The LGBT* community is still experiencing a major health crisis, yet its extent remains relatively unknown and the NHS often fails to provide adequate care
The 1980s and early 1990s saw the AIDS epidemic wipe out entire gay neighbourhoods in cities across the world. AIDS, promiscuity and homosexuality were confused as one and the same, and gay and bisexual men were portrayed particularly negatively in politics and the media. By their very nature, they were ‘icky’, seedy, sexual creatures. AIDS was a ‘gay problem’, and LGBT* people were condemned as perverts to the sidelines of national life through legislation and cultural representation.
It is thanks to the continuous activism of one of the largest and most successful civil rights campaigns of modern history that so much has changed both here in the UK and across the developed world.
Since 1997, Section 28 (which banned local authorities and schools from portraying homosexuality in a positive light) has been repealed, the age of consent has been equalised, same-sex couples have been allowed to adopt, a ban on serving in the military has been lifted and trans people are now able to legally change their gender.
2014 also saw the first legally recognised marriages of same-sex couples; a victory which many older members of the LGBT* community, almost all of whom lost friends and loved ones to the AIDS crisis, never thought they’d see in their lifetimes.
The shadow of AIDS has lifted and LGBT* life has very much entered the mainstream. Soaps and dramas feature fully formed and authentic gay, lesbian, bisexual and trans characters. LGBT* people openly serve in the House of Commons and present The Great British Bake Off.
Despite this, a lot of progress still needs to be made. One in every six lesbian, gay and bisexual people have been the victim of a hate crime or incident in the previous three years, and a third of trans people experience transphobic abuse on an annual basis. A 2010 survey of British social attitudes found that 36 per cent of people—more than a third—thought sexual relations between two adults of the same sex were “always or mostly wrong.”
Sexually active gay men are still not allowed to donate blood, and under a (relatively unknown) clause included the 2013 same-sex marriage bill, married trans people cannot have their gender changed legally without the explicit permission of their spouse.
Critically, the LGBT* community also continues to suffer a number of serious mental and physical health problems which largely remain hidden from the public, the political conversation, the health service, and even the community itself.
The statistics are shocking. LGBT* people of all ages are more likely than the rest of the population to have contemplated or attempted suicide, to be depressed, to suffer from anxiety, to self harm, to binge drink, to take illegal drugs, to have unsafe sex, to have cancer and, increasingly, to be HIV positive.
According to a 2011 study by Stonewall—the largest of its kind conducted anywhere in the world—lesbians and gay women in the UK are more likely than other women to have breast cancer, to self harm, and to attempt to take their own lives. They’re also considerably less likely to have recently had a smear test, and more likely to drink and take drugs regularly.
The LGBT Foundation found that 40 per cent of lesbian and gay women drink to intoxication at least three times a week, compared with 25 per cent of women as a whole. This trend can be observed across much of the community—the same study found that more than half of gay and bisexual men have taken drugs in the past year, compared with just 14 per cent of men in general. This regular intoxication and the risky behaviour it encourages, Stonewall warns, are critical factors in heightened rates of sexually transmitted infections—especially HIV—among the LGBT* population.
LGBT* people at the same time remain less likely to get regular health check-ups. 30 per cent of gay and bisexual men in the UK have never been tested for HIV, and 25 per cent have never been tested for any STI. Of these men, 83 per cent told Stonewall that they didn’t think they were at risk from STI infection.
In the case of London, the picture is especially bleak. Public Health England recently announced that 13 per cent of sexually active gay and bisexual men living in London have HIV, compared to less than 4 per cent of those living outside the capital. Up to a quarter of HIV+ men living in London are unaware that they have it, and the rate of new infections there were 33 per cent higher in 2014 than in 2013.
AIDS is no longer a death sentence, but it appears that many young gay and bisexual men remain dangerously unaware of the prevalence of the disease and the extent to which they are at risk. The rise in the popularity of ‘chemsex’ parties, which use libido-enhancing drugs to fuel anonymous orgies, is particularly representative of this. We are running head-first towards another AIDS crisis, and increased awareness among both the community and the public as a whole is the only solution.
Gay and bisexual men are also more likely to have issues with body image and self esteem. The LGBT Foundation found that they are more dissatisfied with their physical fitness, height, weight, face, features, genitals, diet and muscularity than heterosexual men. The pressure to look good is relentless and it certainly takes its toll; although gay and bisexual men are more likely to have a healthy BMI, they are also far more likely to not meet the recommended levels of exercise, a statistic which is almost certainly influenced by the prevalence of eating disorders and body dysmorphia.
Mental health issues among the LGBT* community go much further than this. Researchers from Cambridge University recently found that whereas between 5 and 6 per cent of heterosexual men and women reported mental health issues, this figure rises to almost 15 per cent for gay men and 19 per cent for gay women. The LGBT Foundation revealed that in 2012/2013 it received calls from more than 2,000 people and offered 1,098 counselling sessions in Manchester alone.
The situation appears worse when it is considered that young LGBT* people seem to be more severely affected. This year, the LGBT Foundation found that young people who identify as lesbian, gay or bisexual are almost four times more likely to make plans to kill themselves, and 3.6 times more likely to actually attempt suicide than their age demographic as a whole. The statistics for young trans people are even more disturbing—48 per cent of young trans people have made at least one suicide attempt, and a massive 85.2 per cent claim to have harmed themselves at least once. Over a third of young lesbian, gay and bisexual participants tried to kill themselves in the past twelve months, and over half of young LGBTQ+ people reported to have self-harmed either now or in the past.
Shamefully, LGBT* youth also represent a disproportionate number of young people who are homeless, with the top five issues highlighted by them being family rejection, mental health issues, alcohol abuse, homophobic bullying and sexual exploitation. Parental rejection was also the biggest factor behind participants being forced to sleep on the streets.
There is clearly a massive issue here, yet the political conversation fails to mention it and the NHS is often failing to provide adequate care. A considerable number of LGBT* people who access the health service have negative experiences which are specifically connected to their sexual orientation. Cambridge University found in 2014 that LGBT* people are 50 per cent more likely to report “negative experiences with primary care services,” and Stonewall has been especially critical of what it sees as systemic failures.
It found that when gay and bisexual men access the health system to diagnose, monitor, or treat mental and physical health problems, they are not treated with the compassion, confidentiality and openness needed.
Stonewall suggests that gay men often feel like they’re neglected by the health system, which is legally responsible to treat everyone equally, due to GPs focusing solely on their sexual health despite their increased likelihood to have depression, anxiety, and suicidal thoughts.
LGBT* people as a whole often feel like they can’t talk about issues openly with their GP due to anxieties about privacy and confidentiality. This has massive consequences for whether or not they take advice on all sorts of health issues and ultimately if they have access to the testing and monitoring.
Healthwatch, a state-funded watchdog, condemned the NHS earlier this year as treating trans people as “second class citizens” – some have to wait over a year for an appointment at a clinic, and the process of gender reassignment can sometimes take as long as six years.
The extent of the health problems faced by the LGBT* community is unique in its scale, yet it is also relatively unknown. If it is to be tackled, it needs to be discussed far more openly and frankly—in schools, Parliament, the media, and the health service. The NHS needs to better tailor its treatment for LGBT* patients, and—in the case of STI transmission and HIV infection—LGBT* people need to take on the responsibility to protect themselves and their community. Talking about the horrors of the 1980s is only the first step to achieving this.