Health: Lesbian, Bisexual and Trans Women

Baroness Barker Excerpts

Wednesday 3rd December 2014 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government what the National Health Service is doing to improve the health of lesbian, bisexual and trans women.

[Baroness Barker (LD)]

My Lords, in 1999, shortly after I became a Member of your Lordships’ House, I met Lord Campbell of Croy at an event. During our conversation he said, with a note of some pride in his voice, that he had been the Member speaking in your Lordships’ House when the ladies abseiled in from the Gallery to protest against Section 28. Much has changed since then. Section 28 is now history and, as someone who suffers from vertigo, I have to say that I am glad we no longer have to descend by ropes; we can walk in and take our place alongside everybody else in your Lordships’ House.

Today is historic. This is the first time that we have ever had a debate in this House about lesbians, bisexuals and trans women, and their health needs in particular. I am not turning my back on our gay brothers but I just ask them: today, please don’t rain on our parade.

I am delighted to say that the noble Baroness, Lady Gould, has agreed to take part today. She is my predecessor as the chair of the gender identity forum, and she will be talking about the needs of trans women. This debate has been planned and is being followed by many members of our community. I wish to thank in particular Jane Czyzselska from DIVA magazine, and the readers who contributed points; Jess Bradley from Action for Trans Health; Ruth Hunt, the admirable new director of Stonewall and the Lesbian and Gay Foundation in Manchester, which, under the leadership of Siân Lambert, produced a report, Beyond Babies and Breast Cancer, which sparked today’s debate.

The NHS constitution says that it,

“provides a comprehensive service available to all”,

irrespective of,

“gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status”.

However, the problem is that we have a growing body of evidence that says that it does not do that.

In 2008 we had Stonewall’s report, Prescription for Change: Lesbian and Bisexual Women’s Health Check. There was a bisexuality health briefing in 2012, a GP survey covering 2012-13 and the Beyond Babies and Breast Cancer report. It may be small-scale and most of it is very qualitative data, but there are consistent findings that lesbians, bisexual women and trans women experience discrimination in the NHS. The problem is that lesbians are often lumped in together with gay men. The needs of gay men are not insignificant; they are very important, but they are different. On the other hand, lesbians are included in the health needs of all women, yet our health needs are very different. Somewhere along the way, principally because of a lack of awareness and training in NHS staff, we end up getting a very poor service.

Almost half the women who were surveyed for those reports were not out to their GP, and when they did come out their statements were ignored. Only three in 10 lesbian and bisexual women said that healthcare workers did not make inappropriate comments when they came out. I have a wonderful quote:

“I was once asked by a male GP if I was in a sexual relationship. To which I replied yes. He asked if we were using condoms. I said no. Before I could say anything else, he went on a 10 minute rant about using condoms, being on the pill, STIs. When he stopped for air, I replied that I would ensure that my girlfriend would take care from now on. He spluttered and went bright red before promptly stabbing me with an injection that I really didn’t need!”.

Another story is as follows:

“After coming out to a nurse at a GP practice when I went for a smear, she did not know whether to test me for chlamydia and suggested that I see next time if I’m ‘still …’—presumably she meant still lesbian! I haven’t been back to the GP since”.

That is the important thing, and I can attest to similar experiences myself over the past 30 years. When there is such an inappropriate response from a health worker, it completely undermines your confidence.

Very few lesbian and bisexual women have been properly tested for STIs, and those who do turn up at genitourinary medicine clinics have a much higher incidence of STIs than heterosexual women. Quite often, health workers give them the wrong information and advice. One woman said:

“I was treated for cervical cancer after receiving a positive smear. I was originally told that I didn’t need a smear as I had never had sex with a man”.

There are other ways of contracting this viral infection. Sometimes lesbians get a bit fed up with having to be the teachers of the health workers who should be dealing with us.

A number of reports both in this country and abroad have been published about the fact that rates of smoking and alcohol consumption are statistically higher among lesbians and the gay community. It is tough when you have to deal with discrimination every day, and sometimes it is hard to be as healthy and fit as you should be. Some of us make an effort. I am pleased to report that I managed to give up smoking two years ago and I am still going strong. But there is only one alcohol clinic that is specifically targeted at gay women, and that is Antidote, run by London Friend. The problem is that generic services really do not target their messages at lesbians at all.

I turn to cancer screening. Because of lifestyle factors, we know that lesbians and bisexual women have a higher rate of diagnosis, but again there are no specific services and very few specific messages targeted at women from our community. On mental health, the reports we have suggest that although many women live perfectly healthy and happy lives, there is an increased incidence of mental ill health. Its prevalence is greater still among bisexual women. I have to say that there are no data on any of these conditions to show what happens to lesbian, bisexual and trans women from black and minority ethnic communities. There are simply no resources. Lesbians cope well, but there are no mental health services that are particularly designed to help us, and as a consequence we have to be pretty resilient on our own.

Some things can be done that could make a difference. The biggest difference would be made if clinicians and front-line staff in primary care recognised and understood that some of us are gay. They should not always ask questions that presume we are not. Bless them, sometimes they say things for the most benign of reasons, but it is still discrimination and they need a lot of training to help them get over what is essentially a flaw in their medical practice. Some partnerships have been formed between certain specialist organisations and lesbian and gay community groups which have worked very well. Manchester has the Pride in Practice project where the Lesbian and Gay Foundation has worked with nurses and doctors so that they are trained to ask questions in a way that does not make a presumption about the person to whom they are talking.

There are many more things that could be done. I am not asking for special services. That is not going to happen, given the financial situation at the moment. The NHS is a service for us all and therefore some of us, because of our background, have the right to expect that that universal service will meet our needs.

I have four specific points to put to the Minister. The first is to ask when Public Health England will put forward a strategy for promoting the health and well-being of lesbian and bisexual women. There is one for gay men; there is not for lesbians and bisexual women. Secondly, will NHS England develop a data standard on sexual-orientation monitoring? At the moment there is no monitoring of the way in which we interact with the NHS. Thirdly, the biggest problem is that GPs simply do not know how to talk to us. Can the Minister work with the Royal College of General Practitioners to develop some standards for questions to be asked of patients in a non-pejorative way? Lastly, in our work with GPs, could the health outcomes of lesbians and bisexual and transsexual women be part of the overall monitoring of GP practice?

We are citizens of this country. We are taxpayers. We support the National Health Service. It is only fair that we should expect it to recognise that we exist and should be able to access those services with dignity like everybody else.