HPHD LGBT Health and Sexual Diversity

Question 1

What is sexual orientation?

Answer 1

Used to describe what gender you are attracted to - includes feelings, behaviour and identity however the 3 may not coincide

Question 2

Define:
Gender identity
Gender expression

Answer 2

Gender identity is how someone feels to be - their own internal perception of their gender

Gender expressions is how someone dresses, talks, acts, it is the way someone lives in society and interacts with others

Question 3

Define:
Transgender
Transsexuals

Answer 3

Transgender is an umbrella term for those whose gender identity or expression differs from their birth sex eg transsexuals, transvestites, cross dressers

Transsexual people are those who feels a consistent desire to fulfil their life as a member of the opposite sex - may undergo gender reassignment medically

Question 4

Why do the LGBT population experience poorer health?

Answer 4

The problem is not about them being LGBT, but about discrimination and marginalisation
eg 50% experience abuse at school (20% from teachers), they can be discriminated by healthcare providers, 12% are rejected by their family.

This leads to a distrust of authorities inc healthcare, isolation, and may rely on sub-cultures for a support network leading to risky behaviour eg go to gay bars where theres drink, drugs, cigs

Question 5

How do some stereotypes about LGBT patients can affect their healthcare?

Answer 5

• Lesbians can be refused smear tests
• It can be assumed that all gay/MSM are at high risk of HIV (may not have anal sex or be very careful)
• a butch looking woman doesnt need contraception
• a lesbian doesnt want children

Question 6

What are the specific health needs in the LGBT community?

Answer 6

• mental health services
  Higher levels of anxiety, depression, suicidality
• smoking and substance cessation support
  Higher rates of smoking, alcohol, drugs
• cancer (increased prevalence of anal cancer in MSM)
  Lesbians still need smears
• STIs
  HIV and syphilis more common in MSM
  WSW can contracts STIs

Question 7

How can doctors provide good ethical care to LGBT patients?

Answer 7

• validate the patients identity
• confidentiality, dont reveal their sexuality or gender without their permission
• be able to distinguish between patients problems and their identity eg if a gay man comes in with suicidal thoughts, dont assume its because hes gay

Question 8

Why is it difficult to get accurate info about sexual behaviour?

Answer 8

• sexual problems may not be obvious eg someone not being happy with any offered contraception
• patients may be reluctant to raise a sexual problem eg stigma, embarrassment, religious issues, fear of judgement
• doctors may struggle to ask personal and traumatic questions eg rape, detailed sexual activity

Question 9

What is the NATSAL survey?

Answer 9

The National Survey of Sexual Attitudes and Lifestyles - it is the main source of info in the UK about sexual behaviour.

Question 10

What is cultural identity?

Answer 10

Culture is defined by each person in relationship to the groups with whom he or she identifies. It is based on heritage as well as circumstances and personal choice.

Question 11

Why is diversity important to health care delivery?

Answer 11

• there is increasing diversity of both populations and work force
• taking a patient centred approach to care improves outcomes

Question 12

How can culture impact on patients presentation to health services?

Answer 12

• the way they view mental health problems
• their view of which services they choose to accept
• the treatment and management strategies they find acceptable
• may have reduced access to services