Steve Slack on why being gay is still bad for your health

Steve Slack

• Increase image
• View all images

Despite improvements in UK legislation protecting the rights of lesbian, gay, bisexual and transgender people, discrimination is still affecting the quality of health and social care this community receives.

So why does being gay still negatively affect your health? Attitudes in the UK have significantly improved, particularly in relation to legislation, including the abolition of section 28 of the Local Government Act 1988, employment protection rights, rights around goods and services, and legal recognition of same sex partnerships. Yet gay communities continue to be disproportionately affected by ill health, self-harm and suicide.

While gay and bisexual men are the group most at risk of acquiring HIV in this country, there are other health risks, such as poor sexual health compounded by low self-esteem, poor body image, and eating disorders. Stigma and homophobia continue to contribute to poor sexual health among gay communities and many health and social care agencies fail to recognise the specific needs of lesbians, gay men, bisexual and transgender people.

A health colleague of mine recently commented, in all innocence, that we should treat everyone the same and that sexual orientation is irrelevant. However, as Thomas Jefferson said: "There is nothing more unequal the equal treatment of unequal people." We should recognise that the lesbian, gay, bisexual and transgender community has specific needs that should be addressed - and high on that list is tackling homophobia and stigma.

Concealed identity

Research undertaken by Sigma in 2004 demonstrated that over 50 per cent of gay men had not disclosed their sexuality to their GP. Reasons for lack of disclosure included concerns about breaches of confidentiality and in some cases fear of a negative response from their doctor. Such lack of openness is likely to lead to poor communication between doctor and patient and may, in some cases, impede a dialogue about alcohol and drug use and sexual activity.

This year, the Health Protection Agency, which provides detailed information about HIV prevalence, reported that a significant proportion of people diagnosed late with advanced HIV infection had been in contact with healthcare professionals in the preceding year due to HIV symptoms. This may indicate the ongoing stigma related to HIV and GPs' fears of offending patients, but it may also indicate a general lack of openness about sex, sexuality and sexual practices between patient and doctor.

In 2006, Stonewall investigated homophobic harassment experienced by NHS and social care staff and concluded that a culture of homophobia was affecting staff performance and the effectiveness of service delivery. A locum consultant haematologist from the North East documents his experience after his personal mail was opened at the office. He said: "My secretary discovered that I was gay and objected to working for me and doing my correspondence to patients... I reported this to my manager, the clinical director, who said he was powerless, that the lady had a right to express her opinion and that I had to sort it out myself. The lady refused to speak to me, bad-mouthed me to her colleagues and was supported in her attitude by clerical management."

Groups at risk

The Department of Health has recently produced a briefing entitled Reducing Health Inequalities for Lesbian, Gay, Bisexual and Trans People. It provides evidence of the health needs of lesbian, gay, bisexual and trans people. It suggests that some lesbians may have a slightly increased risk of breast cancer due to lifestyle issues such as being less likely to have children, less likely to seek gynaecological care, more likely to be overweight and more likely to drink alcohol than heterosexual women.

In a national survey, 12 per cent of eligible lesbians never had smear tests because they thought they were not at risk of cervical cancer. Some lesbians even reported being refused smear tests, despite evidence that some of them were at risk of developing cervical cancer.

The report author, Dr Julie Fish of DeMontfort University, says: "Healthcare and other professionals commonly assume that lesbian, gay, bisexual and transgender people's health needs are the same as those of heterosexual people, unless their health needs are related to sexual health. These briefings are intended to show that these people can be younger, older, bisexual, lesbians, gay men, trans, from black and minority ethnic communities and disabled, and to dispel assumptions that they form a homogenous group."

Changing attitudes and laws in the UK have significantly improved the lives of lesbian, gay, bisexual and transgender communities, but it is clear that health and social care professionals, policy makers and the public have much to learn if we are truly prepared to reduce health inequalities and ensure equal access to all.

The Centre for HIV and Sexual Health is hosting a conference on this topic called All Things Equal in Sheffield on 19 June. For more information visit www.sexualhealthsheffield.nhs.uk