Between Policy and Practice: Experiences of LGBTQ+ Service Providers in a Shifting Sociopolitical Climate

Abstract

Abstract While Miami-Dade County (MDC) is home to a large LGBTQ+ population, little is known about what specific services are being delivered to the many different LGBTQ+ communities in MDC (e.g., Immigrant, Spanish, and Haitian-Creole speakers). As part of an initiative to better understand how communities and academic settings can work together to deliver services to marginalized communities, we (the authors) were awarded a grant to improve health outcomes for MDC’s LGBTQ+ population through structural interventions. Due to changes in agency priorities, our grant was disrupted in the second year of our assessment phase. This qualitative study aimed to assess the experiences of those who serve LGBTQ+ communities in MDC, including healthcare providers, community-based organizations, and LGBTQ+ liaisons in local government. We conducted 33 semi-structured interviews and one focus group, for a total of 35 participants. Reflexive thematic analyses revealed seven main themes: (a) impact of the sociopolitical climate, (b) barriers to providing healthcare and social services, (c) staff diversity and cultural competency training needs, (d) cultivating safe spaces, (e) organizational capacity, (f) trust and community engagement, and (g) data acquisition and application in LGBTQ+ healthcare. Participants voiced concerns about the growing disconnect between new restrictive laws and on-the-ground realities. Additionally, participants expressed a strong commitment to LGBTQ+ communities while recognizing a gap between their goals and capacity, constrained by limited resources and systemic barriers. Findings offer practice-informed insights aiming to strengthen the systems that support LGBTQ+ individuals in MDC and call for coordinated, community-informed strategies to foster sustainable change. PUBLIC HEALTH SIGNIFICANCE LGBTQ+ individuals face health disparities shaped by structural, social, and political barriers. Exploring the experiences of those serving LGBTQ+ communities reveals gaps in cultural competence, organizational capacity, and data collection, highlighting the need for inclusive policies and targeted, evidence-informed interventions to advance equitable healthcare access and health equity for LGBTQ+ communities.