By Warren Heggarty
The LGBTI community is a very diverse collection of groups, each with its own characteristics. Some of these groups, for example, concern same sex attraction. Others are related to gender identity.
Dr Adam Bourne (above), a researcher from the UK now based at La Trobe University, Melbourne, says that the one thing that unites all LGBTI people is ‘sharing some sense of being different.’ Beyond the diversity, there are three broad points that apply to LGBTI people as a whole and which health providers need to understand:
1. There are specific health issues that have a disproportionate affect upon various LGBTI groups. Examples include the effect of HIV upon gay men and anxiety upon trans* people.
2. There is stigma and discrimination, often stemming from a lack of knowledge about LGBTI people.
3. There are certain policies and procedures which health providers can choose that can make LGBTI groups feel welcome and thus contribute to solving the above.
In a training lecture held on 27 June 2018, Adam sketched some of the specific health issues. The overall conclusion we draw from this sketch is that there is a disproportionate burden of health and wellbeing issues affecting LGBTI people.
For example Lesbian and Bisexual women are more likely than average to be overweight, more likely to have type 2 diabetes, more likely to drink alcohol to excess, more likely to smoke, and more likely to have poor mental health. Bisexual women particularly report high levels of anxiety and depression. There also tends to be less attention to preventative measures such as pap tests.
Gay and Bisexual men are more likely to use and abuse drugs, to have HIV and to have HPV anal cancer. Australia has done quite well compared to other countries in terms of early detection of HIV, but some other figures are alarming. Gay and Bisexual men experience four times the level of anxiety and depression and six times the level of suicide and self -harm when compared to the general population.
People who are Transgender, Intersex and gender diverse have been the subject of much less research. However the research that does exist is alarming. In a survey of 800 people cited by Adam, 49 percent had attempted suicide and 75 percent had reported anxiety and depression. There is also the problem of having to disclose and even ‘explain’ their gender status over and over again, not always to empathetic or understanding.
Stigma and discrimination
Adam says that at the root of the additional ill health lies stigma and discrimination. Members of LGBTI groups are more likely to be single and less likely to have contact with family. As a result they become more heavily reliant on aged care, which raises significant challenges in its own right.
Many health care workers have a limited level of understanding of the issues relating to LGBTI people. Adam says that in the USA, only seven hours of an entire medical degree course is devoted to LGBTI issues.
Few LGBTI people are confident that aged care services would be able to understand or meet their needs. One third have never told their own GP, and this is even higher in rural areas. The widespread existence of stigmatising views against LGBTI people among people aged 65 and over can lead people ‘back into the closet,’ unable to be open about their sexuality or gender identity.
“Making it easy for people to disclose safely”
Adam says that it is ‘hard to overemphasise’ the importance of making it safe for LGBTI people to disclose their sexuality or gender identity when attending health services. Here are six key points that can make a positive difference.
1. Visible signs that the service is welcoming to LGBTI people have a ‘profoundly positive affect’ on people. A clear policy of non-discrimination, prominently displayed will make a good welcome mat.
2. Supporting service users and their families, while keeping assumptions in check and using neutral, non-gendered language.
3. Making it easy for people to disclose safely – bearing in mind that not all LGBTI people have an identity that is 100 per cent ‘set in concrete.’
4. Using inclusive language, reflecting terms the people use of themselves.
5. Having mechanisms for addressing discrimination.
6. Continuous reflection and staff development.
There is research on the ‘economic cost of homophobia.’ However, Adam acknowledged that because of ethical considerations it is not possible to conduct randomised trials to test what sort of difference these approaches make. However, two points for which we do have evidence are:
- When the right conditions exist, the people who provide services feel more confident in working with LGBTI people.
- LGBTI people who are LESS fearful of discrimination are MORE likely to seek help for their issues. If they feel safe to disclose, it means that their health worker can ask the right questions. A service that is welcoming and accepting towards LGBTI people will generate a good name and recommendations through the grapevine.