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Stonewall Cymru's Inside-Out Project was a community led piece of research focussing on lesbian, gay and bisexual (LGB) people's experiences of accessing health services in North and Mid Wales which recognised that LGB people themselves are the best people to understand the health issues relevant to other LGB people. The project operated between April 2006 and March 2007.
University of Central Lancashire (UCLAN) Centre for Ethnicity and Health Community Engagement team to offer a number of local LGB people training and guidance to devise the research and collate the results.
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Stonewall Cymru has identified the difficulties of accessing and consulting with lesbian, gay and bisexual (LGB) people across Wales. LGB people (people with same-sex sexual orientation) are absent from the Census as a 'population group' and their needs are all too often overlooked in the design and delivery of public services.
There are very few community groups / organisations for LGB people in Wales. Stonewall Cymru's Count us in! Report (2004) found 34 diverse groups providing services for LGB people across Wales. 20 groups were run by LGB volunteers for LGB people, and a further 14 groups supporting LGB people while working for other specific target groups such as youth, trade unionists and homeless people. In 2006 there are even less.
These groups have little capacity to voice the concerns and issues of LGB people to service providers, or to respond to consultations when providers seek their views. This lack of an avenue of communication and support is increased in rural areas.
To address this issue, Stonewall Cymru has teamed up with the University of Central Lancashire (UCLAN) Centre for Ethnicity and Health's Community Engagement team to bring their Community Engagement model into Wales for the first time and developed the Inside-Out Project. The UCLAN Community Engagement model develops skills and knowledge within a specific community by recruiting and training community researchers to research an issue of specific concern to that community and support development towards a sustainable future.
To explore Lesbian and Gay and Bisexual (LGB) people's experiences of accessing health services in North and Mid Wales and identify some steps for making them more appropriate and sensitive to the needs of LGB people.
Promotional events were organised in both Mid and North Wales to raise awareness of the Inside-Out Project and to recruit community researchers. Once the community researchers were identified, UCLAN provided a programme of workshops on community based research. Representatives from the local health agencies, university and LGB organisations were invited to set up a steering group to provide guidance and monitor the project. Online 'Google' discussion groups were set up for the researchers and steering group to maintain communication across distances.
The community researchers developed the research tools of focus groups and questionnaires. It was agreed that the respondents would be lesbian, gay and bisexual individuals over 17 years of age who have accessed the local health services in Mid and North Wales. Snowball and opportunistic sampling through existing networks and local LGB venues were used to target the sample group. Respondents were encouraged to provide qualitative data through comments and relating their experiences.
A total of 67 responses from LGB people were analysed, 52 responded through questionnaires and 15 through focus groups and phone interviews. The largest (23%) age group was 30-39. The gender balance was 48% males and 49% females and 3% transgendered or transsexual. Of these 40% identified as gay men, 46% as lesbian / gay women, 11% as bisexual and one male and one female (3%) identified as 'having sex with someone of the same-sex'. 86% of the sample group were 'out'.
The findings highlighted issues around disclosure of sexual orientation (also known as 'coming out') the resulting changes in staff attitude, positive and negative experiences of care, the receipt of appropriate health care for LGB people and the need to increase awareness and understanding within the health care system of the specific health care needs of LGB people.
62% of questionnaire respondents had either come 'out' or been 'outed' whilst accessing a health service, of these 26% felt that this changed the response or attitude of the health care provider. Experiences of attitudinal changes after disclosure ranged from a less friendly atmosphere, a change in mannerism, staff being embarrassed and respondents feeling uncomfortable, to staff being judgmental. Focus groups discussed their experiences of unprofessional attitudes and values from NHS staff, one doctor was described as being:
"Very right wing Christian, very evangelical but it's that thing of when he's in work he's in work, it's very unprofessional"
67% of questionnaire respondents reported a positive and 15% a negative experience whilst receiving care or treatment, and 3% complained to the practice manager or the Local Health Board. However, the qualitative data indicates that respondents had such low expectations that they classified as 'positive' the absence of overt prejudice. The positive experiences reported are summarised as:- a lack of negative reaction from staff to disclosure of sexual orientation, being treated for the illness, and partners being treated with respect and equal footing to heterosexual couples.
10% of questionnaire respondents thought they had received inappropriate advice for their sexual orientation on:- methods of contraception (despite being 'out'), the need to have a cervical smear test and HIV / AIDS testing. Contraception advice for women was discussed by focus groups and expressed as:
"Contraception was offered quite forcibly and it became quite awkward once I came out and no alternative advice was given"
Of the 25 female questionnaire respondents, 20 have regular cervical smear tests. In addition 1 believed she did not need a smear test, 1 was told by a health professional that she did not need a smear test because of her sexual orientation and 3 did not answer. 4 males and 1 female were pressurised to have a HIV / AIDS test because of their sexual orientation, 3 males reported that they were tested without their consent and thought that an assumption had been made that because they were gay men they should have a HIV / AIDS test.
81% if asked, would register their same-sex partner as next of kin. For those who did not register their same-sex partners the reasons given were:- fear of discrimination, not feeling that their sexual orientation would be kept private, and fear of treatment being affected.
65% of questionnaire respondents would feel more confident in accessing health services if health care professionals acknowledged equal status to same-sex relationships in their literature and culture. A high emphasis was given to the need for increased awareness training on sexual orientation issues.
As a result of being involved in the project 4 community researchers have completed the accredited University Certificate in Community research.
Shirley Ann Jones
The Inside-Out project is a community engagement project working in partnership with, and using the community engagement model of, the University of Central Lancashire (UCLAN) Centre for Ethnicity and Health. Click here for further information on the UCLAN community engagement model.
The Inside-Out project is a community engagement project, funded by the Department of Communities and Local Government to build capacity within the lesbian, gay and bisexual community in Wales ahead of the operations of the Commission for Equality and Human Rights.
The Inside-Out project is a partnership project with the Centre for Ethnicity and Health at the University of Central Lancashire (UCLAN).