Empowered people uniting in public displays of solidarity, equality and activism, marching to vibrant sounds: This is Brighton’s 25th anniversary of Pride. Pills and Policies joins the celebration and protest for LGBT rights, with a specific focus on health equality.
Although the day was not centred on LGBT health, there was an underlying emphasis that this was a key area of concern and that the current state of health provision is inadequate. It was nice to see a strong NHS presence at Pride, with representatives from various departments such as paramedics and nurses. On the other hand, the involvement of politicians (mainly from Labour and the Liberal Democrats) was viewed by many as a contradiction to the Pride movement, and was almost intrusive. Clearly, individuals too often felt that policies do not represent their concerns as LGBT youth.
The numerous charities in the parade overshadowed whatever influence the NHS and politicians had, perhaps symbolic of their relative importance in addressing LGBT health concerns. These charities, such as Samaritans and Grassroots suicide prevention, took an active role, providing helpline information whilst other charities handed out condoms. The government does work with such voluntary groups and the private sector, but more should be offered on the NHS.
In general, the health needs of LGBT communities are similar to non-LGBT, but there are some unique needs. Admittedly, the LGBT communities are very diverse and have varying experiences as a result of other factors, including their ethnicity, socioeconomic status, religion and gender. Social factors play a significant role in the uniqueness of the LGBT health needs, with various social agents involved – such as teachers, health service providers, peers, parents and policy makers. There are too many variables occurring simultaneously, making it difficult to pinpoint who should – if anyone – take overall responsibility of LGBT health.
To explore all of this, we spent the day with Luke and Saj, members of London’s Mosaic LGBT youth group. Whilst enjoying the event, we found some time to discuss their specific health concerns as gay men. Amongst other issues, they identified that there were few spaces for the LGBT youth to talk about the challenges they face – something that is a necessity given that many can’t speak freely to their peers, teachers and parents. For Luke and Saj, Mosaic was the answer to this concern, as it was their only source of reliable health information. However, many are unable to access such safe spaces or are even unaware of their existence.
What are the health issues affecting LGBT communities?
When asked, Luke and Saj gave some of the following as their responses, however they are shared concerns within the wider community. These are only a selection of issues, and individual experiences do vary.
The lack of adequate and inclusive sex education puts many LGBT youth at risk of STIs such as herpes, genital warts, chlamydia, hepatitis A and B, syphilis and gonorrhoea.
MSM (Men who have sex with men) account for 40% of people living with HIV in London, but this statistic can be certainly be changed by making improvements to the health sector.
As well as using protection, MSM should be encouraged to be tested, and this should be a stress-free procedure. Free home testing kits provide a perfect solution due to their convenience, although lack of funding has led to their availability being discontinued in many areas.
PrEP (Pre- Exposure Prophylaxis), a HIV treatment drug that offers protection against HIV when taken regularly, is another solution for safer sex. Many specialists agree that this life-saving drug should be available freely on the NHS for MSM and other at-risk groups. The PROUD study showed that PrEP reduces the risk of contracting HIV by 86%, therefore it would reduce overall costs to the NHS since people living with HIV have to take a wider range of medication. A decision on the provision of PrEP should be made by early 2017.
MSM cannot give blood for 12 months after having sex with other men; their blood is still assumed to be more likely to be infected, but this reasoning does not actually make sense since all blood donations are tested and the technology is available to screen blood within 3 months. Groups such as Freedom to Donate are campaigning for policies to comply more closely with actual scientific evidence, instead of out-dated ideologies.
HPV (Human Papilloma Virus) vaccine
Currently in the UK, the HPV vaccine is given to all 12-13 year old girls to protect them against cervical cancer, however it is not given to boys. The reasoning behind this is that by protecting the girls, boys are automatically protected, but in fact it is only heterosexual males who benefit. Homosexual and bisexual males are put at risk by this policy, as the virus can cause penile and anal cancers. Furthermore, males cannot be given smear tests to screen for the virus like females are, so the virus is only detectable at a stage when it is often too late to intervene. The Gay Men’s Health Charity (GMFA) rightfully stresses, “A gender neutral virus requires a gender-neutral vaccination programme”, one which Australia currently provides.
Saj spoke about his experience with the HPV vaccine: “Only one hospital in London offers it for men (Northwick Park), and even funding for that is running out. Newham (the borough which Saj lives in) told me they don’t do it!”
Cervical cancer and breast cancer
Lesbians and bisexual females have been found by some studies to be at greater risk of developing cervical cancers, due to fewer of them going for regular cervical screenings, many not using contraception, and not changing sex toys between partners. This group has also been identified as being more likely to develop breast cancer, as they are less likely to breastfeed or have children, tend not to use oral contraceptives, supposedly smoke more and tend to be more overweight. These concerns are legitimate, however many of the studies make sweeping generalisations – the incidence of cervical and breast cancers amongst lesbians and bisexual females seems to be largely a secondary result of the discrimination they face and the way the health and education services are disengaged from them.
The results from much of the research on LGBT health are not reliable since the sample sizes for the studies tend to be too small. Understandably, many people do not feel comfortable disclosing their sexual orientation or gender to GPs, so their true identity is not recorded in surveys. Furthermore, this gives the false impression that there is not such a great demand for LGBT health issues to be considered. LGBT people should not be made to feel as though disclosing their identity would change the quality of healthcare they receive. Trust needs to be built with GPs, who should not assume that everyone is heterosexual or binary.
