism that occurs. And when people are more disconnected from others, well, A, it has an effect on their health.
SPEAKER_01Yeah.
SPEAKER_02And B, it also has an effect on our society. So if people are not coming together for a common cause, it really can have the opposite effect, right? If people are not connected, they they find themselves terrorism like that. Yeah, lost.
SPEAKER_00Lost adrift at sea, you know, which is not fun.
SPEAKER_02No, not at all. And through this work, I also wanted to make sure that people see that the limitations that queer people face for healthcare in rural areas isn't just a dumb problem. It's an all of us problem because it's looking at what are those barriers, facilitators that people experience to access healthcare. And those are things that are present, like we've talked about today. They're present in urban areas, and they're also present for people that are maybe living in a rural community, but they're not queer, right? And so I have three comparison groups in my research. And so there's rural people who are not queer, there's rural people who are queer, and there is queer people who live in urban areas.
SPEAKER_01Okay.
SPEAKER_02And so the reason I compare across these three is that then we can see that there are these same barriers that exist for people, no matter where they are or who they are. So for example, in rural communities, lack of transportation to access healthcare affects everybody. Yeah. And it's more pronounced among queer people because when we look at the urban population for queer people, they also have challenges around access and utilization that their heterosexual counterparts do not have in urban areas. Yeah. So it's kind of a way of understanding how do these factors compound and intersect with each other in a way that produces distinct outcomes in the population. But really, it's calling attention to things that are affecting people no matter who they are or where they live.
SPEAKER_00I feel like that's a big deal. You know, like, yeah, these things affect us no matter who we are or where we live.
SPEAKER_01Yeah.
SPEAKER_00Right. So it's like that connection, I feel like, where I haven't really grown up in a rural area, but it's like, wow, the things that I experience with healthcare, they're probably also experiencing in a very similar way, but with the added geography distance, right?
SPEAKER_02Yeah. And a key takeaway is that healthcare disparities are not accidents.
SPEAKER_01Yeah.
SPEAKER_02They are a product of systemic forces. And so those are forces that, you know, people contain multitudes. They have many aspects of who they are.
SPEAKER_00Yeah.
SPEAKER_02So in my research, I control for all those factors. And so things like socioeconomic status, things like race and ethnicity, immigration status obviously plays a big role too, especially in the current climate. That really shapes people's experiences and institutions, their sexuality, their gender. But even there's some really interesting research that's been done for how people who are more queer presenting, I guess you could say, people who are challenging gender expression maybe in different ways, they experience worse health outcomes than people who are more normative. So if someone walks into a clinic, for example, and they're a man who has a more feminine gender expression, they're more likely to receive worse care and have worse health outcomes, right? And that's supported by research that's been done on this, and it's really interesting to think about the role that that plays and how those then effects are more pronounced in certain areas where maybe there's higher levels of stigma or maybe there's different cultural beliefs. And again, this is pronounced in rural areas, but rural areas vary a lot. The question of rurality is a really tricky one, but I think it's interesting in the context of the United States because when we think about what is the United States, right? Like there's always like the Iowa caucus plays such a big role. And so there's these states that for a long time people said they were flyover states, that there was these, you know, lots of rural population there. Yeah. But it's a big part of the United States. Like most of the United States, I think it's like 76% of the United States is considered rural. Now, most of the population doesn't live in a rural area, obviously. Because that's the whole way the urbanization works. And so people live in these urban concentrations. That gives us a lot to work with, though, that there's a ton of the population still that lives in rural areas. And actually, fun fact about when I started doing this research, people were like, do gay people even live in rural areas? Right.
SPEAKER_00And actually, I was wondering about that. Yeah.
SPEAKER_02Great question, right? And so there is actually another interesting concept from queer theory that describes that, and it's called queer metronormativity. So queer metronormativity is this concept that gay people only live in urban areas, right? That that's where they live. But actually, 20% of the LGBTQ plus population in the United States lives in a rural area.
