Stigma and Discrimination against LGBTQI people: A lasting barrier to sexual healthcare
By Robbie Bedbrook
In the bustling city-centre of Sydney, Australia a 17-year-old gender fluid boy steps into my consult room for his first appointment to discuss transitioning. His name is Tom^, however his family still dead-name* him. They, along with their family doctor, believe Tom is in a phase and denied his chance to transition before puberty. Navigating your sexual identity as a teenager usually involves some confusion, however this journey for Tom was also plagued with mental health struggles due to his repressed gender identity. Later that day, I see a middle-aged man named Peter for a STI test; he has travelled five hours from his isolated, rural home to have his testing done. His local general practitioner (GP), who is still one hour from his house, has vocally expressed discomfort with Peter’s sexuality and Peter has avoided STI tests for nearly two years as a result. When his tests come back, we’ll discover Peter has had untreated chlamydia for potentially over a year.
These stories aren’t unique; stigma and discrimination against LGBTQI** people limits access to sexual healthcare daily, all across the globe. Research has demonstrated time and again that LGBTQI people are at risk of poorer health outcomes than their heterosexual and cisgender counterparts, as well as more likely to engage in high-risk behaviours, such as the crystal meth ‘chemsex’ crisis increasingly affecting men who have sex with men. This is true in even the most progressive countries and affects physical health, mental health and overall wellbeing. Many believe this is due in large part to the Minority Stress model, whereby both the possibility and reality of homophobia and transphobia have very real impacts on people’s health. This was unfortunately demonstrated in some recent research in Australia following the divisive and harmful marriage-equality postal-survey.
As a nurse working in sexual health and primary care, you don’t have to look far to see stigma embedded into attitudes and healthcare systems. I once worked with a GP who told patients she didn’t practice ‘gay medicine’ and to see one of the LGBTQI-identifying doctors for their STI test. While I do believe this doctor (somehow) thought she was being sensitive to her patient’s needs, she allowed her own attitudes and beliefs to shape the kind of care she was willing to deliver. As healthcare workers, we don’t have that option; we must strive to treat all patients equally. Who knows what impact this comment had on that patient, who encountered stigma even in an alternative, progressive part of Sydney.
When people think of stigma against LGBTQI people they often think obvious, overt examples; derogatory language, hate speech and violence. These examples exist and are rife with health-related consequences, absolutely, but just as damaging are the subtle, ingrained forms of stigma we may not even be aware of. Medical registration forms that don’t include diverse gender options, gendered-only bathrooms, assuming a person’s sexuality, relying too heavily on labels (such as gay and straight, male and female) and practitioners not having the knowledge around sexual health as it relates to LGBTQI patients all impact on a person’s willingness to access care, as well as the type of care they receive.
Of course, this discussion so far assumes there is even the ability to seek LGBTQI sexual healthcare when for many people across the globe expressing their sexual orientation or gender identity is a criminal offense. As it stands, around 70 nation-states^^ still criminalise sex between people of the same sex, with punishments varying from fines, to jail time and even the death penalty. While some people flee their homes and seek asylum in other countries due to persecution, it can be notoriously difficult to prove refugee status based on sexuality or gender identity. Furthermore many LGBTQI refugees face terrible atrocities while in detention, including increase rates of gender and sexual based violence and being denied access to appropriate healthcare.
Given this issue is so multi-faceted and manifests differently across different nations and territories there is no one perfect solution. The first step will always be to increase your knowledge around the issues affecting LGBTQI people; increased understanding leads to increased empathy, a powerful driver for change. It’s also important to look local; if you live in a country with broad legislative protections for LGBTQI people, you might be able to target subconscious biases, but if you live in a country that criminalises the very right for LGBTQI people to exist, then your focus might be campaigning and advocating for basic protections under the law.
Stigma and discrimination can touch everyone but their impact on LGBTQI people is profound. It can be as opaque as being denied the right to transition, like Tom, or as insidious as being aware your doctor doesn’t approve of your sexuality and avoiding STI tests, like Peter. In everything we do, we should seek to better educate ourselves and challenge our beliefs about groups of people we perceive as different to ourselves. In doing so, we’ll come to realise that something as ludicrous as ‘gay medicine’ doesn’t exist; there’s just medicine, and there’s just people.
^All names in this article have been changed to protect confidentiality.
*Dead-name refers to a transgender person’s name before they transitioned, usually associated with the gender they do not identify with (note: not all gender diverse people will take a new name, however if they do it’s important to respect this and never dead-name that person).
**LGBTQI stands for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex and will be used as an umbrella term throughout the article. The author understands and respects the different lived-experience for each person and that some people with diverse genders and sexualities do not identify with this acronym.
^^This statistic is true as of May 2017: some facts may have changed since then (for example, India decriminalising sex between people of the same sex).
About the author:
Robbie Bedbrook is a Registered Nurse from Sydney, Australia who works clinically and as a consultant in content creation. His brand ‘Nurse Robbie’ and his video channel ‘Hot on Health’ aim to increase rates of health literacy and advocate for nurses globally. Robbie is an Honorary Associate Lecturer with the University of Wollongong, Australia and the current Curator of the Sydney Global Shapers.
Facebook: Nurse Robbie, Hot on Health (@nurserobbieofficial - https://www.facebook.com/nurserobbieofficial/ )
YouTube: Hot on Health (https://www.youtube.com/channel/UCs_UlPL70W6_Rz3_H9G5EEA/videos)