LGBT Health and Well-Being

Voices from the South West

Messages from 2010 Pride Progress and Transformation survey

Brenda Weston, Equality South West

Session aims to ...

... share insights from ESW’s Pride, Progress and Transformation survey, 2010 Top ten health concerns and issues for contributors

Disability and sexual and gender identity

Sexual health matters

Ageing as a lesbian, gay bisexual or transgender person

Health issues for lesbian/gay women

Health and Transgender

Dignity and respect: using health care services

Visibility/monitoring

Profile of contributors to survey

• 362 survey responses in total • 271 responded to question re gender

identity • 279 responded to question re sexual

identityo 49 (13.5%) known to be Transgendero Gay 41% 114o Lesbian 34% 94o Bisexual 14% 40o Other 11% 30

Top health concerns“What health issues most concern or affect you? Is this related to your sexual or gender identity?” 243 responses• 46% (112) did not link concerns to

identity

• 36% (87) linked concerns to sexual identity

• 18% (44) related concerns to gender identity

Top 10 health concerns1. Mental Health 452. Sexual Health 353. Cancer 24. Obesity/weight 165. Gender dysphoria 126. Ageing 117. Heart /coronary 98. General Fitness/Exercise 89. Women’s sexual health 810.Asthma/allergies 7* Linked to gender or sexual identity by one or more respondents

Incidence of disabilities among contributors

• 23% (65) self-identified as disabled (some have multiple disabilities)

• 3.2% (9) were ‘not sure’.

(18% of working age in SW have one or more disabilities)

Nature of disabilities among contributors

• Physical impairments 34.7% 26• Mental Health issues 32.0% 24• Sensory impairments 18.7% 14• Learning impairments 9.3% 7• Other (please specify) 25.3% 19*

*Includes 4 people who are HIV positive.

Some key issues• Many shared areas of concern between LGB and T

people but need to differentiate between health and care issues in training, policies and practices

• Providers should recognise/respond to issues arising from demographic ageing as an LGB and/or Trans person

• Important to monitor sexual and gender identity (but also adhere to privacy/confidentiality rules)

• Awareness, training, and standards of behaviour a major issue for all NHS staff.

• Making LGBT acceptance/inclusiveness visible • Many testimonies of good/excellent support from NHS

Common areas of concern

• Training and awareness• Visibility and monitoring • Respect for confidentiality/privacy• Pivotal role of GPs and local surgery staff• GUM services• Evidence of ‘LGBT-friendliness’• Inter-agency integration/communication • LGBT aware mental health services

Training and awareness

• Move away from heterosexist assumptions. • Ensure up to date knowledge.• “…staff not accepting that I should be with my civil partner during

discussions with a doctor immediately prior to a procedure”• “Lack of knowledge, respect or even interest in a person’s sexual

identity/relationships”• “Unnecessary surgery, that in there, and we’re supposed to look after

him!”• “It wasn't only the nurse who treated me with disgust, it was two of the

receptionists in the same doctor’s surgery as well...”• I was under section at St Lawrence’s Hospital in Bodmin (psychiatric).

My consultant told me he was not prepared to release me unless I changed my sexual identity. Never got to the root of this, but in subsequent consultations he was OK

Sexual health

Common issues related to • HIV - people’s attitudes, and the quality of care• Accessibility and quality of information and advice

about sexual health/ avoiding infection. • Confidentiality in disclosing personal and medical

details“HIV - disclosing personal issues within healthcare settings !!”

•  Role of health professionals, especialy GPs: gatekeepers or facilitators?

Ageing and health• Increased dependency on health and care

services geared towards heterosexuality“the prospect of being banged up in a care home with a

bunch of straight old men is not appealing!!”

“Getting old and being 'heterosexualised' - that is to say, my age making my lesbianism suddenly invisible.”

• Long term effects of medical and surgical treatment for transition and beyond.“I am over 65 and a transwoman - I am concerned at almost the complete lack of information that will inform my GP and myself re my hormone treatment, its long term effects on my body and on other treatment…”

Particular issues for Lesbian/Gay women

• Gynae services, reproductive rights and persistence of assumptions

• Lack of accessible, accurate information re sexual health and other identity-related risks

• Lack of health practitioner knowledge re above

• Lack of info re access to fertility treatment• Choice of (female) GP

Lesbian/gay women’s voices• “I still get asked as an introductory question in my

smear tests ‘what contraception are you using?’”• “...when asked if I’m sure I’m not pregnant I have to

explain that I’m gay.”• “Don’t know where to find information on sexual

health and protections fro STIs aimed …at lesbians.”• “More advice on whether as a lesbian I need a smear

test. My GP seems unable to answer the question!”• “Cervical screening – do I need it or not What are the

real statistics for lesbians who do not have sex with men?”

• “…lesbians are automatically treated (as infertile). This …exposes couples to increased risk of multiple births…”

Particular issues for Transgender people

Five main areas of concern• Difficulties and obstacles (including funding)

to gaining gender reassignment treatment

• Effects of hormone and surgical treatments

• Mental health and well being

• Systemic lack of practitioner awareness when accessing treatment for mainstream conditions

• Ageing: enlightened health/social care

Transgender people’s voices• “The difficulty and diversity in diagnosing transgender issues,

and the varied treatment received depending on where you live.”

• “Issues around possible transition (and) issues around cervical smears.)

• “DVT (deep vein thrombosis) and hormones”

• “My mental health in relation to discrimination and how I feel about my body and my true gender and sexual identity…”

• “Lack of proper care and services for Transgendered people in the NHS...”

• “...I still have some internal male bits. Some professionals have difficulty dealing with this.”

• “The realisation that it will not be too long before I will need residential/ similar care I do not think the providers are geared up to this.”

Dignity and respect: using health care servicesWhen using health care services• 86% of contributors felt they were treated

with respect all, or most of the time.

• Less than 3% said they were ‘rarely’ or ‘never’ treated with respect.

• Some identified models of good practice

• Some experiences ranged between embarrassing, humiliating and homophobic or transphobic.

Issues of dignity and respect

• “Some people’s attitudes limit the amount of people I can be truly honest with.”

• “…staff not accepting that I should be with my civil partner during discussions with a doctor immediately prior to a procedure (I was told -there isn’t room for you both in the cubicle…)”

• “Lack of knowledge, respect or even interest in a person’s sexual identity/relationships – I perceive either fear, ignorance or unwillingness.”

• “Sorry I can’t really help you – you’re rather uncharted territory.”

• “Unnecessary surgery, that in there, and we’re supposed to look after him!”

What improvements could be made?

Visibility and monitoring

A majority of PP&T contributors favour sexual and gender identity monitoring.– Potential for avoiding assumptions and

embarrassment.

– Better service planning

– Higher visibility and awareness among NHS staff and other service providers

Voices on monitoring

“(All) agencies have an awful lot of work to do before the stats they have will fully reflect our presence and needs…”

“...a large number of health and social care providers do not know (the) real ... mix of people they are providing services for (partly because we use hopelessly under-reported statistics...”

“All services, whether public, private or voluntary should be monitoring who accesses their services and report accordingly.”

“I think that the doctor etc should ask for sexual orientation so they can offer better advice and rule out things quicker.”

“Less invisibility. I find I have to really make it very clear that I am not heterosexual.”