To see how far the medical marketing community has come in its efforts to better engage LGBTQIA+ audiences — and how far it still has to go — one only needs to look at its work in the realm of HIV.

In 2004, Gilead Sciences introduced Truvada to the U.S. market and, eight years later, the drug was approved by the Food and Drug Administration for HIV pre-exposure prophylaxis (PrEP). However, it wasn’t until 2016 that Gilead began focusing its marketing attention on social media sites and dating apps — in other words, the places where its targeted patient populations were most likely to be reached.

This isn’t to diminish the company’s efforts, which dovetail with a Department of Health and Human Services push to end the HIV epidemic in the U.S. by 2030. But it shows the challenges the industry continues to face in marketing to LGBTQIA+ individuals. While LGBTQIA+ adults comprise about 8% of the U.S. population, they are far from a monolith. Yet they’re often treated as such.

Todd Sears, CEO of Out Leadership, can offer perspective. He notes that while marketing to LGBTQIA+ audiences even 20 years ago was considered “risky” and “specific,” the paradigm has shifted considerably. More than 20% of Gen Zers, after all, now identify as members of these communities. That presents more opportunities for health and wellness organizations to market their products and services in a way that is inclusive rather than segmented.

Mastercard’s True Name initiative allows transgender and nonbinary customers to choose the name on their credit card, even if the name doesn’t correspond with the one on their driver’s license.

The effort, Sears says, is there. He applauds Mastercard for its 2021 True Name initiative, which allows transgender and nonbinary customers to choose the name engraved on their credit card, even if the name doesn’t correspond with the one on their driver’s license.

“That’s a good example of how companies can create something that’s specific for the community, but then also talk about it in a meaningful way,” Sears notes.

On the other hand, Rivendell Media CEO Todd Evans sees progress in scale and scope. Over the last few years, he has observed a push for mass reach via TV ads, notably for HIV drugs. But while he commends medical brands for understanding the inherent value in big national campaigns, he believes they should give more consideration to independent LGBTQIA+ media.

Evans adds that healthcare marketing is unique, in that it flounders when it fails to speak to the right audience about the right condition or service at the right moment. But the siloed nature of advertising firms and the comparatively insulated nature of LGBTQIA+ communities have limited the pace of change.

There is also an important trust component with LGBTQIA+ audiences, which is too often overlooked. While infection and mortality rates for HIV have decreased significantly over the past few decades — thanks in no small part to preventative drugs such as Truvada — there remains a stigma associated with patients who are HIV-positive.

In particular, communities of color have higher infection rates compared to other groups. That could present brands with a chance to communicate about living with the disease without shame. To that end, organizations such as ViiV Healthcare have established community programs to tackle the issue of HIV stigma.

Such programs are a work in progress, Sears says. “If you look at the medical industry and medical marketers, there’s an opportunity for them to continue to raise issues of importance to the community through their talents.”

While evaluating the current landscape, it’s important to note the success of the social justice movement over the last two decades in securing human rights for the LGBTQIA+ community, including the 2015 Supreme Court ruling that legalized same-sex marriage. Sears attributes such accomplishments in part to the support of businesses that, whether or not they were acting for the “right” reasons, correlated their economic interests with the push for marriage equality.

He notes that seven years ago, nearly 400 companies signed an amicus curiae brief in support of marriage equality. Several prominent healthcare companies, Johnson & Johnson, GlaxoSmithKline and Pfizer among them, were a part of the effort.

At the same time, there are lingering — some might say robust — anti-LGBTQIA+ challenges in numerous state legislatures. This, Sears believes, places the burden on health and wellness companies to push back on behalf of LGBTQIA+ populations.

To quantify how a state’s policies toward LGBTQIA+ individuals affect its economic environment, Out Leadership created the State LGBTQ+ Business Climate Index, which is based on 20 factors and ranked on a scale of 1 to 100 points. By putting numbers to paper and outlining the economic costs of anti-LGBTQIA+ discrimination, Out’s hope is that states will pay far closer attention than they otherwise might.

The reaction of healthcare organizations to the reversal of Roe v. Wade also provides a blueprint for potential corporate accommodations should the U.S. Supreme Court chip away at LGBTQIA+ rights, including the landmark Obergefell v. Hodges ruling that required states to license and recognize same-sex marriage.

In the wake of Dobbs v. Jackson Women’s Health Organization, which overturned Roe, numerous health and wellness companies announced they would cover travel costs for employees seeking access to abortion in states where it remains legal. This is meaningful considering that several other LGBTQIA+-related civil rights landmark cases were predicated on Roe.

Then there are the segments of the community that remain both vulnerable and largely underserved by the medical marketing world. Matthew Griffith, VP of content strategy at Eversana Intouch, points to transgender individuals. They account for roughly 0.6% of the U.S. population, he notes, and are faced with restrictive policies in several states that affect their access to basic healthcare treatment.

Source: Getty Images.

While several marketing efforts have broadly courted the LGBTQIA+ community, there hasn’t been a great deal of success in terms of outreach to transgender patients, according to Griffith. As a result, Eversana Intouch has been pressing its clients to engage with this population directly. Only by discussing what transgender patients expect from their care journeys and mitigating potential roadblocks to positive outcomes can brands build substantial trust with this cohort.

Along those lines, Griffith believes medical marketers must actively promote access to care for transgender patients, noting the host of obstacles that impede reliable physical and mental health treatment. A recent survey conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality found that nearly 30% of transgender individuals have postponed medical care when sick or injured due to disrespect and discrimination by providers.

