Issues for Gay, Lesbian, Bisexual, Transgender (GLBT) individuals
Being part of a minority sexual group influences patterns of health.[1] In 2003 the Tasmanian Department of Health and Human Services conducted a Gay, Lesbian, Bisexual and Transgender (GLBT) Needs Assessment Survey. Survey results indicated that isolation from one another and the general community was of greatest health concern. Depression was also identified as a major issue, with 40% of participants listing depression as a personal health and wellbeing concern. A related issue is that of discrimination and 36% nominated homophobia (physical or verbal harassment) as impacting upon their lives. [2]
End of Life Care –Issues for GLBT people
For all patients receiving palliative care, their lifetimes’ social experiences come together at the end of life to provide a network of relationships which provide the dying person with their most essential emotional and practical support. There can be discontinuities and unresolved issues which the dying person, or other people in their life, may hope to resolve before the person dies, and there are patterns of resilience, coping and vulnerability which the dying person has evolved over their lifetime, which determine how they will respond to their situation. Within this common context, GLBT people experience some issues which are uniquely related to their social experience and identity.
Relationships with Health Care Providers
Health professionals need to be aware of the issues faced by some members of the GLBT community when providing care. Not all issues highlighted here are valid for all GLBT individuals but awareness of greater risk factors or propensity to some illnesses is needed.
In health consultations, not all GLBT individuals will volunteer their sexual orientation or identity. In a study of 575 lesbians, gay men and bisexuals in New York, the reasons given for non-disclosure were: not comfortable discussing it, concern about bad reaction or treatment, not wanting it on their medical record or worry that someone would find out (health insurer, employer, or family). [3] Some individuals will ‘screen’ healthcare professionals before engaging in a relationship, or will go to someone that has been suggested to them. [4] By telling you of their sexual identity, this person is putting a large amount of trust in you as a health professional. Ask what kind of support they would like from you, and what is important to them at this time.
Health professionals are sometimes uncomfortable with providing services to GLBT individuals. [5] Ethically responsible health professionals will ensure that this does not result in subsequent discrimination and substandard care. It is important to keep language free from heterosexual bias – words like “wife” or “husband”. More importantly, use the client/patient’s words back to them when making reference to their “partner”, “girlfriend”, “boyfriend” etc..
Patients may also become unfairly stigmatized by health professionals when a medical diagnosis such as HIV/AIDS, is assumed to have been contracted through male same-sex contact, or the patient’s participation in trading sex for money, or as a consequence of needle sharing and IV drug use. Health professionals have a duty of care to educate and advise patients of how to reduce the risk of their disease to themselves and others, but not to criticize a patient’s choices.
Particular Health Concerns for Gay, Lesbian, Bisexual and Transgender Individuals
GLBT individuals do not always access health services, for some of the reasons given above. They may also not access health screening services, consequently being at greater risk of developing some cancers. (eg, lesbian women experience higher rates of breast cancer, and gay men, particularly those with HIV, experience higher rates of HPV-related cancers including penile and anal cancers).
Significant rates of mental illness have been reported among lesbian and bisexual women, with up to 2-3 times higher rates of depression, anxiety disorders and suicidal ideation. [1] This is also true of same sex attracted youth (especially males) who have high rates of distress, despair and suicide. [6] Substance misuse often complicates mental illness for gay and lesbian people. People with higher levels of distress are more likely to self-medicate with alcohol and other drugs.
Self –identified bisexuals are also reported as experiencing high levels of abuse or violence (including sexual coercion), discrimination (also from gay men and lesbians) and ill health. [7] Particular health issues affecting the transgender community (which includes transsexuals, cross-dressers, and the biologically intersexed) relate to the use of hormone therapies, illegal drugs, HIV infection and participation in the sex trade. [8]
HIV AIDS has long been an issue for many GLBT individuals. Dependent upon lifestyle, some GLBT individuals will have a risk of contracting HIV. Many support services were instituted in the 80s and 90s but these are not necessarily still in place now, or are not necessarily accessible, particularly to people living in rural areas. Very effective treatments have subsequently become available for controlling, but not curing, HIV AIDS. There are now many people living with HIV who have done so, or will do for many years. The key health and social problems for most HIV positive people now relate to managing a complex chronic disease, rather than an inevitably terminal illness with a short prognosis.
