Sexual Health Issues With Lesbian and Gay Patients’

Executive summary

Sexual orientation is a question that several people around the globe have had a challenge accepting and embracing. Health care provision is a priority in the United Kingdom. Individuals are expected to access quality health care irrespective of their sexual orientation. Gays and lesbians are discriminated against in health care provision despite requiring specialized health care. The inequalities in health care have compromised the quality of life of lesbians and gay people in the United Kingdom. Inequalities and discrimination against gay and lesbian people have led to increased drug and substance abuse among the population. However, these challenges can be solved by the National Health Service through the development and establishment of legislations that promote equity in health care irrespective of sexual orientation.

Introduction and Methods

Sexual orientation is a question that several people around the globe have had a challenge accepting and embracing. This has led to prejudice among the lesbian, gay and bisexual communities. However, the health care sector must ensure that quality health services are availed to individuals irrespective of their sexual orientation. Health inequalities are a challenge that has affected the quality of health care provision among lesbians, gays, and bisexuals in the global community in the recent past. This has affected their healthy stay. This paper discusses and highlights the ways that health inequalities can disproportionately affect lesbian and gay people in the United Kingdom community (Hinchliff, Gott, & Galena 2005).

Several research activities have been conducted in the past by several health professionals to determine the effects of inequality health care provision among lesbians, gay and bisexual people in the United Kingdom. These research activities have assisted other individuals in better understanding the plight of gay, lesbians, and bisexuals. However, most people could not understand and appreciate them in the past. This also contributed to the unequal health care provision (Hinchliff, Gott, & Galena 2005).

Several decades of research have shown that equity in health and health care is of immense societal importance given its ethical and social justice implications (Kim & Fredriksen-Goldsen 2012), and it’s the core philosophical underpinning to service the healthcare needs of all populations in a socially and culturally appropriate way (Neville & Henrickson 2006). However, extant research has found that appropriate and equitable health care for the lesbian and gay population in the United Kingdom (UK) remains a mirage (Hinchliff, Gott, & Galena 2005), even though the Department of Health (DH) and the National Health Service (NHS) acknowledge that lesbian, gay, bisexual and trans (LGBT) people benefit from distinct and specialized health services in the UK (Meads, Buckley & Sanderson 2007), and that sexual orientation is included in current efforts to mainstream equality and diversity in healthcare (Fish & Bewley 2010). Extensive research on the inequality in health care provision among gay and lesbian people has not been conducted in the United Kingdom because this has not been addressed effectively (Meads et al 2007).

The review of the literature aims to identify ways through which health inequalities disproportionately affect LG people in the UK. The review is intended to not only identify the key domains that progress and exacerbate health inequalities among this group of the population but to also map existing research in these domains and outline recurrent evidence. Sexual health – particularly HIV and AIDS – has dominated thinking and UK policy directions about LG health for years, but many NHS agencies have now realized that the needs of LGBT individuals go far beyond this (Moore 2011) and that LGBT people have specific concerns that are not necessarily met by health service providers and can experience social and health inequalities (Sheriff, Hamilton, Wigmore & Giambrone 2011). Additionally, it is clear from emerging research that while there is a mounting recognition that LG people from an underserved population in healthcare (Neville & Henrickson 2006; Brown & Groscup 2009), there are few published data in the UK to inform as well as direct the development of a health agenda (Fish & Bewley 2010). This review will therefore serve as evidence-based guidance on how nursing personnel can identify health inequalities affecting LG people in practice settings, and how they can successfully deal with these issues to ensure equity in health and healthcare among this group of the population. More importantly, the review intends to illuminate the health inequalities affecting LG people, with the view to assisting them to become visible and recognized users of health and social services across the country.

In methods, the current literature review uses the systematic approach, also referred to as the best-evidence syntheses or practice-based research synthesis, because it guarantees thoroughness, comprehensiveness, transparency, and unbiased review of the literature (Rhodes 2011). A systematic review, according to this author, ensures the objectivity of findings not only because primary research articles are methodologically appraised and synthesized, but also because it uses strict methods to locate, appraise and synthesize all research on a topic. To scope out the research area and identify research articles with subject-specific content, we consulted health service providers, campaigners, social workers, and experienced researchers on LGBT issues.

In the search strategy, it is imperative to note that peer-reviewed literature was identified through five large, comprehensive databases (PubMed, Academic Search Premier, CINAHL, Health Source – Nursing/Academic Edition, and MasterFILE Premier). We used various combinations of key terms including: ‘gay’, ‘lesbian’, ‘LGB’, ‘health inequalities’, ‘LGB equality in health’, and more. A total of 25 peer-reviewed articles were identified using these search terms and were subsequently reviewed by the researcher to establish if they met the criteria for the systematic review. The researcher applied the following inclusion criteria:

  1. Papers were to be either primary research articles or reviews of primary research published between 2003 and 2013;
  2. Studies were to be UK-based, though the researchers sampled articles from the United States and Sweden for comparison purposes;
  3. Studies that investigated the healthcare and social needs of LGBT people;
  4. Studies that employed recognized qualitative or quantitative methodology and validation (for primary research articles).

Using these methods, a total of 12 studies were identified that met the inclusion criteria (10 from the UK, one from the United States, and one from Sweden). Six of the articles were quantitative, there were qualitative, one used a mixed-method approach, and two were reviews of primary research. I took time to review all the articles and summarize data around emerging themes and patterns relating to health experiences and inequalities affecting LG people. Reports and policy statements on LGBT people, especially within the UK context, were also evaluated to expound on the emerging themes, but data arising from them were not included in the final review. Overall, some of the themes that were identified from the review include discrimination and stigmatization; health risk behaviors; mental health and psychological distress; sexual health of LG people; delay/failure to disclose sexual orientation; lack of awareness; negative responses from health professionals; lack of adequate training of service providers on LG health issues; lack of health information and literature on LGBT; and homophobia and heterosexist.

The next sections report on the findings of the systematic review (This is the chronological explanation and review based on the topic as sequentially arranged, and not Systematic Review, which requires the input of more than one researcher). The findings have been grouped around these themes, which directly or indirectly contribute to the health inequalities affecting LG people in the UK. The findings begin by contextualizing the lesbian and gay health issues to understand the problem in a far wider context. Afterward, the findings in the various thematic areas mentioned above will be discussed, before winding up the review with a conclusion and several recommendations for practice.