The NHS has a Gender Services department, although there are only 7 publicly funded Gender Identity Clinics in England. Many people have to travel far across the country to access these services, and with ever-rising demand, the waiting lists are lengthening. Access depends on referrals by a GP, who might not always be best placed to make that decision especially since many are not specifically trained on trans health matters.
Certain services such as hair removal are less accessible on the NHS, and not all clinics offer counselling, so the care can feel incomplete. Private services are available and offer a faster process, although they don’t come cheap, so this causes inequalities in outcomes. Some people resort to obtaining non-prescribed hormones from the internet, which can be highly dangerous due to problems with dosage.
Although health workers are not allowed to discriminate against trans people based on their personal views, they sometimes do so indirectly e.g. by using the wrong pronouns out of ignorance, or finding a reason not to refer someone for a certain procedure like gender confirmation.
An additional criticism that many trans people have regarding the provision of Gender Services is how gender dysphoria is often treated as synonymous with mental health issues, whereas the two are very different.
NHS England recently founded a Transgender Network, which aims to address the failing of the current systems, working directly with trans people.
Depression and suicide
‘44% of young LGBT people have considered suicide’
General cuts to mental health services have had a greater impact on at–risk groups such as LGBT youth, as many find it harder to seek the help they require.
PSHE and sex education
Increasing awareness is arguably the surest way of having an impact on most aspects of the health of LBGT communities, as changing attitudes in society would directly affect the daily lives of LGBT people. Teachers and public health workers have a great capacity for making significant change. Why then, is PSHE (Personal, Social, Health and Economic) education not compulsory in schools if it can help to bring an end to homophobic and transphobic bullying?
Luke advocates for more comprehensive PSHE lessons that spark open discussions, as well as a bigger presence of LGBT people in the general media, saying that this would benefit everyone, not just LGBT people.
As a Person of Colour himself, Luke went on to discuss the intersectionality between race and education on LGBT health matters: “I’m going to make a controversial statement: POCs are probably the most ignorant when it comes to LGBT issues. Heteronormative behaviour is ingrained in their heads.” It can be easy to excuse these differences as merely cultural ones, meaning there is nothing that can be done to change them, however it is a problem of awareness. Services don’t have to explicitly target LGBT POCs, but they should be accessible to everyone.
Green Party’s Caroline Lucas passed a bill last month to make PSHE compulsory, however the government ‘ignored it’. They concluded that there should be no legal requirement to teach PSHE, as well as leaving Academy schools with the option of not teaching sex education.
Substance misuse, hate crimes, homelessness and prostitution also affect the well-being of LGBT youth substantially.
In conversation with an NHS worker:
The sad reality is that LGBT services are underprovided because they are not seen as emergency services, or as an economic priority. Having to spend so much on a minority is not seen as a viable or vote-securing strategy for politicians.
The creation of Clinical Commissioning Groups and handing over of responsibilities for public health services to local authorities has meant that there are geographical disparities in care. For example, sexual health leaflets and information on clinics are more advertised in parts of North London than East London. Having initiatives that are targeted to a specific location is favourable, however, there must also be a national standard for healthcare.
There are services that many people are not informed about; besides creating new services where there aren’t any, there needs to be improvements in public health and marketing strategies to promote the currently available services. It is not just the LGBT youth that are not informed, it is health professionals too; better training is necessary for them, as well as a complete database of what’s on offer.
Your healthcare not only depends on where you live, but also on your age to a large extent; there are many points for intervention between the ages of 0-19 (health visitor for ages 0-5 and school nurse for ages 5-19). These professionals are trained in safeguarding, so they can identify any issues that a child is facing and can make referrals (applying the clinical assessment framework to provide a relevant action plan). When you reach age 20, you bear more of the responsibility for the healthcare you receive, as you have to seek help individually and rely on GPs or information from the internet, which can be misleading. There should be a smoother transition in healthcare from child to adult services, with sufficient guidance offered to those who need it regardless of their age.
So whose responsibility is it to make a difference in LGBT health?
Policymakers have the easy scapegoat of saying that the problems LGBT people face are social rather than political, so it is not their responsibility to make a difference. It is easy to vaguely say that attitudes need to change, without looking at how current policies shape those attitudes. Many politicians make judgements that are tied too strongly to their personal beliefs (including religious ones), seemingly forgetting that there are actual people whose lives are deeply affected by their selfish decisions. Perhaps the responsibility does lie with them – there is so much politicians can do in terms of allocating funding for mental health, gender services, making PSHE compulsory, offering HPV vaccines to boys or at least all MSM, free HIV home testing kits etc. They are meant to be leaders, so they should lead the way and set an example for other people in society; for the teachers, the parents, and whole communities. In order to achieve full legal and political equality, there needs to be greater inclusion of LGBT people in all aspects of society and politics, as well as better availability and marketing of services. This would reduce the stigmatisation and discrimination that LGBT communities face, leading to better mental health, better relationships with healthcare providers, and healthier lifestyles in general.
Pills and Policies will keep up with developments in LGBT health, and we hope to see substantial changes by the next Pride. Follow us on wordpress and twitter to stay updated.