"Inclusive Care" Is Not Always Affirming Care: Reflecting on Perspectives From LGBTQIA+ Consumers and Providers.

Enhancing healthcare experiences for lesbian, gay, bisexual, transgender, queer, intersex, asexual and people with other diverse identities, experiences and bodies (LGBTQIA+) is a complex and evolving challenge. While policy and professional frameworks often focus on inclusive processes, LGBTQIA+ people emphasise affirming experiences, including being listened to, validated, respected, and having their lived experiences recognised, over specialised clinical expertise alone. Consumers describe affirming care as feeling seen, respected, and safe within clinical encounters, experiences that contribute to relational safety and meaningful engagement with care. Drawing on our reflections of conducting two qualitative studies, in this Perspective, we argue for a nuanced, flexible, and participatory approach to healthcare that centres these consumer-defined experiences of affirming care. Primary healthcare providers should intentionally foster relational safety, by applying empathy, respect, and reflective practice to validate diverse identities and experiences within everyday care. While LGBTQIA+ specific knowledge and clinical expertise remain important, they should build upon, rather than precede, providers' relational skills embedded within patient-centred practice. Positioning affirming care as a relational foundation of healthcare practice embeds inclusive approaches within routine care, with specialised LGBTQIA+ expertise serving to extend, rather than define, affirming practice. Clinicians can begin by reflecting on what they already do to support safe and respectful care, and identifying small, consistent changes that more intentionally centre individual identities, experiences and needs in everyday practice. Integrating LGBTQIA+ health education into existing frameworks for communication, person-centred care and reflective practice may therefore provide a more accessible and sustainable pathway for workforce capability in primary care. Training, policy, and service design should balance applied clinical knowledge with relational skills, reflexivity, and humility, guided by consumer perspectives of what constitutes affirming care. Embedding these principles into everyday practice is essential to ensuring healthcare systems more effectively meet the needs of LGBTQIA+ communities.