Access To Health Services For Lesbian And Gay People - Essay Example

?Access to health services for lesbian and gay people Public services such as health care provision have a duty to meet the needs of all of the population on an equal basis, and indeed in the UK there are mechanisms and policies in place which are designed to ensure that this takes place. There are, however, particular groups which, according to the scholarly literature, appear to be less well served by national provision. This paper explores the way that lesbian and gay people access health services, noting that this group tends to access health services less frequently than the norm, and is less satisfied with healthcare also. It highlights the main issues that have been identified in this area for both health care providers and patients, and reviewing solutions which have been proposed to ensure that this group of patients receive the health care services that they require. It is estimated that between 3 and 6 per cent of patients seen by doctors are gay or lesbian (Bonvicini and Perlin, 2003). If bisexual and transgender people are included, then the percentage rises to around 10% (Lee, 2000). Many of these encounters, however, take place in such a way that the sexual orientation of the patient is not made known to the doctor and so it is likely that the figure may be even higher than this. In fact this problem of invisibility marks one of the main challenges facing healthcare providers at the present time: how to meet the needs of a group which are not always easy to identify, and which may be reluctant to access services which it really needs? (Edwards, 2012). The needs of this very diverse group of patients are often ignored simply because they are not well understood or because the health services are not geared up to the special needs of this group. Furthermore there has been a gradual realisation in recent years that some issues such as the AIDS epidemic have been used to stigmatise gay and lesbian people, even though it is clear that not everyone who has sex with people of the same gender shares a gay or lesbian identity (Meyer, 2001). Definitions are complex, and it takes effort to overcome societal prejudice and offer services which are accessible to all sectors of the population, according to their actual needs. The way that health care providers deal with gay and lesbian patients, is, however, very important for the long term health of these patients. One empirical American study (Paroski, 1987) found that gay and lesbian adolescents acquired their early knowledge about the gay and lesbian lifestyle from a range of formal and informal sources, including contact with healthcare providers. Many of the young people had acquired a stereotypical view about homosexuality from these sources, some of which was negative and harmful to them. This highlights the important education and support role that healthcare providers have. They should be presenting balanced information to young people in a non-judgemental way so that they do not become socialised into negative images of themselves, or of groups who have different sexual orientation than that of themselves. Encounters with the health services can be pivotal experiences for gay and lesbian young people, and negative experiences at this stage can have lasting effects on the willingness that they will have in later life to seek medical help. There have been several studies which have reported general dissatisfaction among gay and lesbian people with the health care that they receive (White and Dull, 1998). This is matched by findings which show that as many health care professionals have trouble talking communicating with non-heterosexual patients. One recent study of 2 GPs in Sheffield found that almost half had difficulty addressing non-heterosexual lifestyle issues and some even displayed openly homophobic attitudes (Hinchliff, 2005). It is not surprising, then, that gay and homosexual patients are often reluctant to be open about their sexual orientation in a primary healthcare setting. The consequences of keeping silent about sexual orientation can be serious, because it can lead to less than ideal care for the patient. Lesbians are less likely to have had children, and this raises risk for some kinds of cancer, but the issues mentioned in the previous paragraph mean that this group are in fact less likely than average to attend screening programmes. Evidence from an American study found, however, that lesbians are significantly less likely than heterosexual women to have seen a medical provider or to even have a regular source of healthcare (Heck et al., 2006) while the figures for gay men were much the same as for heterosexual men. This suggests that even within the group of gay and lesbian patients, the factors which influence men and women may be different, or may be having differential effects. As in the rest of society there are many varieties of gay and lesbian family structure, notably fragmentation and complexity which are typical of postmodern society (Stacey, 1996) and this has implications for the way that health providers deal with issues like patient confidentiality, visiting rights in hospital, access to children etc. Administrative systems can be designed to operate along non-sexist and non-judgmental lines, so that patients who do not fit the traditional married couple structure have the same rights as everyone else. Very often it is a matter of vocabulary and the avoidance of heterosexist assumptions rather than any major policy change that is recommended. Cohen (2004) found that social relationships are associated with health outcomes and cited three variables in particular, namely social integration, social support and negative interaction as being particularly influential. Gay and lesbian people are often stigmatised and it is assumed that they face higher risk than the general population due to high risk (and notably sexual) behaviours. The evidence from several studies has shown that this group do indeed have higher incidences of some health conditions, but these