The different conceptual perspectives that may be applied in minority areas to enhance a better understanding of the health issues and concerns of gays, lesbians, transgender, and bisexuals

A diagram illustrating the different conceptual perspectives that may be applied in minority areas to enhance a better understanding of the health issues and concerns of gays, lesbians, transgender, and bisexuals.

Findings from the Review

Findings from the literature review related to the key thematic areas described above. A summary of the review’s major findings is presented in the matrix contained in the Appendix. It is important to note that the findings are free from researcher bias since a systematic review methodology was used.

Contextualizing Lesbian & Gay Health Inequality Issues

Internationally, lesbian and gay health issues are receiving increased attention from government departments, policymakers, and other mainstream commentators. Several states recognize the plight of the gay and lesbian community and have established policies to address their health concern, for example, the United States. Current literature demonstrates that the Australian government has instituted a Ministerial Advisory Committee on Gay and Lesbian communities to help it address health inequalities and social issues affecting this group of the population (Fish & Bewley 2010). As reported by these authors, the Department of Health (DH) in England and Wales is currently engaged in promoting inclusive services to minimize health inequalities affecting gay and lesbian communities by including sexual orientation in concerted initiatives aimed at mainstreaming equality and diversity in healthcare (e.g., the Pacesetters Program).

These initiatives coupled with my main findings illuminate the fact that LG people have a multiplicity of physical, mental, psychological, and sexual health needs that substantially differ from those of heterosexuals. The health of gay and lesbian people is not appropriate due to the discrimination and unequal health provision they receive in the United Kingdom. This has led to increased drug and substance abuse such as cigarette smoking and alcohol among others (Meads et al 2007). They are more likely to be exposed to homophobic and heterosexist experiences when accessing health services (Weber 2008) and are therefore more likely to avoid primary medical care or to desist from revealing their sexual orientation to health care providers (King & Nazareth 2006), leading to substandard care and further isolation (Sheriff et al 2011). It is therefore imperative to critically assess and evaluate the literature on the health inequalities that disproportionately affect LG people, with the view to inform future policy and practice initiatives, but also to come up with evidence-based guidance on how stakeholders can identify health inequalities affecting this group of the population and provide viable solutions to ensure equity in health and health care.

Discrimination & stigmatization

In their quantitative research study done with LGBT participants 18-75 years old, King and Nazareth (2006) found out that lesbian, gay, and bisexual people (LGB) people experience prejudice and discrimination in healthcare settings, and often demonstrate higher rates of anxiety, depression, substance use disorders and suicidal ideation than heterosexuals. In a large mixed-methods study involving 6490 participants, Fish and Bewley (2010) acknowledge the role of governments to not only contribute to improving the health status of LG people without discrimination but also to develop, adopt and implement programs that address discriminatory practices that continue to undermine the health and well being of persons because of their sexual orientation or gender identity. These authors bring into the limelight the notion of the “private sphere”, which is essentially a site for discrimination, oppression, and rejection of people in same-sex relationships by family, friends, and even health professionals (Brown & Groscup 2009).

Several articles reviewed echo similar sentiments about discrimination and stigmatization of LG people in healthcare settings. Discrimination and stigmatization act as barriers to equitable access to health care services among LG people (Kim & Fredriksen-Goldsen 2012). In their influential research on the perceptions of LGB people in primary health care services, Neville and Henrickson (2006) found that despite an apparent acceptance of LGB individuals in recent times, there still exists an underlying stigma associated with living a heterosexual lifestyle, which directly affects the health and well being of these diverse communities. The majority of participants in Neville’s study reported exposure to discriminatory practices upon disclosure of one’s sexual orientation due to the assumption of heterosexuality (heteronormativity) and even outright homophobic experiences in healthcare contexts. Such an orientation, as acknowledged by Moore (2011), presents major barriers to the LGB people’s ability to access health care as some health care workers feel uncomfortable in providing services to this group of the population. A major finding in the Neville and Henrickson (2006) study is that discriminatory practices and stigmatization directed at the LGB people by nursing staff often materializes into the provision of substandard care for this group of the population.

Citing previous studies, Sheriff et al. (2011) suggest that discriminatory practices, along with other adverse notions such as negative stereotyping, prejudice, and stigma, have undeniably led the lesbian and gay population in the UK and elsewhere to be isolated and hidden from the mainstream heterosexual society. Their qualitative UK-based study targeting young LGBTs and care practitioners found high levels of discrimination, bullying, and stigmatization directed at young LGBTs’, who consequently found it difficult to request care from practitioners lacking basic training on how to communicate with the LGBTs’ and solve their health issues. Their findings imply that it is particularly challenging for LGBT individuals to “come out” and access social and health services compared to heterosexuals in the general population. Reporting on their major findings in their quantitative research study using 6338 participants, Kim & Freidriksen-Goldsen (2012) argue that lack of social support and group connectedness for LGBT people leads to discrimination, prejudice, and stigmatization, which effectively curtails their chances to receive equitable services in healthcare environments.

Health Risk Behaviours

A majority of the studies reviewed show that LG people engage more in health risk behaviors than heterosexuals, yet fail to access critical health services that serve as a medium to address these risks. Overall, some of the health risk behaviors identified among this group of the population include smoking, alcohol misuse, having multiple sexual partners, sexual experiences in childhood, and lifestyle diseases such as obesity (King and Nazareth 2006; Meads et al 2007; Weber 2008). The study by King and Nazareth (2006) found that men classified as gay and bisexual were more likely than those classified as heterosexual to be current smokers, to be heavy drinkers of alcohol, to report having had more than one intimate sexual partner in the last month, to indicate sexual experiences in childhood, to indicate current psychological distress, and to be generally discontented with their sex lives. Similarly, according to the study findings, women classified as lesbian and bisexual were more likely to be current smokers than those classified as heterosexual and were substantially more likely to indicate possible alcohol misuse, to have had more than one intimate sexual partner in the last one month, and to report significant sexual experiences in childhood (Fish & Bewley 2010).