SPEAKER_00What?
SPEAKER_02Yeah. So it's it's it's a significant number. That is, yeah.
SPEAKER_00And I think what would that be 20% would that be? Like how of what number?
SPEAKER_02About three million people.
SPEAKER_00Three million. Wow. Yeah. Okay.
SPEAKER_02Three million people is a lot. That's like the size of a city, you know.
SPEAKER_00And then what is defined as rural? Like what's a rural town? Like how many people would that be?
SPEAKER_02That is a question of a lot of debate. So as I started to disentangle what rural and urban means, uh-huh. Some people in the rural sociology space conceptualize it as a gradient where you have the urban center with the greatest population.
SPEAKER_01Okay.
SPEAKER_02And then there's a gradient that goes out to suburban. And then the further you get away from that urban core, the more rural it becomes. Now, that being said, there's many different definitions. So some government agencies, like the US Census Bureau, uses one definition for understanding rurality. In the context of healthcare, we have government agencies like Health and Human Services that use a different way of understanding rural. So there's really not one way of that there's, you know, if there's 15,000 people in an area, is that a rural town? Maybe. And I say maybe because there could be, for example, a place that has 15,000 people, but 20 minutes down the road, there's a town of 500,000, right?
SPEAKER_01Yeah.
SPEAKER_02So it depends a lot. And so I conceptualize rurality as the greatest distance from the urban core.
SPEAKER_00Okay.
SPEAKER_02So it means different things in the context of regions too. So in the western United States, where we have greater geographic distances from urban cores versus in the northeast, where we have a lot smaller distances, right? Like the states in the northeast themselves are smaller. Versus in the west, states like Texas, California, Arizona are really big states. It takes, you know, 12 plus hours to drive across the state of Arizona versus in Massachusetts. You can probably drive across multiple states in 12 hours. So I think that plays a big role. So regionally, rurality differs. And going back to some of those core concepts of the social structures of colonialism, that is where colonialism began, right? In the United States. And so it's a reflection of the way in which land has changed over time and who is using that land.
SPEAKER_00Do you feel like colonialism has impacted outreach efforts to rural areas?
SPEAKER_02Yeah, I think so. I think that colonialism has really shaped everything that's happening in the United States, right?
SPEAKER_00Definitely, yeah.
SPEAKER_02Yes. And, you know, in terms of outreach, yeah, we see where the parts of the population that have some of the most pronounced health outcomes that are negative are Native Americans. And a lot of that is through colonial practices, right? Where there's a course that I've taught and it explores the colonialism of health. And one key part of it is that there was obviously violence, which is one of our public health measures, but there's also the spread of infectious disease that occurred during colonization that had a tremendous effect on the indigenous population. And that resulted in both widespread loss of life, lots of highly rates of mortality, but it also had effects on food systems. So when there was parts of the population dying off because of infectious diseases that were new pathogens that were being brought by settlers, then there was people who were in charge of the crops who died in the process. And so now the population can't eat, right? Those are things that are reflected in our contemporary society as well. Where, and we see examples of this, right? During the COVID-19 pandemic, there was those rural communities and Native American communities had a very different response to the pandemic relative to urban areas. And a lot of it was because there was limited resources. So getting PPE out to Native American communities was really tricky. And so they used other mitigation efforts to try to prevent the spread of the virus. So having stricter quarantine or stricter regulations around movement, which kind of goes along with uh colonialism, right? That there's restrictions around who can move and a lot of it has to do with resources.
SPEAKER_00Yeah, or not wanting to take the vaccine. Right.
SPEAKER_02Yep.
SPEAKER_01Absolutely.
SPEAKER_00Which, when you look at all the things that you just mentioned, you know, it makes sense why you would mistrust the government and someone that's saying from a different state, different very far away from you, it's like, hey, take this. Yeah. Because why would you trust that?
