Vector Volume 11 Issue 2 - 2017

Individual and interpersonal
While accessing healthcare, LGBTQIA+ individuals
face interpersonal barriers in the form of clinicians’ lack
of knowledge and discrimination as well as their own
individual internalised homophobia.
DSM-5 now allows for self-identification as asexual as
an alternative to diagnosis with ‘hypoactive sexual desire
disorder’ or ‘female sexual arousal/interest disorder’ [25],
historically, a lack of interest in sex has been pathologised
by Western medicine.[26]
Many practitioners have limited training and
awareness around the importance of comprehensive,
non-judgmental sexual history taking. Clinicians’
unconscious biases often result in LGBTQIA+ clients
being forced to ‘out’ themselves in response to questions
that assume heterosexuality and do not recognise
gender diverse or intersex experiences (e.g. asking a
trans woman about birth control). This exacerbates
existing awkwardness around sexual and mental health
and is associated with significant discomfort, which
may contribute to patients’ decisions
not to disclose their sexuality or gender
identity.[13] Additionally, some GPs did not
understand different sexual practices and
felt uncomfortable broaching the topic.
[14] One third of LGBTQ* Australians
still hide their sexuality or gender identity
when accessing healthcare.[15] In youths, half did not
disclose.[16] This not only impacts individuals’ ability to
build trust with healthcare providers but also undermines
the provision of targeted health services such as human
immunodeficiency virus (HIV) testing in men who have sex
with men (MSM).
Healthcare providers’ lack of knowledge regarding
TGD identities and unique health needs is a common
theme.[17-20] Having to educate healthcare providers
was found to be a key contributor to negative GP
encounters in Australia.[17] A lack of sensitivity [19, 20]
with practitioners asking invasive or offensive questions
[17] and misgendering clients through the use of incorrect
pronouns or old names [15, 21] contributes to these
barriers. Clinicians not working in TGD-specific fields
often have little knowledge on the issue, resulting in
these clients’ exclusion from mainstream health services.
[2, 15, 21] Even clinicians regularly engaged with TGD
clients enlist gatekeeping behaviours which restricts
access to hormonal and surgical intervention.[17, 22] This
discourages TGD individuals from raising mental health
concerns and many find this process of “assessment”
to be degrading and pathologising.[21] Moreover, rigid,
binary views of gender results in non-binary individuals
feeling invisible and unwelcome to services.[23]
LGBTI people in Australia
are five times more likely to
attempt suicide in their lifetimes
Internalised homophobia may manifest as a further
barrier to seeking healthcare services. Consequently,
during periods of illness, individuals turn to pharmacies
and only seek health services when self-medication has
been unsuccessful.[27]
Structural
LGBTQIA+ communities also face a myriad of
structural barriers to quality healthcare.
Australia is currently the only
Western country which requires TGD
adolescents to gain Family Court
‘approval’ to access hormones.
Despite the time-sensitive nature of
hormone therapy, the legal process
can take up to 10 months, and cost
tens of thousands of dollars.[28] However, this is currently
under review by the Family Court.[29]
TGD communities, especially non-binary individuals,
also face inaccurate medical record keeping that do
not reflect individual’s chosen names, genders and/or
pronouns and a lack of gender-neutral bathroom access.
[18, 23] Moreover, TGD individuals experience discomfort
in gendered spaces such as gynaecologists’ clinics [23]
and heightened discomfort surrounding pap smears and
breast checks.[18, 22] The relegation of TGD services to
the realm of expensive private healthcare[15] is at heads
with their increased risk of poverty, underemployment and
housing instability.[18, 19, 23]
Additionally, the view of LGBTQIA+ identities as
inherently pathological by some providers is discriminatory.
[13, 21, 24] TGD individuals may face clinician discomfort,
disgust, ridicule, contempt and even refusal of treatment.
[19, 21-23] One participant of the Australian and New
Zealand TranZnation report was told by their doctor
that she was ‘the filthiest, most perverted thing on earth’
while another was informed they ‘needed to find god not
hormones’.[21] Asexuality is also pathologised. While
Furthermore, unconscious bias can also manifest
in the distribution of research funding and practitioner
training. Compared to the relative visibility of gay men’s
health around the HIV/AIDS epidemic, TGD health as well
as queer women’s health have largely been ignored.[13]
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