The multi-site, cross-sectional research study conducted by Meads et al (2007) found similar results. This study revealed that gays and lesbians are more likely to smoke, abuse alcohol, and attempt suicide. Moreover, it also revealed that a higher percentage of gay and lesbian people are most likely to be affected or disturbed mentally. In a related study done in the United States, Kim et al (2012) reported that lesbians and bisexual women have demonstrated elevated risks and higher prevalence of obesity, smoking, and drinking alcohol than their heterosexual counterparts in the general population, thus are more exposed to health risk behaviors than heterosexual women. Weber (2008) found statistically significant positive correlations between exposure to LG lifestyle and drug use and abuse, and between internalized homophobia (arising from discrimination and stigmatization) and both alcohol use and abuse among this group of the population.

Several researchers have attempted to explain why LG people engage in health risk behaviors. Citing previous studies, Weber (2008) argues that the higher prevalence of smoking and alcoholism among the gay and lesbian population can be attributed to social oppression negative self-stereotyping (viewing own sexual orientation negatively), and internalized homophobia. The researcher states that lesbian and gay people abuse drugs and alcohol to cope with their sexual orientations. In another study, King and Nazareth (2006) state that most LG people feel rejected by society and its institutions, including healthcare services, thus use and abuse alcohol and drugs as a means of coping. In her review of primary research articles and policy documents on LGBT, Barnes (2012) reports that alcohol consumption and drug use rates, including intravenous drug use, are higher in LGBT people than it is in heterosexuals due to crises in social identity, self-rejection, and internalized homophobia (Hinchliff, Gott & Galena 2005).

Extant research demonstrates that although heterosexual people exhibiting similar health risk behaviors often seek help from healthcare providers (Fish & Bewley 2012), only a small number of LG people ‘open up to their health care providers about their sexual orientation or their health risk behaviors for fear of negative reaction from the care providers (Barnes 2012), leading to an entrenchment of the alcohol/drug use and abuse culture (Kim et al 2012). King and Nazareth (2006) consider this orientation within the context of health inequalities by suggesting that individuals classified as gay and lesbians are more likely to be smokers, and are therefore more often poised to be affected by smoking-related diseases, including cancers, cardiovascular diseases, and chronic obstructive airway diseases (Kim 7 Fredriksen-Goldsen 2012). Similarly, these researchers have also acknowledged that the increased drug and substance use among this population exposes gays and lesbians to diseases such as cancer and liver-related infections. However, LGBT people will continue to suffer in silence because of a lack of routinely measured details and hospital activity data on the relationship between sexual orientation and the diseases that often affect the lesbian and gay population due to engaging in health risk behaviors (Meads et al 2007; Kim & Fredriksen-Goldsen 2012).

Mental Health & Psychological Distress

Lesbian and gay people report higher levels of mental health problems and psychological distress than heterosexuals in the general population (King and Nazareth 2006). The study conducted by Meads et al (2007) revealed that gays and lesbians are more prone to mental health challenges than heterosexuals in the United Kingdom society. The number of lesbians and gays who attempted suicide was higher than that of heterosexuals according to research conducted by Meads et al. (2007) in the United Kingdom. In a previous study, King and Nazareth (2006) found higher rates of common psychological and mental health problems, as well as anxiety and mood disorders in a large sample of gays and lesbian people residing in England and Wales. Consistent with these findings, Moore (2011) acknowledges that LGBT people are twice as likely to attempt suicide as heterosexual people and that the sexual orientation of gay people puts them at an elevated risk of developing mental illness than straight people. Moore cites previous research to demonstrate that gay and bisexual men are most at risk of mental health illnesses and suicide ideation than lesbian and bisexual women. The distress has contributed to the high cases of mental health and suicide among gay and bisexual men in the United Kingdom over the past years. Generally, gay and bisexual men are not accepted in the community and are more prone to ridicule than lesbians and bisexual women (King and Nazareth 2006).

Gay, bisexuals, and lesbians are part of the community despite their sexual orientation. However, they have faced rejection from straight men and women, which contributed to mental health and psychological distress. Although the community rejects and ridicules them, the health care sector must acknowledge their plight and provide health care services that may enable them to recover from the psychological distress and mental heal heath, which has led to suicide among them (King and Nazareth 2006). Meads et al (2007) acknowledged the increased cases and reports of mental health and psychological distress among lesbians and gays in the United Kingdom. Therefore, the health care industry must ensure that gays, bisexuals, and lesbians are not discriminated against and they freely access mental health care and psychological attention as heterosexuals in the community. Generally, gays, bisexuals, and lesbians cannot be assisted by heterosexuals but by medical practitioners. Equality health care will ensure that gays, lesbians, and bisexuals boost their self-esteem and easily approach health care centers in cases of depression (King and Nazareth 2006).

Homophobia & Heterosexism

Homophobia and heterosexism have greatly contributed to the health inequality in the global community (Weber 2008). Generally, homophobia is a term that is used to refer to homosexuality fear. Certain individuals are threatened by individuals who have a different sexual preference from theirs. Such people may express their fear in different ways, for example, overt violence. On the other hand, heterosexism is the full acceptance of heterosexuality as the most appropriate sexual orientation in society. Moreover, the belief discriminates against other sexual orientations such as gay and lesbian people. The belief underpins areas such as health policies and services among others, which might make gays and lesbians people invisible in society. This is evident in health care forms because there is no place to indicate that an individual has the same sexual partner as a next of kin (King and Nazareth 2006).

Sexual Health of Lesbians and Gay People

According to Weber (2008), the number of gay and lesbian people who seek medical services is slightly lower than that of heterosexuals in the United Kingdom. The low numbers of gay and lesbian people who seek medical services in the United Kingdom have been affected by the factors listed below:

  • Most health providers or professionals are homophobic, which discourages gay and lesbian people to seek medical care considering the attitude of homophobic individuals towards gay and lesbian people.
  • Lesbians and gay are not comfortable recording their sexual orientation because they fear some people may have unauthorized access.
  • Some medical providers do not allow same-sex partners to provide medical consent.
  • Some gays and lesbians fear communicating with health providers freely because it may compel them to disclose their sexual orientation, and may lead to less favorable health care provisions.
  • Gay and lesbian people have restricted access to health care services such as screening, which has led to increased cancer cases among the population.

