Transcript Physical and Emotional Health Needs of Lesbians, Gay

Physical and Emotional
Health Needs of Lesbians,
Gay, Bisexual and
Transgender People
Jess Mookherjee, Public Health Consultant
Kent & Medway NHS & KCC
Sexual Identity. Private or Public?
‘Self-perceived sexual identity is a subjective view of oneself.
Essentially, it is about what a person is, not what they do. It is
about the inner sense of self, and perhaps sharing a collective
social identity with a group of other people. The question on
sexual identity is asked as an opinion question … it is up to
respondents to decide how they define themselves.’
‘A person can have a sexual identity while not being sexually
active. Furthermore, reported sexual identity may change
over time or in different contexts (for example at home versus
in the workplace).’
(Haseldon and Joloza, 2009: 6)
‘sexual orientation’, ‘sexual identity’, ‘or
‘sexuality’ ??? ONS Question
Which of the options on this card best describes how you
think of yourself?
Please just read out the number next to the description.
(Only if concurrent interview)
The numbers on each card are different for each person.
• 27. Heterosexual/Straight
• 21. Gay/Lesbian
• 24. Bisexual
• 29. Other
• (Spontaneous Don’t know/Refusal)
Sexual Orientation definition:
Equalities Bill 2009
• ‘… relates to a person’s feelings rather than their actions’;
• A man who experiences sexual attraction towards both
men and women is ‘bisexual’ in terms of sexual
orientation even if he has only had relationships with
women.
• A man and a woman who are both attracted only to
people of the opposite sex from them share a sexual
orientation.
• A man who is attracted only to other men is a gay man. A
woman who is attracted only to other women is a
lesbian. So a gay man and a lesbian share a sexual
orientation.
Self Defining : the problem with
surveys
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I’m not a lesbian i’m a gay woman
I’m not homosexual , i’m a gay man
I’m transgender and i’m straight
I’m a straight man but i’ve had sex with men
I’m a gay person but i’ve never had sex
I’m bisexual – but i mainly sleep with women
I’m a bit gay
How big is the LGBT population?
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Surveys predict from .3% to 10%
Official estimate is 5%-7%
ONS survey (2011) 1.5%
Figures from the Kent Youth Service show 6%
off young people accessing are LGBT
Integrated Household Survey 2011
• 94 per cent of adults identified themselves as
Heterosexual/Straight
• 1 per cent of the surveyed population, approximately 490,000
adults, identified themselves as Gay or Lesbian
• 0.5 per cent of the surveyed population, approximately
239,000 adults, identified themselves as Bisexual
• 0.4 per cent as ‘Other’
• 3.6 per cent of adults stated they ‘Don’t know’ or Refused the
question
• 0.7 per cent of respondents provided ‘No response’ to the
question
Demographics: The Data Vacuum
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Lesbians are different to Gay Men
Bisexuals differ from Lesbian and Gay Men
Very little information on transgender people.
Overlap of Identity, Attraction and Behaviour
Have you had sex with a same sex individual in the
past year?
• Norway survey = 24%, African Men = 12%
• BASS survey of African Origin people = 6%
attracted to no one.
• Sexual desire not predictive of sexual behaviour.
Reluctance to answer
survey questions on
Sexual Orientation!
What does that say?
Ethnicity & Social Status
• Asians are 27% more likely to skip the question
then white people 13%. (significant odds ratio)
• Mixed and ethnic minority groups use the ‘prefer
not to say’ option more.
• Asking the sexual orientation question AFTER the
religion question seems to have a negative
impact on response.
• Higher education correlates with answering the
question.
Problems of social acceptance and
freedom
• The LGBT population is diverse and
heterogeneous with multiple and differing needs
dependent on personal circumstances.
• Very difficult to assess the needs nationally
• We do know there is significant underreporting
and sexuality is more fluid and complex then the
definitions.
• Therefore one thing LGBT have in common is
social stigma and need for freedom and social
acceptance.
Social Stigma and lack of social
acceptance can lead to health
inequalities
• Lack of information: e.g Lesbians need smear
tests
• Lack of mentorship across generations: e.g
forgetting a gay man still needs to use a condom
• Increased risk of mental health and self harm
problems (including alcohol and drugs).
• Understanding the impact of ‘triple jeopardy’ of
being LGBT and ethnic minority: victimisation,
social isolation and rejection
Health Needs of LGBT people:
Lesbians
• People reporting they are LGBT are generally younger
and so have fewer long standing illnesses.
• DoH report into health of Lesbians reported they are
less likely to have children and more likely to be
overweight then straight women which increases their
risk to CHD and breast cancer.
• The limited opportunities to social network and
socialise creates a reliance on bars and pubs and
increases exposure to alcohol. Lesbians are more likely
to be hazardous drinkers then straight women.
• Double the proportion of lesbians have never had a
smear test (15% compared to 7%).
