LGBT Health and Well-Being

Voices from the
South West
Messages from 2010 Pride Progress and Transformation survey

Brenda...
Session aims to ...
... share insights from ESW’s Pride, Progress and
Transformation survey, 2010
 Top ten health concern...
Profile of contributors to survey
• 362 survey responses in total
• 271 responded to question re gender identity
• 279 res...
Top health concerns
“What health issues most concern or
affect you? Is this related to your sexual
or gender identity?” 24...
Top 10 health concerns
1. Mental Health
2. Sexual Health
3. Cancer
4. Obesity/weight
5. Gender dysphoria
6. Ageing
7. Hear...
Incidence of disabilities among
contributors
• 23% (65) self-identified as disabled
(some have multiple disabilities)
• 3....
Nature of disabilities among
contributors
•
•
•
•
•

Physical impairments
Mental Health issues
Sensory impairments
Learnin...
Some key issues
• Many shared areas of concern between LGB and T people
but need to differentiate between health and care ...
Common areas of concern
•
•
•
•
•
•
•
•

Training and awareness
Visibility and monitoring
Respect for confidentiality/priv...
Training and awareness
• Move away from heterosexist assumptions.
• Ensure up to date knowledge.
•
•
•
•
•

“…staff not ac...
Sexual health
Common issues related to
• HIV - people’s attitudes, and the quality of care
• Accessibility and quality of ...
Ageing and health
• Increased dependency on health and care
services geared towards heterosexuality
“the prospect of being...
Particular issues for Lesbian/Gay
women
• Gynae services, reproductive rights and
persistence of assumptions
• Lack of acc...
Lesbian/gay women’s voices
• “I still get asked as an introductory question in my smear
tests ‘what contraception are you ...
Particular issues for Transgender
people
Five main areas of concern
• Difficulties and obstacles (including funding) to
ga...
Transgender people’s voices
•

“The difficulty and diversity in diagnosing transgender issues, and
the varied treatment re...
Dignity and respect: using health
care services
When using health care services
• 86% of contributors felt they were treat...
Issues of dignity and respect
•
•

•

•
•

“Some people’s attitudes limit the amount of people I can be truly
honest with....
What improvements could be
made?
Visibility and monitoring
A majority of PP&T contributors favour
sexual and gender identity monitoring.
– Potential for av...
Voices on monitoring
“(All) agencies have an awful lot of work to do before the stats they
have will fully reflect our pre...
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LGBT health & Wellbeing

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Findings from the Pride Progress and Transofrmation Survey