Eliminating the obstacles facing the trans community is a sensitive and complicated task for medical marketers, clearly. “Just because you’re transgender doesn’t mean your only healthcare concern is hormonal or transition-related,” Griffith stresses.

He notes engagement efforts can go a long way. “The big thing is just getting patients through the door and doing whatever we can do to partner with local advocates or community organizations. We need to listen to patients without expecting them to solve their own problems.”

That this needs stated overtly speaks to the industry’s larger failures to effectively engage with LGBTQIA+ individuals.

“What we have now in our healthcare market is a sort of revelation that, beyond representation, our actual whole healthcare system is based on a myopic view of who our patient is,” Griffith continues. “That falls into a number of categories across race, ethnicity, socioeconomic background and technological access. But among all the groups that we’ve looked at and the subsectors of patient populations, transgender patients are at the heart of what we can see as our ‘highest risk, lowest care’ segment in the market.”

Given this and myriad other factors, it’s easy to point out marketers’ blind spots around LGBTQIA+ populations. However, Evans believes historical context should be a part of all such discussions.

He says that companies, in healthcare and outside it, have come a long way since the HIV/AIDS crisis of the 1980s and 1990s, during which few media companies showed that “they cared or wanted our business.” The bar is considerably higher now: Evans thinks LGBTQIA+ consumers and employees want organizations not only to solicit their business, but also commit to actions that empower them.

The use of more inclusive language and photography in both educational and promotional materials can make a difference. By way of example, Griffith notes that some organizations have updated websites and other promotional materials to ensure that pronouns are not specifically gendered.

“There’s nothing that’s quick in healthcare marketing, but there are some things that can be done to show your outward material is welcoming,” he says. “There’s a lot of opportunity here for pharmaceutical corporations and other healthcare industry companies to make a real dent in the market.”

Indeed, it’s worth noting again that people who identify as LGBTQIA+ take great pride in that identification and in their communities. This phenomenon shouldn’t be lost on marketers.

While Sears believes some of the criticism around “rainbow-washing” during Pride Month — for instance, temporarily making a company’s logo rainbow-colored to show solidarity with LGBTQIA+ audiences — is justified, he suggests a better gauge of a company’s inclusion efforts is its business practices during the other 11 months of the year.

“There’s an economic interest in inclusion and companies realize that,” he explains. “Businesses are going to have to stand up, come together and push back. Ultimately, I believe that progress takes it out of the realms of religion and culture and puts it squarely in the business perspective.”

Even when a company takes heat for rainbow-washing its logo during Pride Month or launches a campaign that misses its target, Evans says that “showing up is a start” and mistakes can provide learning opportunities. 

Meanwhile, as advertising focused on the LGBTQIA+ community continues to extend well beyond Pride Month, LGBTQIA+ media companies will have to adjust to the altered flow of advertising dollars. That should mean a more reliable pipeline of campaigns throughout the year, which bodes well for the stability of LGBTQIA+ media.

“There’s a lot of adjustment happening right now and I think it’s going to work out ultimately to the benefit of both the advertiser and the consumer,” Evans says. “Almost all my clients are looking at a 360-degree approach. It just takes time coming off COVID for all of that to feed into the marketplace.”

Because much LGBTQIA+ media is locally owned and operated by LGBTQIA+ individuals, any campaign that targets the community creates a win-win situation, Evans adds.

“It is a win for the advertiser getting their message out and a win for that media property. But it is also a win for the LGBTQIA+-specific community, since it is our media that unites the community at home.”

Does medical marketing do right by its LGBTQIA+ workers and customers?

For obvious and understandable reasons, the DE&I conversation in corporate America has focused more on race and ethnicity than it has on sexual orientation and gender identification. But too often efforts to diversify workplaces and leadership teams stop short of pushing for more seats at the table for LGBTQIA+ individuals.

There’s work to be done. According to the 2022 Workplace DEI report released by Culture Amp, a significant gap exists between employees who identify as members of the LGBTQIA+ community and those that do not. Indeed, it indicates that sexual orientation is an “important aspect of identity” for workers and that businesses can do more to establish “an environment where employees feel safe to answer honestly.”

Olivia Kersey, a patient engagement strategist at Prime Global, believes that the industry needs to be more consistent in demonstrating support for the LGBTQIA+ community — and, especially, to go out of its way to avoid so-called rainbow-washing. The best way to accomplish this, she says, is through the formation of LGBTQIA+-focused employee resource groups, which can address inclusion within an organization as well as call on LGBTQIA+ advisers as needed.

Another important step, Kersey adds, is reviewing internal policies to ensure that language and terms are inclusive. Linguistic adaptations and visual representations can go a long way in helping intersex, trans or nonbinary people feel accepted.

“It’s great to see organizations give out donations and publish messaging in support of the LGBTQIA+ community, but organizations need to be queer-inclusive in their actual work as well to make a systemic impact,” Kersey stresses.

Julianna Ricard, associate director of HR operations and employee experience at Mirum Pharmaceuticals, believes the biopharma sector emphasizes diversity among its workforce, especially those individuals who identify as members of the LGBTQIA+ community. She says her company truly lives its “Be Real” core value and that DE&I within the contexts of sexual orientation and gender identification isn’t just another box to tick off.

“I can definitely say that, in my experience, the biopharma industry has been doing a great job at trying to make this a focus,” Ricard says. “Biopharma companies have also made it so that this effort is not coming from HR; it’s coming from the organization itself. We want employees to speak up. We want employees to be involved and engaged in these things.”