SPEAKER_02That's a good point that you bring up. I uh was a part of a project called the Arizona Youth Identity Project. This was during 2020, so lots of stuff to uncover. And it was trying to understand how young people felt about society. And so that was people from the ages of 18 to 26, and they were interviewed on a variety of topics, some of which included the COVID-19 pandemic. And out of that, we were able to publish numerous articles that were exploring themes around vaccine hesitancy or acceptability or refusal. And what we found in our research was that there was a distrust of government because of these long-standing reasons that I think are, you know, in many ways justified. Yeah, that makes sense. Yeah, right. That you know, people say, for example, in Native American communities, felt distrust because generally speaking, these institutions hadn't looked out for Native American communities. They've been kind of left to fend for themselves in many ways. But even more so is that there's been active harm done. So one example of that is the Havasupai people. They had an experiment conducted by some researchers at one of our state institutions that they collected blood samples from without their consent of what they were going to do with the blood samples. And for that tribe, blood is a sacred thing to them. And so it was it was a betrayal, and then that shaped how that community felt about medical researchers. And while the medical researchers had the best of intentions to try to study why there was higher prevalence of certain diseases in this community, they did it in a way that didn't involve the community as equal decision makers and what they would do to achieve their health.
SPEAKER_00Nothing about us without us. That's a really good one. In your research, what would you say are some successful models of community interventions for healthcare, specifically for rural healthcare?
SPEAKER_02Great question. So there is a study I was a part of through the ASU Global Center for Applied Health Research called Parenting in Two Worlds.
SPEAKER_01Okay.
SPEAKER_02And this is an intervention study designed to help parents who are Native American navigate complex topics with their children. One of the studies we did was on sexual health among Native American teens. And so across Arizona, many Native American communities have higher rates of teenage pregnancy and they also have higher rates of sexually transmitted infections. And so understanding that the importance of parents being a part of their child's health and talking to them about it, how do you blend those elements of living in two worlds, really, right? So there's the indigenous knowledge that people have that's really important. The ways in which Native American people think about family are really important. So we wanted to make sure that the intervention we were designing was something that A would actually be implemented and B would be effective. So we worked with the community to develop that intervention. And so working with the Phoenix Indian Center, we developed a program where parents would come in to learn different strategies of how do you talk to your teenage daughter about preventing pregnancy, for example. And how do you do it in a way that's culturally responsive? And for Native American people, welcoming a baby into the world is a wonderful thing. And so making sure that we're keeping that in mind when we're, you know, maybe we're not going to say like, well, there's always abortion or something, right? So, so really being culturally responsive and thinking along with the community of what does that intervention look like, what's going to be effective. And we found a lot of success with it, where parents were able to better navigate those conversations with their kids about sexual health. And it saw a decrease in unwanted teenage pregnancies. And also sexually transmitted infections. And so there were outcomes there that really backed up that involving the community, making sure that it's culturally tailored and reflects their beliefs, and it's something that they would actually feel comfortable talking to their kids about, for example.
SPEAKER_00So did you find that there were similar taboos about discussing sexual health or any sort of like shame or embarrassment?
SPEAKER_02Absolutely, yes. And I think that really speaks to the title of the intervention parenting in two worlds, because they really are parenting these two worlds, right? Where there's the traditions that they have as Native American people that are really important and that they live in this contemporary society that has all these pressures for young people to that couldn't make them end up pregnant. So it's a lot of tensions to navigate, and I think it's just as uncomfortable for most people to talk about sex with their parents, but it's really important. And finding a way of doing it that's culturally responsive definitely shows positive results.
SPEAKER_00That's amazing that you were able to successfully implement that because I feel like that's such a complicated thing to help people navigate. Yeah. So kudos to you.
SPEAKER_02Thank you. Yeah. And I a lot of it is a lot of it's thanks to the community for being a part of it and helping guide it. And I think researchers serve as an important catalyst for changing different dynamics in communities. And that can be positive or negative. So as long as you're again going back to nothing about us without us, that really is the way to go to make sure that you're doing right by the community and implementing something that's really going to make a positive impact.