Several health professionals and providers claim that they treat all patients the same, which means they consider all patients as heterosexuals. Generally, gay and lesbian people do not require specialized health care services, but fair and appropriate medical treatment (Weber 2008).

Delay/Failure to Disclose Sexual Orientation

Gays and lesbian people are not fully accepted in society across the globe. This also affects gays and lesbians in the United Kingdom, which has hindered the willingness of gays and lesbians to freely disclose their sexual orientation. Declaration of sexual orientation is an important factor that enables a government to establish strategies and legislations that protect the community based on their social group. Delay and or failure to declare sexual orientation has enabled the communities to view gay and lesbianism as weird because several people have not declared their sexual orientation, which portrays gays and lesbians as a minority in the society (King & Nazareth 2006). According to the NHS health report on sexual orientation and composition in the United Kingdom, gays and lesbians constitute 5% of the total population. Furthermore, they are not evenly distributed in cities and towns in the region, for instance, 10% of the population living in greater London are gays, lesbians, transgender, and bisexuals (Neville & Henrickson 2006).

However, several people are not willing to disclose their sexual orientations in case they are gay, lesbians, or bisexuals due to the challenges facing the gay and lesbian population in the United Kingdom, especially the inequality in health care provision and discrimination in the society. Generally, gays and lesbians may delay or fail to declare their sexual orientation to others to evade the treatment and challenges faced by gays and lesbians who have disclosed their sexual orientations. Health care provision is important and valued by all in society. Therefore, individuals require quality health services, which compel several lesbians and gays not to disclose their sexual orientations (Neville & Henrickson 2006). Unfair treatment of gays, lesbians, and bisexuals in health care organizations extended further to employees and staff within the industry who are gay or lesbians. The percentage released by the government through the National Health Service representing gays, lesbians, and bisexuals represents about 3.6 million of the population in the United Kingdom, which is a large number (King & Nazareth 2006).

Several people in the United Kingdom and globally fail to disclose their sexual orientation in case they are gay, lesbian, or bisexual due to poor treatment and discrimination the population is facing. Gay and lesbian people should be considered diverse just like the others in the United Kingdom population. The discrimination facing the population has led to inequality in health provision. United Kingdom society wholly accepts heterosexuals, but not gays and lesbians. This has contributed to the discrimination and marginalization of the population (Fish & Bewley 2010).

Lack of Awareness & Negative Responses from Health Professionals

Some research activities have been conducted on lesbians and gays in the recent past. However, these research activities have not been adequate to aid in the development of effective strategies that can be used to enhance the life status of gays and lesbians in the country. The limited information provided to this population has hindered individuals from understanding their needs adequately (Weber 2008). Furthermore, this has led to a misunderstanding and assumption among the health professionals, which has led to the conclusion that the population requires similar health attention and services like heterosexuals. The National Health Service must develop strategies and legislation through the aid of the government to enhance a better understanding of the health requirements and needs of different groups and populations in the country. This is important towards discouraging inequality in the provision of health care in the country (Fish & Bewley 2010).

Previous research activities by Mead et al (2007) have revealed that health needs and requirements research of the gays and lesbian community has not been adequate and extensively conducted. This is because the little emphasis has been directed to the same, which compelled health professionals to believe that the population requires the same treatment as heterosexuals. Lack of awareness of the health needs of the population has been contributed by the late or failure to disclose sexual orientation of gays and lesbians due to the fear of discrimination and poor treatment at the workplace and health care institutions among others (Fish & Bewley 2010).

Lack of Adequate Training of Service Providers on Lesbians and Gay Health Issues

Lesbians and gays are faced with the challenge of health inequality in the country. Furthermore, this is a challenge that other states on the globe face in their healthcare industry. This is due to the inability of health professionals within the health care sector to address the medical needs of individuals in the population. The National Health Service has not adopted and established training strategies that can equip health professionals with the health needs of lesbians, gays, transgender, and bisexual population. The health needs of gays and lesbians are different from the heterosexual population because they are often exposed to health risks. This is because most people consider gays and lesbians to engage in reckless sexual activities, which exposes the population to more health risks compared to the heterosexual individuals in the society (King & Nazareth 2006).

The National Health Service has not been able to provide adequate training for health providers on the needs of lesbians and gays due to the lack of adequate information on the population. Medical providers are trained based on the information that has been provided by medical researchers on the medical needs of different groups and populations in the global community. Generally, the health issues of gays and lesbians are not well addressed by health service providers due to a lack of information on the same (Weber 2008). There are several health issues of gays and lesbians that require extensive research to enable the National Health Service to develop appropriate strategies that can improve the provision of effective and appropriate training to the service providers to enhance better health care for the population. Therefore, the lack of adequate information on the health needs of the population has hindered National Health Service from providing relevant and important training to providers on the health issues of this population (Fish & Bewley 2010).

Lack of Health Information & Literature of Lesbians and Gay People

Medical institutions and professionals rely on the medical information provided by researchers to address the medical needs of different groups in the global community. However, gays and lesbians have suffered poor and unequal health provisions in medical institutions due to the lack of adequate and appropriate medical information on how to treat the medical challenges of individuals in the population. Although several research activities have been conducted by clinicians and medical researchers, much has not been covered on gays and lesbians. Research on gays and lesbians’ medical care is limited because their plight has not been fought for a long time (Weber 2008). Moreover, lesbians and gays are not fully accepted in society, which has led to increased discrimination, especially by heterosexuals. Health practitioners believe that gays and lesbians may require specialized health care; however, the population only requires fair and appropriate health services. Generally, gays and lesbians are disregarded in the United Kingdom society because their rights are not effectively upheld by relevant authorities. This has contributed greatly to the inequality in health provision among the population in the United Kingdom (Fish & Bewley 2010).