can be often traced back to the extra pressure of isolation and negative treatment (Savin-Williams, 1994). The single highest medical risk for gay and lesbian people has been identified as “the avoidance of routine health care” (Bonavicini and Perlin, 2003, p. 115). There are some potentially serious issue with older gay and lesbian patients due to historic and current barriers such as their invisibility in society during their younger years and experiences of homophobia and discrimination which they have encountered (Brotman et al., 2002). One meta-analysis of recent research on the needs of older gay and lesbian citizens found that “the health, social care and housing care of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services” (Addis et al, 2009). This evidence suggests that even though public services have been operating equal opportunities policies for decades, there is still much to be done before this group of service users are treated with the fairness that they deserve. There are particular legal and social issues which affect gay and lesbian people in the end of life and hospice situation, especially in cases where there is familial homophobia and a lack of support for gay relationships. Social workers and other service providers should be proactive in these situations on behalf of gay and lesbian couples, for example, who may struggle with the fragile legal status of their relationship and extra opposition and stress (Connolly, 1996). There are, however, practical difficulties in ensuring that this kind of specialist expertise is available uniformly across service providers and this is an area that policy makers and planners should be prioritising. Gender and sexual orientation are socially constructed phenomena (Annandale and Clarke, 1996) and it is reasonable to assume therefore that solutions to discrimination by staff, or reluctance to seek medical help on the part of patients should be sought in social mechanisms. One strategy that has been documented is the employment of openly gay team members in healthcare settings (Riordan, 2004) coupled with explicit gay-friendly policies in these loctions. This can have the effect of reassuring gay and lesbian patients and encouraging more open discussion in consultations, especially in a one to one situation, or in healthcare settings where a person attends for several sessions and has time to build trust with the staff. There are some risks, however, in single visit situations like emergency rooms and work with the general public, because this can expose gay and lesbian employees to verbal and even physical abuse from homophobic persons, and so appropriate safety and support mechanisms have to be in place to look out for staff and patient safety alike. In large cities special clinics and sessions for gay and lesbian patients can be organised, and this, too, would be an effective way of reducing barriers for this group. In the vast majority of public and private health settings, however, it would not be practical to have gay and lesbian staff in every team or special provision for gay and lesbian patients in every setting. The only way to reduce barriers lies therefore in better general training, less discriminatory language, and an emphasis on respectful and individual patient care which does not presume that patients are heterosexual. References Addis, S., Davies, M., Greene, G., MacBride-Stewart, S. and Shepherd, M. (2009) The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health and Social Care in the Community 17 96), pp. 647-658. Annandale, E. and Clarke, J. (1996) What is gender? Feminist theory and the sociology of human reproduction. Sociology of Health & Illness 18 (1), pp. 17-44. Bonvicini, K. A. and Perlin, M. J. (2003) The same but different: clinician-patient communication with gay and lesbian patients. Patient Education and Counseling 51 (2), pp. 115-122. Brotman, S., Ryan, B. and Cormier, R. (2002) The Health and Social Service Needs of Gay and Lesbian Elders and Their Families in Canada. The Gerontologist 43 (2), pp. 192-202. Cohen, S. (2004) Social Relationships and Health. American Psychologist (November), pp. 676-684. Connolly, L. (1996) Long-Term Care and Hospice: The Special Needs of Older Gay Men and Lesbians, Journal of Gay & Lesbian Social Services 5 (1), pp. 77-92. Edwards, J. (2012) The Healthcare Needs of Gay and Lesbian Patients. In E. Kuhlmann and E. Annandale, (Eds.), The Palgrave Handbook of Gender and Healthcare. Basingstoke: Palgrave Macmillan, pp. 290-305. Heck, J., Sell, R. L. and Shein, S. (2006) Health Care Access Among Individuals Involved in Same Sex Relationships. American Journal of Public Health 96 (6), pp. 1111-1118. Hinchliff, S., Gott, M. and Galena, E. (2005) ‘I daresay I might find it embarrassing’: general practitioners’ perspectives on discussing sexual health issues with lesbian and gay patients. Health & Social Care in the Community 13 (4), pp. 345-353. Lee, R. (2000) Health care problems of lesbian, gay, bisexual, and transgender patients. Western Journal of Medicine 172 (6), pp. 403-408. Meyer, Ilan H. (2001) Why Lesbian, Gay, Bisexual and Transgender Public Health? American Journal of Public Health 91 (6), pp. 856-859. Paroski, P. A. (1987) Health care delivery and the concerns of gay and lesbian adolescents. Journal of Adolescent Health Care 8 (2), pp. 188-192. Riordan, D. C. (2004) Interaction strategies of lesbian, gay, and bisexual healthcare practitioners in the clinical examination of patients: qualitative study. British Medical Journal 328, 1227. Savin-Williams, R. C. (1994) Verbal and physical abuse as stressors in the lives of lesbian, gay male and bisexual youths: Associations with school problems, running away, substance abuse, prostitution, and suicide. Journal of Consulting and Clinical Psychology 62 92), pp. 261-269. Stacey, J. (1996) In the name of the family: rethinking family values in the postmodern age. Boston: Beacon Press. White, J. C. and Dull, V. T. (1998) Health risk factors and health seeking behavior in lesbians. Journal of Women’s Health 6, pp. 103-112. Read More