Healthcare professionals' assumptions as barriers to LGBTI healthcare.

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with LGBTI people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender and non-intersex by default; second, the assumption that LGBTI people do not experience significant problems (and therefore that their experience is mostly irrelevant to healthcare). On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.

Co-producing knowledge of lesbian, gay, bisexual, trans and intersex (LGBTI) health-care inequalities via rapid reviews of grey literature in 27 EU Member States.

BACKGROUND: The health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people are well documented with several reviews of global research summarizing key inequalities. These reviews also show how the health-care needs of LGBTI people are often poorly understood whilst suggesting that targeted initiatives to reduce inequalities should involve LGBTI people. OBJECTIVES: To determine what is known about the health-care inequalities faced by LGBTI people? What are the barriers faced by LGBTI people whilst accessing health care, and health professionals when providing care? What examples of promising practice exist? DESIGN: Rapid reviews of grey literature were co-produced with LGBTI people in 27 countries followed by a thematic analysis and synthesis across all data sets. The review included grey literature from each country that might not otherwise be accessible due to language barriers. MAIN RESULTS: Rapid reviews showed that LGBTI people faced various inequalities and barriers whilst accessing health care. Where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm, and where LGBTI people differed from these norms, discrimination could result. In consultations where LGBTI people feared discrimination and did not disclose their LGBTI status, health professionals lacked the information required for appropriate assessments. CONCLUSION: With greater understanding of sexual orientation (LGB people), gender identity (trans people) and sex characteristics (intersex people), combined with access to contemporary knowledge and training, health professionals can work in collaboration with researchers, policymakers and LGBTI people to develop systems that are better attuned to the needs of all service users.

A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities.

BACKGROUND: Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. METHODS: A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. RESULTS: LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. CONCLUSION: Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.

Revolting bodies, desiring lesbians: an introduction.

This introduction gives the background to this special issue of the Journal of Lesbian Studies that has its origin in the 18th Annual Lesbian Lives Conference of 2011. It traces the theme of Revolting Bodies: Desiring Lesbians across the ten articles of this collection and gives a brief summary of each.

Training healthcare professionals in LGBTI cultural competencies: Exploratory findings from the Health4LGBTI pilot project.

OBJECTIVES: Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience health inequalities and barriers to accessing healthcare at a greater rate than the general population. This paper aims to present the Health4LGBTI training course for healthcare workers and the results of its pilot implementation. METHODS: Funded by the European Parliament, the training course was developed by a multidisciplinary team including LGBTI organisations as part of the Health4LGBTI Project. 110 healthcare professionals from diverse medical fields attended the pilot training in six European Member States. Knowledge and attitudes were compared on the basis of a pre-post evaluation design utilising an ad hoc questionnaire. RESULTS: Knowledge scores increased after the training, irrespective of age and sexual orientation of participants. Attitudes scores generally improved, particularly in terms of inclusivity and a greater acknowledgement of LGBTI health needs and self-competence. CONCLUSION: The Health4LGBTI training course is both feasible and effective in training healthcare professionals and support staff to improve cultural competence and thereby promoting inclusive healthcare practice. PRACTICE IMPLICATIONS: The Health4LGBTI training course can be implemented in different healthcare contexts. Piloting of the course provided an opportunity for healthcare professionals and for support staff to improve their knowledge of, and attitudes towards, LGBTI people.

The Power of Recognition: A Qualitative Study of Social Connectedness and Wellbeing through LGBT Sporting, Creative and Social Groups in Ireland.

The broad research consensus suggesting substantial vulnerabilities among lesbian, gay, bisexual and transgender (LGBT) communities may fail to recognize the protective factors available to these populations. The sparse literature on mental health promotion highlights the importance of understanding strengths-based community approaches that promote LGBT wellbeing. Informed by the Ottawa Charter for Health Promotion, underpinned by Honneth's Theory of Recognition, this paper outlines the findings of a qualitative Irish study on LGBT social connectedness through a diverse range of sporting, creative and social interests. Ten in-depth interviews were conducted with 11 people (including one couple) who self-identified as lesbian (5), gay (4), bisexual (1) and transgender (1) aged between 22 and 56 years. A university Research Ethics Committee granted approval. The data were transcribed and coded using thematic analysis, enhanced through a memo-writing approach to reflexivity. The theme of 'connecting' emphasized the shared nature of activities, with like-minded others through groups established by, and for, LGBT communities. Messages from the study reinforce the central role of LGBT communities in the promotion of mental health and social wellbeing, with important policy and practice implications. This requires the contextualization of the contribution of LGBT communities within understandings of social justice, identity and recognition.

Embracing the "and": between queer and bisexual theory at Brighton BiFest.

Questions of bi identities can be invisibilized and overlooked by queer theorizing and LGBT studies. This article explores the ways in which complex performances of bisexuality can simultaneously encompass and deconstructively critique bi identity in a manner that embraces the "and" between bi and queer, offering important insights into how bi is lived, contested, and reaffirmed. Drawing on the BiCon and BiFest events in the UK, we argue that both the materialities (and supposed fixities) of bi erasures and exclusions and the fluidities that trouble the heterosexual/homosexual divides offer key insights into the spatial and temporal fixing and unfixing of identities.