SPEAKER_00Yeah. Representation, right?
SPEAKER_02It does. It matters. Transparency. Yes, absolutely. And I think that's a a lot of what could be done differently in research, whether it's in the context of healthcare or biomedical research, is that transparency, operating within integrity, these are really important things that will go a long way, especially if we're trying to address disparities in communities who have been excluded from these conversations. We have to be open about it, let them into the process. And people don't need to be a researcher to know what their experiences are, right? Exactly. Yeah, people are the best authorities on their experiences out there. So we're just the people who come in and quantify it or qualify it with data. And then hopefully that data translates into something that can be designed as an intervention.
SPEAKER_00That is really cool that you shared that because it makes me feel like it's possible to change those relationships.
SPEAKER_02Yeah.
SPEAKER_00Right. Like there are ways to address these systemic issues that we're seeing.
SPEAKER_02Right.
SPEAKER_00Right. And that gives me a lot of hope. So I know.
SPEAKER_02Yes. I think that we need some good news. You know, there's a lot of things happening every single day, some of which are alarming and hard to grasp how society has been shaped in such a way. But I think we have a wonderful tool to change it, and that's each other. You know, if we rely on each other, create cohesion in our communities, and really work on those issues that are ones we can all agree on. If most people in Arizona believe that healthcare is something that everybody should have, that's what we should focus on, right? Rather than these kind of fringe sort of issues. Yeah, exactly. Right. And so it's like through changing these other outcomes around healthcare, education, our environment, our really justice system, right? The list goes on. Like I think there's a lot of commonality we could come together on. And if we focus on those things, a lot of these sort of divisive issues, people will probably be like, oh, I guess that actually isn't such a big deal after all, you know.
SPEAKER_00Let's calm down.
SPEAKER_02Yeah, exactly. Like, like focus on the big stuff, you know, and and healthcare is such a big thing. It's been a debate for as long as I've been alive in the United States, you know, like the United States has been ongoing. And since the Affordable Care Act, there really hasn't been a whole lot of meaningful healthcare legislation that's come forward. And in many ways, I feel like we've had the opposite happening where there's all these advances that have been rolled back with, you know, the decision over Roe versus Wade. You know, there's trans health being debated at the Supreme Court. I mean, these things are huge, right? That we're not seeing any movement though in the legislature, at least. In the judicial system, it moves a lot, it seems like, but in the legislative system, not as much.
SPEAKER_00On a personal level, I sometimes struggle to find ways to get out there and advocate. Because you know, a lot of the times I feel like we're put in this position of learned helplessness. Right. You know what I mean? Where we're just like, oh my God, there's so much going on that it's so overwhelming. Like you're constantly bombarded by information, but there are practical ways to get out there and create community, right? And seek those connections. So do you have just for anybody listening, like any practical steps that you've taken besides being on a podcast, you know?
SPEAKER_02Some of the most important things are recognizing that you can't do it all. And so focus on where your strengths are, focus on what you really can do well to make a difference. And so for me, I found this voice in research. And I was like, okay, I think there's something here that I can work with. And that has then informed other parts of my life to create community, create cohesion. And so I think that A, finding what you're really good at and running with it is a really good first step. And then I think having conversations with people in your community is really important. Get to know your neighbors, get to know your colleagues, get to know people that you see on a daily basis and build those connections with them.
SPEAKER_01That are not AI. Exactly.
SPEAKER_02Yes, that are not AI. Get to know real people. Yes, exactly. Touch grass, get out there. And like, you know, something that we talked about was this isolationism. And when we talk about health too, there's another epidemic going on right now. It's a loneliness epidemic. And it's just such a sad thing to think about that people are experiencing loneliness when there's so many people on the planet. And so make connections, meet people, do things that will make it so you meet people you wouldn't meet otherwise. We are losing our third spaces in society. There's less places that we can go and make connections, but the ones that we do have, go there. Go to there.