Discussion

The term LGTB is a phrase that is used around the globe to refer to the minority group of lesbians, gays, transgender, and bisexuals. This term is commonly used in the health care industry and among health professionals around the world. In the recent past, there has been an increased discussion and attention on the importance of focusing on the health care provider to the group of lesbians, gays, bisexuals, and transgender in the global community. Certain states around the globe have identified the need for specialized medical care such as insurance cover for the group, while others have ignored their plight and exposed the group to challenges and problems despite the availability of quality health systems in the respective states or countries. The LGBT community is faced with several challenges medically, however, medical professionals and researchers have extensively tried to explore the group but much has not been discovered and addressed. This has led to the increased need to address the challenges facing the community. Although they are grouped, this group is further subdivided into sections depending on their medical needs and requirements. The subdivision is because lesbians and gays require different health care attention (Neville & Henrickson 2006). Generally, the phrase represents a group and each has distinct health needs different from others although they all require specialized health care attention and services. Although they require specialized and equal health care services, they share several things in common, for instance, discrimination among others. Individuals who fall in these categories are faced with challenges such as discrimination and stigmatization in the workplace and health care facilities (Weber 2008). Their needs and requirements are rarely addressed medically, which has contributed to increased suffering among the population around the world (Weber 2008).

Lesbians, gays, bisexuals, and transgender individuals are faced with several challenges in the United Kingdom. This has contributed to inequality in health care provision among other problems. However, they are equal and important to society just like heterosexuals. Sexual orientation is also one of the most discussed topics in the United Kingdom community. Sexual orientation declaration is a problem among several people, especially at early ages of life due to the experiences of gays and lesbians (King & Nazareth 2006). Discrimination of lesbians and gays has led to the development of health risk behaviors. These behaviors are developed to assist in survival in a harsh society. Society should support individuals irrespective of their sexual orientation. The development of risky behaviors also risks the life of individuals in society, which leads to decreased health status. Risky practices compromise the quality of life among lesbians, transgender, gays, and bisexuals (Neville & Henrickson 2006).

Lesbians and gays are more likely to engage in drug abuse such as the use of cigarettes among others (King & Nazareth 2006). These drugs have negative effects on their lives. Although they resort to drug use as a way of surviving in society, this compromises their life quality. Smoking may lead to an attack of severe diseases such as cancer among others. Therefore, the discrimination of lesbians and gays may also lead to decreased life quality and attack by other diseases such as cancer among others (Rhodes 2011). Furthermore, gays and lesbians may adopt other behaviors such as having more than one sexual partner just like heterosexuals. This exposes them to contracting sexually transmitted diseases. Sexually transmitted infections such as HIV and AIDS may lead to death. The disease also contributes to the high number of deaths caused by a sexually transmitted infection not only in the United Kingdom but also in Chlamydia and warts (Weber 2008). Therefore, the adoption of risky behaviors for survival purposes of society due to increased discrimination is harmful to lesbians and gays. The health care industry must ensure that they receive quality and fair health care, and protect them from the effects of adopting risky behaviors to survive in society (Lee, Taylor & Raitt 2010).

Individuals require equality in health care provision to improve the status of life. A nation requires a healthy population to succeed economically. The population is engaged in the economic activities and implementation of strategies developed. Lesbians and gays have been on the rise in numbers in the recent past (Weber 2008). However, they are faced with challenges such as inequality in health provision and discrimination. This has affected their contributions to the development of the country economically. Most gays and lesbians are educated and top-ranked professionals (Meads, Buckley & Sanderson 2007). Such sexual orientations are mostly realized in learning institutions such as colleges, high schools, and universities among other higher learning institutions. Discriminating against gays and lesbians in health care providers may also affect the economic activities of a country (Brown & Groscup 2009). The government must discourage inequality in health through the establishment of strategies and adopting relevant and effective legislations that promote equality in the health care sector without discrimination. Several states in the globe have adopted the provisions of equal health attention irrespective of sexual orientation, for instance, the United States and Australia. This legislation enables these states to discourage inequality in the health sector and increase economic activities, which have led to consistent development (Fish & Bewley 2010).

Recommendations

Health inequality negatively affects gays and lesbians in the United Kingdom society. This has affected the way of life of gay and lesbian people. However, this can be addressed and the lives of gays and lesbians changed for the better in society. Several strategies can be used to improve the life status of gays and lesbians in society. However, these strategies can be successful if introduced by the government. Government is responsible for making and enforcing policies. Therefore, the government should prioritize developing and enforcing policies and legislations that encourage quality health care to all irrespective of their sexual orientations. This will enable the government to improve the life status of all too (Fish & Bewley 2010). Furthermore, Fish and Bewley (2010) recommend the government establish a policy that enables healthcare organizations to set up departments that deal with psychological and mental assistance for the depressed. This can be useful to gays and lesbians because they are faced with depression due to how society perceives them. Guidance and counseling is a strategy that is successful in managing depression and may lead to decreased suicide among gays and lesbians (Neville & Henrickson 2006).

Some gays and lesbians have poor eating habits that have contributed to high rates and cases of obesity among the population. Neville and Henrickson (2006) recommend the establishment of lifestyle education programs to assist in educating gays and lesbians on the importance of staying and living healthy. The government has established centers and organizations that focus on reducing obesity and encouraging healthy living. Therefore, the adoption of strategies and legislation that encourage the establishment of centers that focus on gays and lesbian lifestyles is recommended by Fish and Bewley (2010) to promote health equality. The gay and lesbian community is faced with several challenges in the global community. This has negatively affected their health status and contributed to increased drug abuse, contraction of sexually transmitted diseases, and high death rates among others (Fish & Bewley 2010). However, there are several steps that the government through the aid of the health sector may adopt and discourage health inequality among the population and improve their life status in the United Kingdom society. Adopting the following strategies may enable a government through its health care sector to discourage health inequality among the gays, lesbians, transgender, and bisexual community in the country (Neville & Henrickson 2006).

