Why is it important to work on LGBTI health?
Our own individual health is vital to each and every one of us; how we feel physically and mentally impacts on all other facets of our lives. So it is natural that ILGA-Europe focuses on LGBTI health issues as part of our human rights and equality work.
Talking about LGBTI health means many things. Firstly, LGBTI people frequently experience discrimination when accessing health services. Potentially, some LGBTI people might not get the care they need at all because of the barriers they face when seeking access to health services. Secondly, trans and intersex people in particular face specific concerns related to pathologisation of their identities and forced sterilisation. Thirdly, there are also specific health concerns that are of greater relevance to LGBTI individuals.
What issues do LGBTI people face when accessing health services?
Discrimination and barriers
Figures from the FRA 2012 LGBT survey are not very encouraging. Due to a fear of experiencing stigma or discrimination, LGBTI people may not disclose their LGBTI identity. On average, 42% of those surveyed would not be open about their LGBT status with any healthcare personnel at all. 10% of those surveyed felt personally discriminated against by healthcare personnel in the 12 months before the survey. Failure to disclose your LGBTI identity could also have specific knock-on consequences for your health. Older LGBTI people are particularly at risk, as anxiety related to earlier negative experiences with health services could make it very difficult to cater for their needs as they grow older.
Some concrete examples of the issues that an LGBTI person might face when accessing healthcare are:
- Inappropriate curiosity, comments or even refusal of treatment by healthcare personnel after disclosure of LGBTI identity.
- Same-sex partners not being consulted on the care given to their partner or their children or even being denied visitation rights.
- Barriers for lesbian and bisexual women receiving fertility treatments, or discrimination during pregnancy.
- Double stigma towards LGBTI people living with HIV/AIDS.
The pathologisation of trans and intersex identities
If you are trans or intersex, you can also suffer particular difficulties when dealing with health services. Your local doctor or health insurance provider may not be aware of the needs of their trans and intersex patients. While hopefully this will require nothing more than a little explanation, unfortunately it might mean that trans and intersex people don’t receive the patient-centred healthcare they need.
- Trans people are still being diagnosed as mentally ill in many European countries. The latest version of the World Health Organization’s International Classification of Diseases (ICD-10) still contains a gender identity disorder (GID) diagnosis. Many countries across Europe still see GID diagnosis as a prerequisite for legal gender recognition.
- Trans people are being forced to undergo inhumane surgical procedures such as sterilisation in order to change their legal gender in several European states.
- Most intersex people have experienced or are experiencing “normalising” surgical procedures without their consent.
- 22% of trans people surveyed by the EU Fundamental Rights Agency (FRA) in 2012 felt that they had been discriminated against by healthcare personnel.
Are there health issues that are specific to LGBTI people?
Yes and No. Illness and health problems are universal, so it seems facetious to suggest that there are differences of any sort. However, there are certain health issues that are particularly relevant to LGBTI people.
Across Europe, the prevalence of HIV transmission among men who have sex with men (MSM) and trans people (trans women in particular) remains high. Diverse factors explain this, for example ongoing discrimination and stigma against LGBTI people, leading in turn to low self-esteem and late diagnosis. The lack of comprehensive sexual and relationship education for young people across Europe also poses a major problem to effectively tackling HIV.
Stigmatisation and discrimination have an additional impact on LGBTI people’s mental health. This is illustrated by the concept of ‘minority stress’. Minority stress is psychological distress related to experiences of marginalisation, discrimination and stigmatisation. It may lead to increased risk of suicidal behaviour, self-harm, or an increased risk of depression. This needs to be taken into consideration by mental health services.
Another factor that may explain higher risks of mental health issues among the LGBTI community are the ongoing harmful practices within the health sector.
An example of this is ‘conversion therapies’. Though sexual orientation was removed from the WHO’s International Classification of Diseases in 1990, some psychologists and psychiatrists across Europe still suggest to their gay, bisexual or lesbian patients that their sexual orientation could be ‘changed’ using conversion therapy. In addition, traumatic relations with healthcare services (in particular in the case of intersex people) may also lead to mental health issues.
These mental health issues may lead to physical health problems, but also to substance abuse or eating disorders.
How does ILGA-Europe work on health?
Access to health is considered as a fundamental right at international and European level. There is clear evidence that health outcomes of LGBTI people are worse than for the rest of the population. However most policy makers and healthcare practitioners do not prioritise these issues, and there is a significant lack of systematic data.
ILGA-Europe work towards to securing effective legal protection against any form of discrimination in healthcare sector, and to prevent that trans people being diagnosed as mental ill.
We are striving to strengthen European legislation and policies by building the knowledge of policy makers on LGBTI people’s health.
Together with our member organisations, who work at national level, we identify and make sure to disseminate good practices. Moreover, if you are interested in joining our mailing list on health, then click here.
We also support and assist with litigation cases in the European courts.
- For more information, contact Cianán Russell, Senior Policy Officer.