Vector Volume 11 Issue 2 - 2017

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Sexual health LGBTQIA+ individuals may also experience poorer sexual health. There is evidence to suggest that women who have sex with women (WSW) are at higher risk for cervical cancer.[32] Both patients and clinicians lack awareness around sexually transmitted infection (STI), specifically human papilloma virus (HPV), transmission during cisgender woman to woman sexual contact. Consequently, WSW are less likely to have Pap or other cervical smears.[33] Key LGBTQIA+ health issues Besides issues of access, LGBTQIA+ individuals have specific healthcare risks, needs and concerns. Pertinently, LGBTQIA+ individuals have significantly poorer mental and sexual health. They also have higher incidence of certain chronic diseases such as cardiovascular disease, asthma and diabetes.[30] Mental health Poorer mental health is one of the ways that stigma affects LGBTQIA+ individuals’ wellbeing. Compared to the general population, LGBTI people in Australia are five times more likely to attempt suicide in their lifetimes and more specifically, TGD-identifying individuals are eleven times more likely.[31] LGBT people are also twice as likely to be diagnosed and treated for mental health disorders, and 24.4% of LGBT people aged 16 and over currently meet the full criteria for a major depressive episode.[31] Reasons for poorer mental health are also based in internalised, inter-personal, organisational and structural stigma and discrimination.[31] These include: bullying at schools, lack of bullying laws, ostracism from families and faith communities, fear of employment and economic stability, and inner conflict and internalised phobia about their respective identities. LGBTQIA+ individuals also have higher risk for poor coping mechanisms and substance abuse.[32] In addition, MSM have greater incidence of HIV. In Australia, HIV transmission occurs primarily through male-to-male sex with 68% of new HIV diagnoses in 2015 having been attributed to male-to-male sex.[34] Besides the greater susceptibility of anal mucosa, this increased incidence arises from the concentration of HIV within MSM sexual networks in Western nations.[35] Receptive anal intercourse in male-to-male sex may also increase risk of hepatitis B, HPV and herpes.[32] In NSW, MSM are also more likely to report ever having had an STI, particularly chlamydia, pubic lice, genital herpes, syphilis, anal warts and gonorrhoea.[36] As some of these STIs are risk factors for anal cancer, MSM are also at greater risk for anal cancer.[32] However, MSM are also more likely than any non-MSM to be tested for STIs.[36] Furthermore, poor data collection means that the sexual health of TGD populations in Australia remain poorly understood. The tendency to collapse TGD experiences into a single ‘third gender’ category ignores the vast differences in risk associated with different gender identities, sexual orientations and partners. For example, the Kirby Institutes’ 2016 annual report on STIs recorded sex as ‘male’, ‘female’ and ‘transgender/ missing’.[37] This is particularly disappointing in the context of trans women in particular being significantly overrepresented in global HIV prevalence.[38] Aging Owing to Australia’s aging population, the issue of older Key messages • LGBTIQA+ people face barriers to healthcare access, historically influenced by discrimination from the medical profession • Health disparities exist between LGBTIQA+ individuals and the general population, particularly in the areas of mental health, sexual health and chronic disease • Further research and education, a collective effort to treat LGBTIQA+ people with individual respect, and a willingness to learn, will help to reduce health inequalities *In certain parts of this article, terms to refer to the sex, sexuality and gender diverse individuals may change dependent on the groups of people being researched in the various research articles cited. 7
