The Map That Was Never Made: What Science Knows About Rural LGBTQ+ Health
Connecting the Dots: Episode 1. Watch here: https://www.youtube.com/watch?v=GeSthD9IlQ0
By Yoyce Geronimo Galvan, M.A. | Held & Seen Coaching
If you are queer and rural, you already know that finding affirming care is hard. What you may not know is that science has been part of the problem.
A 2026 study from Texas A&M University mapped every piece of research done on rural LGBTQ+ health in the United States over the last 24 years. What they found should make all of us angry and all of us paying attention.
Between 2000 and 2024, researchers produced 167 peer-reviewed studies on the health of rural LGBTQ+ people in this country. They screened 13,284 articles to find them, rejecting 98.7% of everything they looked at. During that same period, over 3,000 articles on mental health broadly were published in a single year.
That number, 167, is where this conversation starts.
What 24 Years of Research Actually Produced?
The volume problem
167 studies over 24 years. For context, only 3% of the more than 500 LGBTQ+ projects funded by the National Institutes of Health have focused on rural communities. The federal government's own research infrastructure has been directing resources away from rural LGBTQ+ populations for decades. Not by accident, but by funding priority.
In the early 2000s, the field produced roughly three studies per year on rural LGBTQ+ health. After 2013, that number climbed to an average of twelve, driven largely by expanded federal investment in health equity research and the cultural and legal shifts of that decade. 76% of all 167 studies were published after 2014.
That growth is now being actively reversed. The paper documents that the NIH has terminated over 300 active LGBTQ+ health research awards as of 2025. The studies that were supposed to come next may not get written.
Who the research studied, and who it did not
There is an important distinction that this study surfaces and that I want to name clearly: being included in a study is not the same as being the subject of one.
A study that recruited multiple populations may have included lesbian women in the sample without ever designing questions, methods, or findings around their specific experience. That is the difference between appearing in research built for someone else versus being the reason the research existed at all.
Sexual minority men appeared in 83% of studies and were the exclusive subject of 37% of them. Sexual minority women appeared in 43% of studies but were the exclusive focus of only 6%. For transgender and gender diverse people, older adults, and adolescents, the dedicated research was even thinner.
Being counted is not the same as being seen.
The overrepresentation of sexual minority men is not simply a bias in researchers' preferences. The paper explains the mechanism: online platforms and physical LGBTQ+ organizations that researchers use for recruitment disproportionately serve sexual minority men. Non-urban organizations tailored to sexual minority women and gender minorities are far fewer, which means the recruitment infrastructure does not exist, which means those populations do not get studied, which means the infrastructure never gets built for them. It is a self-reinforcing gap. And it has been running for 24 years.
What the research covered
Nearly half of all 167 studies focused on sexual health, including HIV testing, condom use, PrEP uptake, and STI transmission. The concentration is not arbitrary. HIV/AIDS has a deeply established research infrastructure and federal funding history that shapes what gets studied and where it gets published.
The consequence is a significant gap in what we know about mental health, substance use, chronic disease, aging, and healthcare access for rural LGBTQ+ people. Those are exactly the areas where the research predicts the greatest need. And they are almost entirely unstudied.
The intervention gap
85% of 24 years of research was descriptive. It documented health outcomes, measured disparities, and named problems. Only 15% tested what to do about them.
The field has spent two decades building a monument to a problem and almost no time figuring out how to solve it. The paper calls for research that simultaneously measures what works and tests how to deliver it in real rural contexts. In plain language: it is time to stop documenting that rural LGBTQ+ people are suffering and start testing what actually helps.
What This Means: Four Things to Carry With You
1. Your invisibility in the research is not a reflection of your importance.
The absence of data about rural queer women, rural trans people, rural LGBTQ+ elders and adolescents is a structural failure. It is a product of funding decisions, recruitment infrastructure, and institutional priorities. It is not a statement about your value or the legitimacy of your experience. The research did not skip you because your life does not matter. It skipped you because the system was never built to find you. That belongs to the system, not to you.
2. When you struggle to find care that fits your life, there is a documented structural reason.
You are not asking for too much. The evidence base needed to train providers, justify funding, and build programs that actually work has been systematically underfunded for decades. Your experience of struggling to find affirming care is a policy outcome, not a personal failing. Remember that the next time you wonder if you are the problem.
3. The research funding that built even this limited knowledge base is being cut right now.
The 167 studies that took 24 years to produce were built largely on NIH funding. That funding is now being dismantled. The studies that were supposed to come next, the ones that might have finally looked at rural queer women, trans elders, and LGBTQ+ adolescents with the rigor they deserve, may not get written. This is not background noise. For rural LGBTQ+ communities, paying attention to what is happening to research funding right now is part of taking care of each other.
4. The things that have actually helped were built by people who refused to wait. Peer Peer support. Community health workers. Telehealth programs designed to bridge geographic distance. Faith communities that chose inclusion over tradition. These things exist not because the research caught up first, but because people inside rural LGBTQ+ communities decided that waiting for the data was a luxury they could not afford.
That has always been how marginalized communities survive. Not by waiting for the system to study them into worthiness. By building what they need with what they have.
You have been doing that your whole life. That is not a small thing. That is everything.
Resources for Rural LGBTQ+ People
Crisis and immediate support:
Trevor Project (LGBTQ+ youth): 1-866-488-7386
Trans Lifeline: 877-565-8860
988 Suicide and Crisis Lifeline: call or text 988
Find affirming providers and community:
Held & Seen Coaching: LGBTQ+ affirming support for people navigating identity, relationships, belonging, and self acceptance with greater confidence and authenticity. heldseen.com/lgbtq
CenterLink: directory of LGBTQ+ community centers including rural and smaller-city organizations (lgbtcenters.org)
PFLAG: chapters in smaller communities and rural areas; support for individuals and families (pflag.org)
GLBTQ Legal Advocates and Defenders (GLAD): legal resources for LGBTQ+ people (glad.org)
About This Series
Connecting the Dots takes peer-reviewed research relevant to LGBTQ+ adults, trauma survivors, and family caregivers and translates it into plain language, with the data, the context, and the resources that the research itself rarely provides.
Study referenced: Croan V et al., "A scoping review of the methods, content, and populations of rural LGBTQ health research since the new millennium." Rural and Remote Health 2026; 26: 10258. https://doi.org/10.22605/RRH10258
Yoyce Geronimo Galvan, M.A., is a queer Latina behavioral health strategist and the founder of Held & Seen Coaching. She holds a Master's in Clinical and Counseling Psychology and spent over a decade designing national behavioral health programs for Latine and LGBTQ+ communities. She coaches in English and Spanish.