  • The National Health Service should develop and implement a research agenda that can enhance better understanding of gays, lesbians, transgender, and bisexuals’ health. This population is faced with health inequality because their health requirements and needs are not fully understood by most people in the society, health professionals inclusive. There is little information on the population on medical care hence most people do not understand their health requirements and demands. Although there are research activities that have been conducted by health professionals and clinicians, it is not enough to aid in improving the health status of this population in the United Kingdom community. The National Health Service is concerned with the health status of individuals in the states, it ensures that appropriate and relevant programs are developed and implemented to enhance a better understanding of the health demands of this population. This will enable individuals and health professionals to appropriately respond to their health needs (Giambrone ‘et al 2011).
  • Sexual identity and orientation data should be collected by surveys that are funded by the National Health Service (Moore 2011). National Health Service is the organization or department that is concerned with the health of all individuals in the state. They must ensure that the health status of different groups in the state is addressed appropriately (Fish and Bewley 2010). This department can conduct several health types of research using other organizations through funding. This enables the National Health Service to easily access such data and encourages the collection of credible and reliable data. One of the most important qualities of good research is the collection of quality data that produces reliable conclusions (Moore 2011). This enables the organization to understand the sexual composition, identity, and orientation of individuals in society. National Health Service and the government have not been able to respond to the medical needs of this population because credible information on their composition and the actual number is not available and accessible by relevant organizations and authorities. Accessing the actual number of this population may enable the government through the National Health Service to introduce strategies that allow the establishment of programs that address the provision of appropriate and fair health services to all individuals. The National Health Service has not been able to determine the extent of the medical requirements of this population, which has triggered the delay and slow research on the health requirements and the demands of this population. Therefore, determination of the composition and the actual number of individuals in this population will enable the government through the National Health Service to establish and implement a realistic plan to address the health needs of this population (Weber 2008).
  • Technology should be used in the handling of gender identity and sexual orientation data to enhance credibility. Technological use affects the operation of several organizations and industries in the United Kingdom community. This enables easy access by relevant authorities (Rhodes 2011). The National Health Service is concerned with the collection and storage of health information in the country, it will ensure that the data on sexual orientation and identity is collected and stored electronically. This will enable the department to easily access the data and update it easily when needed. Furthermore, altering the manual stored data is possible, which might affect the quality of data collected and affect appropriate responses (Neville & Henrickson 2006). Therefore, National Health Service will ensure that medical records are electronically collected and stored to enhance the safety of the records and loss or access by unauthorized parties. Generally, electronic collection and storage of data may enable the National Health Service to obtain relevant informative information on lesbians, gays, transgender, and bisexual population in the country. Additionally, an electronic system may enable the National Health Service to obtain relevant information about the subpopulations of this group (Moore 2011).
  • The National Health Service will assist in the standardization of sexual orientation and gender identity. Although there have been several research activities conducted to enhance a better understanding of the gay and lesbian population, researchers have not been able to present extensive and reliable findings (Moore 2011). This has not been possible due to the lack of reliable and appropriate data on the population. Standardization of data on this population will enable the National Health Service to assist researchers and clinicians enhance a better understanding of the health demands of this population hence reducing health inequalities experienced in the past few years (Lee, Taylor & Raitt 2010).
  • The National Health Service should support research methodologies that relate to the health of gays and lesbians. Gays and lesbian health research are challenging.
  • A comprehensive approach will be developed and established by the National Health Service to assist in training researchers on lesbian and gay people. National Health Service conducts health research through its programs. In the recent past, there has been an increased concern for the health of gays and lesbians. This has also led to increased research activities on the topic (Fish & Bewley 2010). However, there have not been adequate research activities of the population. This will be encouraged through this program.
  • Encouraging the inclusion of minorities such as gays and lesbians in the research method to enhance the reliability and quality of research on this population. National Health Service applies different models in the collection and analysis of data in the state (Weber 2008). Furthermore, NHS uses different policies to aid in the completion of data collection, which is geared towards obtaining reliable and credible data. The lesbian and gay population will be included or excluded in the analysis of the data to enhance the reliability of the data obtained.
  • The National Health Service will develop and establish strategies that encourage heterosexuals, especially health professionals to accept and appreciate lesbians and gays. Gays and lesbians are discriminated against by heterosexuals in the community. Generally, heterosexuals discriminate against lesbians and gays because they lack adequate information on gays and lesbians (King & Nazareth 2006).

Conclusion

Health inequalities can affect gays and lesbians in several ways in the United Kingdom community. Health care services will be offered to individuals in a nation fairly irrespective of their sexual orientations. The health status of a nation is important because it contributes to the success of the respective country or nation. The United Kingdom requires a healthy population to implement its strategies successfully and achieve its goals and objectives within the stated deadline. Achievements of goals and objectives reflect the success of a nation. Health inequality has negatively affected lesbians and gays in the United Kingdom. This has led to the adoption of risky behaviors to adapt and survive in society. Gays and lesbians have adopted behaviors such as drug use and smoking. Smoking affects the life status of individuals because it leads to diseases such as cancer among others. These diseases require close attention and adequate health care.

Lesbian and gay people report higher levels of mental health problems and psychological distress than heterosexuals in the general population. This is common in the United Kingdom because gays and lesbians are not universally accepted. Previous research on health inequalities in the United Kingdom revealed higher rates of common psychological and mental health problems, as well as anxiety and mood disorders in a large sample of gays and lesbian people residing in England and Wales. Furthermore, according to Fish and Bewley (2010), lesbian and gay people are twice as likely to attempt suicide as heterosexual people, and the sexual orientation of gay people puts them at an elevated risk of developing mental illness than straight people. Therefore, the provision of appropriate health care to the gay, lesbian, transgender, and the bisexual population is a challenge due to the lack of information on their health needs. This has led to health inequalities. However, this can be improved and addressed through increased research on this population to provide relevant information and enable the training of health service providers.

References

Barnes, H 2012, ‘Health needs of lesbians’, Primary Health Care, vol. 22 no. 6, pp. 28-30.

Brown, MJ & Groscup, JL 2009, ‘Homophobia and acceptance of stereotypes about gays and lesbians’, Individual Differences Research, vol. 7 no. 3, pp. 159-167.

Fish, J & Bewley, S 2010, ‘Using human rights-based approaches to conceptualize lesbian and bisexual women’s health inequalities’, Health and Social Care in the Community, vol. 18 no. 4, pp. 355-362.

Hinchliff, S, Gott, M & Galena, E 2005, ‘I dare say I might find it embarrassing: General practitioners’ perspective in discussing sexual health issues with lesbian and gay patients’, Health and Social Care in the Community, vol. 13 no. 4, pp. 345-353.

Kim, HJ & Fredriksen-Goldsen, KI 2012, ‘Hispanic lesbians and bisexual women at heightened risk or health disparities’, American Journal of Public Health, vol. 102 no. 1, pp. e9-e15.