LGBTQIA+ individuals is topical. LGBTQIA+ individuals in aged care have specific care needs such as ongoing HIV/AIDS treatment and hormone therapy. Having lived through the criminalisation of homosexuality, many may be impacted by an internalised need to go ‘back into the closet’ for fear of discrimination.[39] Improving access To reduce the aforementioned barriers and risks, various areas can be improved. Institutionally, education around LGBTQIA+ issues of sexuality, gender diversity, access and risk should be integrated into the medical curriculum. Trainees should be taught to adopt non-judgmental approaches to history taking and communication.[16, 40] Whilst questions such as “do you have a boyfriend/girlfriend?” seem innocent, they carry value judgements on what is considered ‘normal’. Instead, more inclusive terminology should be encouraged to enable clinicians to invite discussion around sexual health without assuming heterosexuality or gender binaries. Encouragingly, previous efforts in introducing LGBTQIA+ content through lectures and clinical simulations have been effective in decreasing at least clinician discomfort in providing LGBTQIA+ related care.[41-44] Clinicians should also create environments of inclusiveness. This includes respecting patients’ chosen pronouns and names, and keeping open minds about their relationships. This is imperative to building trust. Introducing intake forms that include diverse gender identities and LGBTQIA+ specific signage or educational brochures also increase patient comfort.[40] Additionally, revision of current data collection systems would enable more targeted healthcare delivery for TGD populations. This could be aided through mandatory recording of both sex assigned at birth and current gender identity which would enable the disaggregation of different TGD experiences.[45] Conclusion LGBTQIA+ people face on-going barriers to healthcare on individual, interpersonal and structural levels and have an increased risk of mental, sexual and chronic illnesses. Thus, in order to improve health outcomes, barriers to access should be targeted on both interpersonal and structural levels. Ultimately, treating LGBTQIA+ people with individual respect and a willingness to learn will go a long way in in reducing these inequities. Acknowledgements The authors acknowledge and thank Gale Chan for their contributions to the drafting and revising of this article. Photo credit ©2008 laverrue, accessed from https://www.flickr. com/photos/23912576@N05/2942525739 Ryan melaugh, accessed from https://www.flickr.com/ photos/120632374@N07/13974181800 Conflicts of interest None declared Correspondance salwasayeed70@hotmail.com alexanderlee193@gmail.com References 1. Australian Bureau of Statistics. General Social Survey: Summary Results, Australia, 2014 2014 [cited 2017 September 9]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/ mf/4159.0. 2. Clark TC, Lucassen MFG, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: Results from the New Zealand Adolescent Health Survey. Journal of Adolescent Health. 2014;55:93-9. 3. Mulé NJ, Ross LE, Deeprose B, Jackson BE, Daley A, Travers A, et al. Promoting LGBT health and wellbeing through inclusive policy development. International Journal for Equity in Health. 2009;8(18). 4. Potter J, Goldhammer H, Makadon M. Clinicians and the care of sexual minorities Potter J, Goldhammer H, Makadon M, Mayer K, editors. Philadelphia: American College of Physicians; 2008. 5. World Health Organisation. International Statistical Classification of Diseases and Related Health Problems 10th Revision 1992 [updated 2016. 10:[Available from: http://apps. who.int/classifications/icd10/browse/2016/en#/F60-F69. 6. Australian and New Zealand Professional Association for Transgender Health. Standards of Care [Available from: http://www.anzpath.org/about/standards-of-care/. 7. World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender and gender nonconforming people 2011 [Available from: http:// www.wpath.org/site_page.cfm?pk_association_webpage_ menu=1351&pk_association_webpage=3926. 8. Mayers L, Chow K. Same-sex marriage survey: Petition to deregister Pansy Lai, doctor in No campaign ad, taken down. ABC News. 2017. 9. Daniel H, Butkus R. Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians. Annals of Internal Medicine. 215(163):135 — 7. 10. Minto CL, Liao L-M, Creighton SM, Woodhouse CRJ, Ransley PG. The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: A cross-sectional study. Lancet. 2003;361(9365):1252 — 7. 11. Smith D, Mattews W. Physicians’ attitudes toward homosexuality and HIV: a survey of a California medical Societyal of Homosexuality. Journal of Homosexuality. 2007;52(3/4):1 — 9 12. Ard KL, Makadon HJ. Improving the health care of lesbian, gay, bisexual an transgender people: understanding and eliminating health disparities. Boston, Massachusetts: The Fenway Institutee; 2012. 13. Australian Human Rights Commission. Resilient Individuals: Sexual Orientation, Gender Identity & Intersex Rights 2015. 14. Hinchliff S, Gott M, Galena E. ‘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. 2005;13(4):345. 8
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Vector Volume 11 Issue 2 - 2017

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