A prominent theme of AIDS2020 was the promotion of LGBT+ inclusive healthcare. In the United Kingdom, almost one in four LGBT+ people have witnessed discriminatory or negative remarks against LGBT+ people by healthcare staff (Stonewall UK). This means that, for some, healthcare settings do not feel safe. If a healthcare setting does not feel safe, a person may not use it. If they do not use it, they may miss out on treatment which could be potentially life-saving and they may look for alternative means of treatment. 37% of transgender people in Scotland have avoided healthcare treatment due to fear of discrimination (Stonewall Scotland). Until it feels fair and safe for everyone, it is not fair and safe. 

At AIDS 2020, Abhina Aher (@meisabheena) discussed the impact of punitive laws on transgender people accessing healthcare services in India. She clearly stated that people will not access services where they face stigma and fear criminalisation. But what about where criminalisation does not exist? Does this mean that services are adequate? Not always. 

I was grateful to Max Appenroth (@MaxAppenroth) for sharing his experience of accessing healthcare in Germany. His words were powerful, stating ‘I am not here to feed your curiosity’ in response to inappropriate questioning from medical staff. In the UK, one in four LGBT+ people have experienced inappropriate curiosity from healthcare staff. Half of transgender people and more than a third of non-binary people have experienced this; 29% of transgender people have experienced this in the last year alone (Stonewall UK).

I believe it is the responsibility of healthcare professionals to educate themselves and each other on the needs and experiences of LGBT+ people. This can be done through cultural competence training, consulting LGBT+ activists and engaging in meaningful feedback discussions with the LGBT+ community. However, it is not enough to just ask the questions, they must listen to the answer and make necessary change.  I would like to share some of the words from stories which I found particularly compelling at AIDS2020:

“Our voices have been silenced, like we are not sexual beings… why are you leaving us behind” Tebogo Nkoana, Transgender and Intersex Africa

“I cannot trust this medical system to really address my needs appropriately…. When we seek healing, we often experience damage… Wherever I go, I expect not to be treated appropriately because knowledge is lacking…it is the ethical obligation of medical professionals when you enter that field…you care for everyone” – Max Appenroth, Trans Activist

“People are walking into your spaces with a lot on their mind and it’s very important that we make sure we accommodate them…The system continues to fail us – racism, homophobia and stigma of HIV… I had to work to find my own breath through healing”” – Darius Rucker, Williams and Associates

Transgender women are 49 times more likely to be living with HIV globally. Gay, bisexual and other men who have sex with men are also more likely to be living with HIV (World Health Organisation). It is essential that healthcare services meet the needs of the LGBT+ community. Health Protection Scotland released a report in December 2019 on the implementation of HIV PrEP in Scotland. Between July 2017 and December 2019, 53,000 people were accessing sexual health services in each calendar quarter (i.e. July to September, October to December etc.). Of these 53,000, 0.2% identified as transgender. A breakdown of those prescribed PrEP in each quarter is also given. 0.7% of those prescribed PrEP in the final quarter (October to December 2019) identified as transgender. Although not everyone who identifies as transgender may benefit from PrEP, this number is low. Healthcare Protection Scotland has stated that this number is increasing with time. But, how can we expect an increase if our spaces don’t always feel safe?

I am a medical student in Scotland and I can recall only one session where I was taught about the needs of the LGBT+ community. As a member of this community, I find this upsetting. I would like to see changes to the curriculum to broaden the knowledge of those studying to become healthcare professionals. This should include the testimonies of the LGBT+ community.

If you are a healthcare professional who would like to make your service LGBT+ inclusive:

  1. Educate yourself on what you don’t know and refrain from inappropriate curiosity. Below are some resources which may be helpful in getting started:
  1. Ask for feedback on your service from LGBT+ patients, listen to their feedback and act on it.
  2. Don’t make assumptions, every person has their story.

If you identify as LGBT+ and need to attend a healthcare setting:

  1. Please know that you have allies within the NHS who are working hard to drive change.
  2. If you feel able to, please continue to give feedback on your care experiences.
  1. The onus is not on you to educate others.

 

If you have come across any additional resources which you would recommend, please do share in the comments.

(@_Sophie_Corbett)