King, M & Nazareth, I 2006, ‘The health of people classified as lesbian, gay and bisexual attending family practitioners in London: A controlled study, BMC Public Health, vol. 7 no. 127, pp 1-12.

Lee, E, Taylor, J & Raitt, F 2010, ‘It’s not me, it’s them: How lesbian make sense of negative experiences of maternity: A hermeneutic study’, Journal of Advanced Nursing, vol. 67 no. 5, pp. 982-990.

Meads, C, Buckley, E & Sanderson, P 2007, ‘Ten years of lesbian health survey research in the UK west midlands’, BMC Public Health, vol. 7 no. 1, pp. 251-259.

Moore, 2011, ‘Shaping the service to fit the person’, Nursing Standard, vol. 25 no. 22, pp. 20-22.

Neville, S & Henrickson, M 2006, ‘Perceptions of lesbian, gay and bisexual people of primary health care services, Journal of Advanced Nursing, vol. 55 no. 4, pp. 407-415.

Rhodes, EA 2011, ‘Literature review’, The Volta Review, vol. 111 no. 3, pp. 353-368.

Sheriff, NS, Hamilton, WE, Wigmore, S & Giambrone, BLB 2011, ‘What do you say to them? Investigating and supporting the needs of lesbian, gay, bisexual, trans, and questioning (LGBTQ) young people, Journal of Community Psychology, vol. 39 no. 8, pp. 939-955.

Weber, GN 2008, ‘Using to numb the pain: Substance use and abuse among lesbian, gay, and bisexual individuals, Journal of Mental Health Counseling, vol. 30 no. 1, pp. 31-48.

