Discrimination and impact on general health care needs
It is sometimes assumed by health care professionals, policy makers, and patients that lesbian, gay and bisexual (LGB) people do not have unique health needs as a consequence of their sexual orientation.
This position is justified on the belief that it is perceived that being gay is something that a person “does” rather than what a person “is”. It is assumed that sexual health is the only unique health care need of a gay person, and, if that is the case, women do not have any unique health needs at all.
This, however, is not the case. Research suggests that LGB people have very specific concerns that are not necessarily met by service providers. Research has demonstrated that LGB people can experience broad social inequalities. Discrimination and homophobia can have a significant impact on LGB people’s engagement with society and infrastructures in society. It also has a significant impact on how they are treated by some health care providers.
LGB people may experience social exclusion at a variety of stages in their lives. They may leave school early as a result of homophobic bullying, may not participate fully in their communities, may be asked to leave their family home, and may find it difficult to find employment as a result. Young LGB people may seek support and a community in adult environments, and participate in high risk-taking behaviour. LGB adults may continue to face discrimination in their adult life, as they seek work, enter relationships, and as they take steps to start a family. Older LGB people may experience illness or poverty, and require sensitive state support and intervention.
Throughout LGB people’s lives, LGB people may also continue to disclose their sexual orientation in new environments and situations, and respond to incidents of discrimination and homophobia. They may experience discrimination and discriminatory practices from service providers, and the public sector. They may, for example, be reluctant to disclose their sexual orientation to their GP, because they anticipate discrimination, but then fail to receive appropriate health care. This perpetuates the health inequalities. A variety of trigger points throughout a person’s life can therefore lead to social exclusion.
LGB people also experience social exclusion as a consequence of the fact that they often belong to other minority groups that also experience discrimination. For example, LGB people can also be BME and therefore experience the same incidents of exclusion as other BME people. LGB people can also be disabled. Lesbians can experience poverty, in common with women in general. Two women in a relationship may experience a higher degree of poverty than a man and a woman. LGB people therefore do not exist in isolation as a separate, distinct community, but experience the same trigger points for social inequalities as other people. LGB people, however, may not benefit from preventative steps put in place to reduce exclusion of other groups, because they experience homophobia, and the health sector does not always take proactive steps to tackle discrimination.
It is therefore likely that if a group of people experience discrimination and social exclusion, they are also likely to experience health inequalities. Research suggests that LGB people have very specific health concerns (see below) and that the health sector needs to deliver targeted appropriate care to patients on the grounds of their sexual orientation. LGB people feel that this is not always the case in health care delivery.
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