There are specific problems related to providing appropriate aged care services for the GLBT community. Older people generally are not viewed in terms of their sexuality, and are likely to be presumed to be heterosexual. [9] Many older GLBT individuals lived through very hostile overt discrimination in their early years. They may be less open regarding their sexuality as a result. It has been reported that homophobia and heterosexism are even more common in elder care systems than within the health care system generally, with for example, lack of available supported accommodation for elderly same-sex couples. [10]
Relationships with family and end-of-life decisions
Some GLBT individuals are not in close contact with their family of origin. Some have no children, or have children who do not accept their sexuality. [9] All of this can impact at the end of life, meaning that for those GLBT individuals who are relatively isolated with few practical support networks, their options for where they can be cared for are reduced. Equally, others have strong family and social networks, or it may be a time for reconciliation with family, old friends or with children.
Not all GLBT individuals are open about their sexuality. Family and friends may not be aware of their relationships. Long-term friendships may not be recognised for what they are. This may mean the person who is ill, or their partner, may not be openly acknowledged. They may be unknowingly, and even knowingly, excluded. It may be the responsibility of health professionals to recognize a partner’s rights in end-of-life decision making in the face of family opposition or ignorance.
In end-of-life decision making, the preferences of the person who is ill to have a partner advocate for them may not be recognised by their family. Same sex partners may not be recognised either socially or legally. This could be in respect to carers leave, as next of kin in decision making, in business matters, decisions about burial or cremation, and access to the body of the partner while dying or after death. This may also include rights to benefits after a partner has died. GLBT people in relationships which are not recognized under the law may need to give power of attorney to their partners to ensure they are not excluded from participating in important decision making about the care of their partner. [11]
Care at home at the end of life may be difficult for GLBT individuals. They may need to ‘come out’ to health professionals at this time regarding their living arrangements. They may be judged in a negative light by caregivers for their sexuality. As a result of this, carers for example may not communicate well with health professionals. [9]
Bereavement
There is a lot of literature from the early years of HIV / AIDS when bereavement issues associated with multiple ongoing losses was first acknowledged. Much of this is still relevant in relation to loss of a same sex partner and what that entails.
Death of a life partner and the subsequent bereavement period is difficult for anyone. For those in a same sex relationship, there are other issues to be considered. A GLBT individual may not be recognised as bereaved. This is especially true if their relationship was not known or acknowledged. Health professional, family and social support may be lacking during this time. It is important that same-sex partners are offered the same support that heterosexual partners would receive. They should not have to ask for it when they are already distressed.
Policies and Resources
Ageing
Websites
References
- McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Med J Aust. 2003 Jun 16;178(12):643–5.
- Blanch Consulting. Gay, Lesbian, Bisexual and Transgender Health and Wellbeing Needs Assessment. 2003 Mar;100pp.
- Stein G, Bonuck K. Physician–Patient Relationships Among the Lesbian and Gay Community. Journal of the Gay and Lesbian Medical Association. 2001 Sep;5(3):87-93.
- Eliason M, Schope R. Does “Don’t Ask Don’t Tell” Apply to Health Care? Lesbian, Gay, and Bisexual People’s Disclosure to Health Care Providers. Journal of the Gay and Lesbian Medical Association. 2001 Dec;5(4):125-34.
- Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. J Adv Nurs. 2006 Aug;55(4):407–15.
- Smith AM, Rissel CE, Richters J, Grulich AE, de Visser RO. Sex in Australia: reflections and recommendations for future research. Aust N Z J Public Health. 2003;27(2):251-6.
- Heath M. Pronouncing the silent ‘B’ (in GLBTTIQ). Gay & Lesbian Issues and Psychology Review. 2005;1(3): 87-91.
- Schilder A, laframboise S, Hogg R, Trussler T, Goldstone I, Schechter M, O'Shaughnessy M. "They Don't See Our Feelings." The Health Care Experiences of HIV-Positive Transgendered Persons. Journal of the Gay and Lesbian Medical Association. 1998 Sep;2(3):103-11.
- Price E. All but invisible: older gay men and lesbians. Nurs Older People. 2005 Jun;17(4):16-8.
- Brotman S, Ryan B, Cormier R. The Health and Social Service Needs of Gay and Lesbian Elders and Their Families in Canada. Gerontologist. 2003 Apr;43(2):192–202.
- Irwin L. Homophobia and heterosexism: implications for nursing and nursing practice. Aust J Adv Nurs. 2007 Sep-Nov;25(1):70-6.
This page was created on 03 November 2009.
Last updated 28 July 2010