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  • Outline background to the survey
    Steering group/Poole council/ input from external partners/ sponsorship
    Open ended questions and mass of data returned
  • How do you describe your sexual /gender identity?
    A number of Trans respondents describe themselves in their reassigned gender identity.
    “Is your gender different to that assigned to you at birth?”
    13 heterosexual. Responses sifted.
  • A number of multiple responses
  • Mental health includes: Stress, depression, anxiety, panic attacks, bipolar disorder
    Sexual healthSTIs, HIV/AIDS
    Cancer – non specific
    Obesity/weight Diet, eating disorders
    Gender dysphoriaTreatment, identity, transition, reassignment body issues
    Ageing Includes associated care issues and options
    Coronary
    General fitness
    Women’s sexual healthIncludes FtM transgender issues
    Asthma/allergiesVarious
  • Other issues
    Diabetes 6
    Access to gay-friendly GPs5
    Arthritis/gout 6
    Alcohol4
    Dentist services 4
    Disability 4
    Blood pressure/hypertension3
    Dementia3
    Mobility3
    Muscular issues3
    Smoking3
    Caring issues (partners/relatives)2
    Fertility issues2
    Sensory impairment2
    Urinary problems 2
    Drug problems1
  • Training and awareness – in general, to move away from heterosexist assumptions. Specifically, to ensure up to date knowledge.
    “Health care providers need to realise that there is more than one way to live and love. As soon as they’ve got that down, we’ll be fine.”
    Visibility and Monitoring of discriminatory/negative behaviour towards LGBT people
    Respect for confidentiality/privacy in all interactions in line with legislation
    Pivotal role of GPs and surgery based staff (list of gay/gay friendly practices/establish sexual orientation for patient records/diagnostic aid/accuracy of LGBT knowledge)
    GUM services (accessibility (times/places)/GP based clinics/information/better advice to young LGBT people)
    “My previous GP was fantastic & cared for my former partner right up until his HIV/AIDS related death...my new GP is 100% homophobic and will not treat me...the complaint system does not work...”
    Visible evidence of LGBT-friendly health centres, and health and social care institutions, clearly identified as such (posters/websites etc): a safe environment for ‘coming out’
    “Scared to talk to dr”
    “I have never come out to my GP... I think there is a lack of services across the board, especially regarding what they would consider (my) low level mental health needs...”
    “Gay friendly GP services - clearly identified would be lovely, or a website with reviews of LGBT or women friendly GP's.”
    Integration and communication between agencies
    e.g.s Gender Identity Clinic and GPs/ health and social care providers/mental health services and housing providers
    Mental Health services
    Need to be aware of and respond to the range of issues arising
    Parental rejection
    Sexual abuse in childhood
    Transgender/sexual orientation confusions
    A range of therapies, emphasis on talking therapies
    Information about support groups
    “In 1986 I was under section at ... Hospital... 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)
    “Specialist LGBT services. Growing up LGBT in a predominantly straight world is harder than any heterosexual could imagine.”
  • Declining physical health through ageing process leading to 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!!”
    “overtly religious based organisations, who push their beliefs, should be available to people with similar views (under public service contracts), but should not be contracted by health or social services to deliver services to the general public.”
    “Worry that I will suffer from dementia or similar as I get older and will get confused about my identity which will cause problems with the respect and dignity that I will require as a human right.”
    “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 eg heart etc.”
  • E.g. assumptions that women are having sexual intercourse/ using contraception /pregnancy may account for symptoms
    A lack of information on health issues and risks affecting lesbians/gay women
    sexual health and STIs
    “Don't know where to find information on sexual health and protection from STIs, aimed specifically at lesbians.”
    cervical screening
    “... refused a smear test by GP as (I am a) lesbian, despite previously insisting (this is) necessary…”
    “More advice on whether as a lesbian I need a smear test. My GP seems unable to answer the question!”
    support for couples wanting to conceive as compared with heterosexual couples
    Importance of choice of female/gay friendly GP
  • Services for trans people seen as an easy target for funding cuts
    A systemic lack of Trans awareness
    Difficulties in accessing services and gender reassignment treatment
    Difficulties in accessing health care provision that is appropriate and sensitive to the needs of Trans people
    “The slow, laboured and sometimes begrudging medical help and support with my Gender Dysphoria psychologically and physically. Hard to arrange, often costly and often unsympathetic Gender Reassignment Surgery. The seemingly 'Endless' waiting times for medical appointments. Hospitals and their staff.”
    “GPs & NHS Consultants, Doctors, Nursing Staff, should be further educated and regularly monitored in their … care approach. A more informed, respectful and genuinely caring attitude would be preferable to an ignorant, disrespectful, humiliating and often very frightening one.”
    “… medical professionals don’t know how to treat me when I need them to.”
    Need for a clear and consistent transition pathway
    Body issues combined with isolation as a particular cause of anxiety, stress and depression.
    “My mental health in relation to discrimination and how I feel about my body and my true gender and sexual identity… I have felt like a gay boy trapped in a girl’s body since I was five and don't understand why… My head is messed up over this stuff and there doesn't seem to be anybody who understands or who I can talk to. It affects me everyday.”
    Issues associated with Transgender and ageing
    “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.”
    “Arthritis - probably influenced by gender identity (and) hypertension -probably influenced by gender identity but also hereditary..”
     
  • LGBT health & Wellbeing

    1. 1. LGBT Health and Well-Being Voices from the South West Messages from 2010 Pride Progress and Transformation survey Brenda Weston, Equality South West
    2. 2. 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
    3. 3. Profile of contributors to survey • 362 survey responses in total • 271 responded to question re gender identity • 279 responded to question re sexual identity o o o o o 49 (13.5%) known to be Transgender Gay 41% 114 Lesbian 34% 94 Bisexual 14% 40 Other 11% 30
    4. 4. 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
    5. 5. Top 10 health concerns 1. Mental Health 2. Sexual Health 3. Cancer 4. Obesity/weight 5. Gender dysphoria 6. Ageing 7. Heart /coronary 8. General Fitness/Exercise 9. Women’s sexual health 10. Asthma/allergies 45 35 2 16 12 11 9 8 8 7 * Linked to gender or sexual identity by one or more respondents
    6. 6. 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)
    7. 7. Nature of disabilities among contributors • • • • • Physical impairments Mental Health issues Sensory impairments Learning impairments Other (please specify) 34.7% 32.0% 18.7% 9.3% 25.3% *Includes 4 people who are HIV positive. 26 24 14 7 19*
    8. 8. 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
    9. 9. 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
    10. 10. 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
    11. 11. 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?
    12. 12. 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…”
    13. 13. 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
    14. 14. 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…”
    15. 15. 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
    16. 16. 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.”
    17. 17. Dignity and respect: using health care services When 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.
    18. 18. 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!”
    19. 19. What improvements could be made?
    20. 20. 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
    21. 21. 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.”
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