Health Needs: Gay Men
• Less likely to disclose orientation to GP then Lesbians are.
• Express dissatisfaction with heterocentric health related
publicity
• Anal cancer is associated with anal-receptive sexual activity,
as well as with genital warts, hepatitis B, human papilloma
virus, herpes simplex virus, HIV and smoking. The incidence
of anal cancer is 20 times more common in gay men than in
the general population (Anderson et al 2004)
• 80% of new HIV infections are to men who have sex with
men.
• 59% of people with AIDS are Gay men
Bisexual People
Bisexual people can suffer from both homophobia and heterosexism and
bisexuality is often not accepted as an identity, because it is assumed they
can choose to be either gay/lesbian or heterosexual (DoH 2007c). Many of
the health needs of bisexual people relate to their experience of discrimination
(Dobinson et al 2003).
• Bisexual women are more likely to identify their experience of mental
health professionals as more negative than lesbians
• Bisexual men are more likely to say that a causal link between their sexual
orientation and their mental health issues was made by mental health
professions
• Bisexual women and lesbians experience more negative healthcare
treatment than heterosexual women (Banwell et al 2005). Bisexual
people’s health has not been researched as a separate issue from lesbians
and gays, until recently. However, there is evidence of the following issues:
• Bisexual men are less educated about Sexually Transmitted Infections, less
likely to see appropriate literature, use condoms appropriately and have
more unsafe sex than gay men (Devlin et al 2003)
Transgender people’s health
There is a persistent assumption that one’s gender is
assigned at birth and is male or female (DoH 2007d).
Transgender people face prejudice, particularly in the
form of:
• Limited employment opportunities
• Limited personal relationships
• Limited access to goods, services and housing
• Reduced health status
• Limited safety
• Reduced access to health and social care (DoH 2007d).
Despite limited research into transgender people’s health, many are at risk of
a range of physical health problems, including alcohol and substance abuse,
violence and HIV (Lombardi et al 2001, Laird and Aston 2003, Kenagy 2005).
Trans: Access to healthcare services
• 17% refused healthcare treatment not related to transgender issues,
because the doctor or nurse did not approve of gender reassignment
• 29% reported that being transgender negatively affected their
treatment by healthcare professionals
• 21% of GPs did not want to help or refused help with treatment (Whittle
et al 2007)
• Transgender men rarely included in breast screening programmes
(Eyler and Whittle 2001)
• Transgender women were rarely offered prostate screening (Kitzinger
2000)
• Placement on wards: transgender men put on female wards,
transgender women put on male wards (DoH 2007d)
• 30% of transgender people in one study experienced discrimination
from professionals (Whittle et al 2007)
Young LGBT
• Most young people know their orientation at 11
or younger. Many don’t ‘come out’ until they are
16. Termed the ‘isolation years’- good sexual and
emotional information need to be available at
this time.
• ‘Gay’ has become a bullying and abusive term in
playgrounds. LGB young people are 30% greater
risk of being bullied then other children. One
survey found 78% of LGB young people had been
verbally abused by other pupils and 23% were
physically attacked.
Older LBGT
Older people are often assumed to be heterosexual,
and the needs of older LGB are frequently
overlooked. One study found them to be:
• ‘two-and-a-half times as likely to live alone;
• Twice as likely to be single; and
• Four-and-a-half times as likely to have no children to call upon in times
of need’ (DoH 2007g).
Older LGBT
This group may have lived through times when
same-sex behaviour was illegal and so have
hidden their sexual orientation. They may feel
particularly vulnerable to harassment (DoH
2007g). Only 14% of older people are open
with healthcare providers about their
sexuality (Heaphy et al 2003).
Emotional and Mental Health
• Bisexual people have poorer mental health than
heterosexuals, gays or lesbians, with higher rates of anxiety,
depression and suicidal thoughts (Dobinson et al 2003).
• The largest UK survey of transgender people found that 34%
have attempted suicide (Kenagy 2005)
• Young LGBT are four times as likely to have depression and
three times more likely to have anxiety disorders (McNamee
2006).
• LGBT men are 7x more likely to think about suicide then
heterosexual men.
• LGB are 5 x more likely to self harm. (Skeg et al 2003).
Most of these problems can be
pinned down to social acceptance and
stigma
• Bisexual people and gay men are more likely to
report to having lost their job due to
discrimination (DoH 2007g)
• Lesbians report more verbal and physical abuse
than heterosexual women (King and McKeown
2003))
• LGB people are more likely to self-harm as a
consequence of discrimination (Meyer 2003)
New Research Areas for LGBT
• Minority Stress Model: the impact of stigma on a
persons well being and emotional health.
• Life Course Perspective: how events and stages
impact subsequent stages.
• The intersectionality perspective: investigating
an individuals multiple identities and the way
they interact.
• Social ecology model: influence of family and
wider society on behaviour and genes and
choices.
Thank for Listening
Be Good to Each Other