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Improving services for gay and transgender patients.

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VOL: 103, ISSUE: 19, PAGE NO: 23

The Equality Act (Sexual Orientation) Regulations 2007 came into force on 30 April, making it unlawful for health a...

The Equality Act (Sexual Orientation) Regulations 2007 came into force on 30 April, making it unlawful for health and social care organisations and staff to discriminate against lesbian, gay and bisexual (LGB) people. The Department of Health has published a package of resources to help healthcare organisations improve the quality and uptake of health services for these patients (DH, 2007a, 2007b; Whittle and Turner, 2007).

Meeting healthcare needs

Stonewall has also published information on the healthcare needs of lesbian, gay and bisexual people (Stonewall, 2007). On women and general health needs the organisation states: 'The health needs of lesbians are one of the most neglected research areas in healthcare. There is, however, increased recognition by some researchers that lesbians do have unique healthcare concerns, and are generally underserved by the health sector.

'Research suggests that lesbians do not respond to preventive healthcare messages, and do not seek intervention or support from the health sector. Lesbians also have specific health issues relating to fertility, pregnancy, sexual health and mental health.

'Research suggests that lesbians want to disclose their sexual orientation to their GP, but are reluctant to do so because they think that they might be discriminated against. Research suggests that lesbians are generally unhappy with the level of service they receive from the health sector.'

On men and general health needs, Stonewall states: 'There has been extensive research that examines the health needs of gay men, yet this research is predominately concerned with the sexual behaviour of gay men, and the prevention, treatment and social policy implications of HIV and Aids.

'This preoccupation with sexual health and HIV can have an impact on service delivery to gay men. Gay men have health needs other than those that relate to sexual activity and HIV prevention. This preoccupation, however, can sometimes affect health service delivery.'

Stonewall seeks to challenge the assumption that women who have sex with women cannot contract sexually transmitted infections. As the organisation points out: 'Women can, and do, exchange fluids, and engage in sexual activity that can have consequences for a woman's health.' It adds that women seek information about safe sex from sources other than the health sector because these issues are generally not discussed with healthcare professionals.

Information on men and their sexual health needs points out that, like the rest of the population, gay men are at risk from STIs, but adds that they remain the group at greatest risk of HIV infection.

Good practice guidance

The DH has published two leaflets to help healthcare professionals improve the quality and uptake of services among these target groups: An Introduction to Working with Lesbian, Gay and Bisexual People (DH, 2007a) and An Introduction to Working with Transgender People (DH, 2007b). The first gives a range of information and advice to healthcare professionals, including the following points:

- At least 6% of the population is lesbian, gay or bisexual;

- 'Outing' someone (revealing their sexual orientation to someone else) could put her/him in danger. Always ask who the person wants you to contact and how she or he wishes to be contacted;

- Many LGB people do not reveal their sexual orientation to healthcare professionals. Try to create an environment where this is possible;

- LGB people have a variety of health needs. The issues are not just about sexual health - others include substance misuse, eating disorders, obesity, mental health, suicide and self-harm;

- Many young people identify themselves as lesbian, gay or bisexual, or may be questioning their sexual orientation. It is important to support them in a non-judgemental way and signpost them to appropriate youth services;

- Civil partnership gives the same legal rights as marriage to same-sex couples, including next of kin and parental rights.

The DH (2007a) states: 'NHS and social care organisations need to ensure that their policies, procedures and practices for staff and patients/service users are inclusive in their language and content.'

The DH (2007b) leaflet on transgender people is intended to support staff to ensure this group does not experience discrimination in service delivery. Its information includes:

- About one in every 11,500 people in the world is transsexual, feeling they belong to the gender opposite to the one assigned to them at birth;

- 'Transgender' means different things in the UK and US so it is preferable to use the term 'trans' for all people who cross gender boundaries, permanently or not;

- Men are as likely as women to be trans;

- Not all transsexual people are able to or choose to have genital reassignment surgery, yet they can still be legally recognised in their new gender role;

- The process of transition between genders can involve a period of living in the intended role, hormone therapy and surgery as appropriate, but not all pathways are the same for trans people;

- Trans people can have a lesbian, bisexual, gay or straight identity. It is always best to ask in a respectful, supporting way about next of kin without making assumptions.

The Department of Health has also published a document on bereavement aimed at transsexual and transgender people and their relatives (Whittle and Turner, 2007), following recent legal changes regarding gender recognition as well as obligations to protect privacy. The document states that this group has particular needs regarding privacy, and that a bereavement may bring up particular issues (see box below).

Advice for the bereaved trans person and their relatives

- A bereavement is a difficult process for anyone but for a trans person it may bring up particular issues. If the trans person has been estranged from her or his family, it may be very difficult to have contact with them again, particularly if they do not accept the person in her or his acquired gender.

- The member of family who died may never have known the person in her or his preferred gender, which may cause added distress and feelings of regret or anger.

- A friend could be asked to act as an intermediary between the trans person and other family members.

- For some trans people a death could present an opportunity to regain contact with the family.

- It is important to remember that people respond to bereavement in different and sometimes unpredictable ways. They may say or do things they regret later. There are different stages of bereavement and they do not happen in the same order for everyone.

- A relative of a trans person who has died may feel a range of emotions depending on the circumstances of the death. The relative may have been the only family member who knew they were trans, or they may have felt unable to deal with their identify and not been in contact for many years, or they may have only discovered upon their death that they were trans.

- The process of bereavement can bring up a whole range of feelings, none of which are 'right' or 'wrong'. Relatives may feel anger towards the trans family member for what she or he put them through in her or his life, or they may feel guilt or regret that they could have done more for her or him.

- Relatives may not know how to tell friends or work colleagues about the bereavement - colleagues may not have known that a member of the family was trans or the relative may anticipate some prejudice. It would be helpful to confide in a friend.

- Although there is still prejudice and discrimination, it may be helpful for relatives to know that their trans family member was fortunate enough to have lived at a time when there was more acceptance.

- If relatives have difficulty understanding these issues, it may be helpful to contact support organisations or visit websites (see the document at

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