Appendix

Author/date Research Questions (or Aims) Methods Used (Sample, data collection instrument,etc.) Main findings Strengths Limitations
King & Nazareth (2006) Comparable health measures (mental, physical and sexual function) of family practice attendees categorized as lesbian, gay, and bisexual Quantitative research. No mention of sample size, but participants 18-75 years old took part. A questionnaire used to collect data Lesbians are more likely than heterosexual women to be smokers, misuse alcohol, report more than one sexual partner in the preceding one month, and report childhood sexual experiences. Gay people have higher levels of psychological distress, are more likely to report childhood sexual experiences, and are more likely to report more than one partner in the preceding month The first study to be conducted in Europe to compare the mental and sexual health of individuals with a range of sexual orientation attending family practitioners (gays, lesbians, bisexuals, and heterosexuals) A small sample of gay and bisexual people, hence difficult to generalize findings; problems in defining sexuality; limitations on data collection
Meads et al (2007) Aimed to indicate the rates of physical health behaviors and other variables of health in a population of lesbians and bisexual women in the United Kingdom Quantitative cross-sectional research. Four surveys were conducted in 10 years. 423 and 615 questionnaires were analyzed during the study. The questionnaire was used for data collection. Lesbians demonstrate high smoking rates than the general population (rate varied from 42% to 55%, being twice the West Midlands regional average of 21% for women aged 16 or more); lesbians demonstrate high alcohol use (rate varied from 25% to 37%, higher than the West Midlands regional average of 7% for women aged 16+); the prevalence of any mental health problem varied between 31-35% and any suicide attempt between 20-31%; Only 29%-45% lesbians had revealed their sexual orientation to health professionals Researchers reported findings of four surveys done over the past 10 years, therefore synthesizing a lot of helpful information on the physical and mental health needs of lesbians and bisexual women Lack of adequate sampling frame due to unknown numbers of lesbians and bisexual women in the UK; difficult to generalize findings due to use of convenience samples; cross-sectional surveys do not establish causation; definitions used in the surveys were not the same as those in the national statistics
Moore (2011) Aimed to not only identify the health needs of lesbian, gay, bisexual, and trans people but also to locate services that are taking steps to improve care for this group of the population Review of primary articles Create awareness on LGBT health issues; train health professionals; LGBT’s encouraged to reveal sexuality to health officials to make treatment and reference easy; reduce discriminatory practices in healthcare settings The analysis has been presented in a straight and easy-to-understand way. Makes too much reference to the suicide of lesbians and gays without attempting to associate the analysis with other known adverse health outcomes affecting LGBT
Fish & Bewley (2010) Drawing from the Yogyakarta Principles, the authors purposed to demonstrate that the right to health for lesbian and bisexual women (LB) does not sorely depend on good health care alone but includes access to health information, participation, equity, equality, and non discrimination Mixed methods approach; a sample of 6490 respondents was used but 5909 met the criteria for inclusion; questionnaire used to collect data Health inequalities for lesbians and bisexuals (LB) include: lack of training and awareness of health professionals on LB rights, sexual orientation, and health issues; poor knowledge and attitudes among health care professionals; lack of equality in access to health care; the dearth of health information and material on LB The findings illustrate participants accounts and experiences; Stonewall (the UK lesbian and gay rights organization) is involved; the study utilizes a diverse sample of LB’s about ethnicity, age, disability, and geographical location Lack of a valid sampling frame in lesbian and bisexual (LB) women’s population, hence purposive sampling strategy was used; study only discusses the qualitative findings
Kim et al (2012) The purpose was to investigate whether elevated risks of health inequalities existed in lesbians and bisexual women (LB) of minority ethnic groups compared with White LB’s and heterosexual women from the minorities Quantitative study; 6338 responses used, 18 years or older; This was Behavioural and Behavioural Risk Factor Surveillance System (BRFSS) was used to collect data LB’s from minority ethnic groups have elevated risks of smoking, lifetime asthma, and disability compared to LB’s from predominantly White communities and heterosexual women; LB’s from minority groupings encounter frequent mental distress and poor general health; obesity, smoking, and mental distress are associated with high asthma rates among sexual minority women The first study to employ a population-based sample to evaluate health disparities among LB’s from minority ethnic groups (Hispanics) by comparing them to both non-Hispanic Whites sexual minority women and Hispanic heterosexual women The operationalization and defined categories of sexual orientation as evaluated in the BRFSS may be culturally limited and may not be relevant in Hispanic culture; a smaller number of Hispanic lesbians and bisexual women and the sample size inconsistencies between comparison groups may have minimized the power of the logistic regression analyses
Hinchliff et al (2005) The study explored “…the difficulties which GPs might face when talking about sexual health with lesbian and Gay patients” Qualitative Study; General practitioners (GPs) identified from practices across Sheffield, UK; a sample of 22 GPs used (nine women and 13 men aged 34-57 years); in-depth interviews used to collect data Non-heterosexual orientation forms a barrier to discussing sexual health matters during consultations with GPs; lack of adequate training of GPs compromise level of care for lesbians and gay people; GPs negative conceptualization and feelings about homosexuals and lesbians compromise the level of care; GPs need further psychosocial training and experiential learning to deal with sexual health needs of lesbians and gays; GPs should be more proactive during consultations, and should also learn communication skills The study was very insightful and detailed due to its qualitative approach None of the samples openly reported themselves as homosexual or lesbian; face-to-face interviews could have a constrained collection of important data due to the sensitivity of the topic; only a third of the GPs contacted decided to take part in the study due to time constraints
Neville & Henrickson (2006) The study purposed to explore the disclosure of sexual identity by lesbian, gay, and bisexual individuals to the general practitioners and primary health care providers Quantitative research study; no mention of sample size, but the study was limited to males and females 16 years of age and over; the questionnaire was used to collect data; total responses were 2269 Healthcare professional attitude towards sexual identity is important to LGBs when choosing a provider; Health professionals assume LGBs to be heterosexual in sexual identity, thereby jeopardizing their overall care and management; nursing profession’s lack specific education on how to interview LGBs and assess their health needs in care contexts; nursing curricula need specifically to address heteronormativity and homophobia within healthcare environments Large sample size provided a firm foundation for future studies; detailed and explicit findings of assessing the healthcare needs of LGBs Sample not statistically representative of the LGB population; difficult to generalize findings due to participant self-selection
Lee et al (2011) The study purposed to “…describe lesbian’s experiences of maternity care, specific interpretations of negative experiences” Qualitative study; hermeneutic phenomenology research design was used; a small sample of 8 women; recruitment is undertaken through snowballing; unstructured interviews were used to collect data Pregnant lesbians in need of health care services either deny or rationalize negative experiences with health care professionals; this group of the population rationalizes negative experiences with care providers to maintain dignity and personal identity; improvements in attitudes to same-sex relationships do not necessarily indicate the absence of homophobia Snowballing ensured a data-rich sample of what was potentially a small and hard-to-identify population; findings are rich in content due to the qualitative methodology used in the study Snowballing can lead to the recruitment of similar participants; disclosure of sexual orientation was a problem, and lesbians who had not disclosed their sexual orientation to midwives refused to participate
Sheriff et al (2011) The study aimed to investigate “…the experiences and support needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people living in Sussex (UK), and the training needs of practitioners working with LGBTQ young people” Qualitative study; a sample of 29 – 11 LGBT identified young people aged 13-26 years and 18 practitioners working with young people; interviews were used to collect data High levels of homophobic bullying among young LGBTs’, making them fear requesting care; practitioners working with young LGBTs’ lack ways to communicate and solve their issues; health and social needs of many LGBTs’ are not being adequately met by existing services across Sussex (UK). The study evaluates other aspects and environments affecting the health of young LGBTs’, such as school, workplace, public services, etc. The study only deals with the mental health of LGBTs’ and not other health-related variables
Weber (2008) The study purposed to investigate whether gay, lesbian, and bisexual (LGB) individual’s experience with heterosexism and internalized homophobia influences their alcohol and substance abuse patterns Quantitative study; a sample of 824 LGB individuals ranging from 18-81 years of age; questionnaire and scales [Schedule of Heterosexist Events (SHE), Internalized Homophobia Scale (IHP), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST)] were used to collect data The study found statistically significant positive relationships between exposure to heterosexist events and drug use and abuse, and between internalized homophobia and both alcohol and drug use and abuse; there are differences in how lesbians, gays, and bisexuals experience heterosexism and internalized homophobia, and; participants classified as having at least one substance use disorder report experiencing heterosexism and internalized homophobia more often than those who are not categorized as disordered on either the alcohol or drug abuse scale The findings were insightful for mental health counselors in uncovering the special treatment concerns for LGBs’ The internet was used to recruit participants and to complete the survey, thus caution should be taken when generalizing the results; self-report measures implies that it may have been possible for participant responses to be influenced by social desirability, hence underreporting of substance use and abuse
Barnes (2012) The study aimed to provide “…an overview of the health needs of lesbians, which are not adequately addressed by primary care in cancer screening, sexual health, health promotion, and mental health” Review of primary research studies Ensure targeted health promotion for lesbians; improve lesbians, gay and bisexual focussed education for health care practitioners, including preregistration training; provide lesbian-specific leaflets and information/education about sexually transmitted infections and cervical cancer risks; primary care services to advertise confidentiality policies as ‘lesbian friendly’; practitioners use gender-neutral language and not assume heterosexuality Well researched; utilizes UK policy documents to lay claims for lesbian health needs The study failed to provide concrete recommendations on how to deal with the lesbian health issues identified
Brown & Groscup (2009) The study purposed “…to examine the relationship between homophobia and acceptance of stereotypes about gays and lesbians” Quantitative correlational study; a sample of 140 participants with a mean age of 21.34 SD=6. 17) and ranging from 18-60 years; used a questionnaire with a 7-point Lickert type scale; attitudes were measured using the Attitudes Towards Lesbians and Gays Scale (ATLGS) The study found relatively little acceptance of most stereotypes about gays and lesbians among participants; the study found few effects for individual characteristics on stereotype acceptance; homophobia is a significant predictor of acceptance of negative stereotypes about gays and lesbians; society is becoming increasingly tolerant of gays and lesbians due to relatively little acceptance of most stereotypes about them Brings into the limelight new information that society is becoming increasingly tolerant of lesbians and gays, hence might react positively to their health and social needs The study could not make definite claims about causality due to its correlation nature; difficulty to generalize findings as data were obtained using self-reports, so respondents may have been inclined to give a socially desirable response to present themselves more favorably; findings may not be replicated across the population as they were demonstrated using only one sample of undergraduate students from a large urban college