SPEAKER_00Find find where that is.
SPEAKER_02Yes. There's wonderful programs that happen at our public libraries that I think are underutilized. There's places you can meet people at coffee shops and at bars, even. I think that there's ways of building connections really wherever you are. And so find places that you like being. And I think you'll naturally meet people there that think like you do.
SPEAKER_00And if you do that, you know what? That is literally revolutionary behavior. Exactly. Right. Systems of power benefit from us being alone and keeping ourselves isolated. So I guess we're just revolutionaries.
SPEAKER_02That's right. We are. Yeah, exactly. It really is revolutionary to be connected, right? And to find community because when we come together, we're very powerful.
SPEAKER_01Yeah.
SPEAKER_02We're very, very powerful when we come together. I mean, there's millions of people that think this way too. And so I think it's finding those people, building those connections. And I'm interested to see where it goes. And I think that we are in the midst of a cultural revolution. I think things are changing. I think that the last five years, like just using COVID as kind of like a starting point for all these catalytic events that have happened in society. We saw the COVID-19 pandemic, we saw the Black Lives Matter movement that same year, right? Yeah. And since then, especially with the current administration, there's all these other counter movements, and these are things that really inspire a lot of change in society. So I think that it's happening right before our very eyes. And these things take time, you know? It's like there's not been any sort of cultural revolution that's occurred overnight. And so throughout history, we've seen it change many, many times. And I think we're all a part of that change.
SPEAKER_00Yeah. And that always is so inspiring because I feel like we're just so resilient.
SPEAKER_02Yes.
SPEAKER_00You know, and it's like sometimes it doesn't feel that way, obviously. But I feel like just from how far society has come, we truly are resilient. Like we found these ways to be resilient in the face of unimaginable horrors.
SPEAKER_02Absolutely.
SPEAKER_00Which is so so good.
SPEAKER_02Yeah, I agree. Yes. And I think I'm glad you brought up resiliency because that's such a protective factor for queer people, both rural and urban, to have the ability, despite the circumstances, despite the structural barriers that exist, people are still able to find health and wellness. They're still able to get by in society. So how do we make sure that everybody doesn't need to rely on resiliency in order to get by? And so I think that addressing these structural factors will really transform people's lives in a positive way. And it makes me feel very optimistic knowing that there's there's changes coming and there's changes happening right now.
SPEAKER_00It's like we can hold the two truths that yes, things are dark right now, but there truly are real reasons to be optimistic. Yeah. And actually have some things to look forward to. And it's I feel like so important to find those things, you know.
SPEAKER_02Yeah. You said something and made me think about how these systems rely on us not doing anything. Exactly. Not making community. And if we're isolated and we're not with people, then we're not talking about these things and we're not like I look, we're on a podcast right now talking about these very topics. And I think that's really important to spread that message and let people know that what their experiences is what other people are experiencing as well.
SPEAKER_00And being able to relate and be like, hey, like I'm also going through that. And you know, I feel like part of fear is also the freeze response, which is what causes inaction. So I don't want us, like by saying this, for anyone to feel bad or guilty of being in a freeze response where you feel like you literally can't do anything, like you can't move. And like, you know, there's resources out there for that. And I'm gonna link these in the description below. So if anyone needs mental health resources or healthcare resources, definitely check those out. I also want to thank the sponsor of this episode, Vitalist Health Foundation. They made all of this possible with their very generous contribution. And finally, Kyle, thank you so much for being here. We really appreciate having you on the Lavender Lounge and just bringing such a wealth of knowledge and expertise. And it really made a beautiful episode. So thank you.
SPEAKER_02Well, thank you for having me. This has been a great experience. It's good to be here and always happy to be a part of these conversations.
SPEAKER_00Yeah. If you want to read Kyle's work directly. I will link the articles to his work below as well. So definitely go check those out. And thank you.