Researchers, experts, and activists in lesbian, gay, bisexual, trans and intersex (LGBTI) health conducted a state-of-the-art review study and 12 focus groups in six EU Member States in the context of the EU funded pilot project Health4LGBTI.
The aim was to better understand the specific health inequalities experienced by LGBTI people and the barriers faced by health professionals when providing care to these groups. The countries involved were Belgium, Bulgaria, Italy, Lithuania, Poland and the UK. Although situations vary across Member States, the study’s findings revealed the existence of health inequalities, barriers, and discrimination based on sexual orientation, gender identity, gender expression and sex characteristics of LGBTI people. The results will be used to develop training for health professionals.
The findings were corroborated by focus groups that were conducted with LGBTI people and with health professionals in the six Member States. The stories and experiences shared by participants revealed a wide variety of ongoing inequalities and barriers in LGBTI healthcare, regardless of whether equality for LGBTI people is supported at the political level or not. LGBTI people and healthcare professionals involved in the project agreed that mandatory training around LGBTI issues is needed by all staff in healthcare services.
The study is part of a 24-month project that started in April 2016.It is funded by the European Parliament and carried out by the European Commission, which contracted a Consortium of organisations and universities to execute it. Key findings include:
- Root causes likely to contribute to the experience of health inequalities by LGBTI people are: i) still prevailing cultural and social norms that assume people are non-LGBTI by default; ii) minority stress associated with sexual orientation, gender identity and sex characteristics; iii) victimisation; iv) discrimination (individual and institutional), and; v) stigma.
- Significant mental and physical health inequalities exist for LGBTI people. For example, LGBTI people are at significantly higher risk of poor mental health compared to the general population which includes higher incidence of suicidal thoughts, substance misuse, anxiety, and deliberate self-harm.
- LGBTI people face barriers when accessing healthcare. Examples include prejudicial attitudes and discriminatory behaviour of healthcare staff; unequal treatment; needs not being recognised; fear of disclosure of gender identity, sexual orientation, or sex characteristics. Cases were reported where LGBTI people see themselves being refused healthcare services due to their sexual orientation, gender identity, or sex characteristics.
- Many health professionals lack knowledge and cultural competence concerning the lives and healthcare needs of LGBTI people. Firstly, medical literature regarding LGBTI people needs to be updated, secondly health professionals’ assumptions can be a barrier to LGBTI people seeking healthcare. These include assumptions that people are non-LGBTI by default; that being LGBTI is irrelevant; and that LGBTI people do not experience significant discrimination. Thirdly, they can find it difficult to challenge anti-LGBTI attitudes from both colleagues and patients.
- Specific groups within LGBTI (particularly bisexual, trans and intersex people) encounter their own specific barriers, and healthcare professionals’ knowledge of these groups is limited.
- Although scarce, in some Member States, examples of promising practice in meeting the needs of LGBTI people are evident.
The study revealed there are significant gaps in research on the topic. For example, there is very limited research with trans and intersex people to better understand their general health profile, experiences, and physical and mental health needs in relation to service provision. Similarly, further research that adopts an intersectional perspective on health inequalities experienced by LGBTI people is required. Where research does exist, it shows that living in rural areas, being a migrant, refugee, and/or asylum seeker, being on a low income, being young or old, and living with disabilities can contribute to health inequalities for LGBTI people and have implications for access to health services.
The findings of the review and the feedback about the kind of training needed gathered during focus group sessions are being used to develop a new training package for healthcare professionals across the EU. This modular training package will expand healthcare professionals’ skills regarding LGBTI people’s healthcare, in order to help address the barriers and inequalities identified.