Despite greater recognition of rights and responsibilities around the care of cancer patients who identify as lesbian, gay or bisexual (LGB) within healthcare systems in the United Kingdom, recent quantitative evidence suggests that they experience poorer care than heterosexual counterparts and qualitative findings are limited. Therefore, in the present study, we present an analysis of the accounts of fifteen British LGB cancer patients (diagnosed with different forms of the disease) of the care received. Data were collected through in-depth individual interviews and analysed using thematic analysis. Three of the emerging themes are discussed. These include an examination of what we conceptualise as the 'awkward choreography around disclosure' opportunities and dilemmas for LGB patients, we describe 'making sense of sub-optimal care' which included instances of overt discrimination but was more frequently manifested through micro-aggressions and heteronormative systems and practices, and explore accounts of 'alienation from usual psychosocial cancer support'. We employ Meyer's Minority Stress Theory (2003) as a lens to interrogate the data and explore the ways in which actual or anticipated prejudice affected their experiences of treatment and support. We close with recommendations to enhance LGB-affirmative cancer care including enhanced training of healthcare professionals and explicit articulation of institutional commitment to LGB equality.

Lesbian, gay, bisexual and trans+ a (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: a) social inequalities, including 'minority stress'; b) associated health-risk behaviours (e.g. smoking, excessive drug/alcohol use, obesity); c) loneliness and isolation, affecting physical/mental health and mortality; d) anticipated/experienced discrimination and e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: 1) Production of large datasets; 2) Comparative data collection; 3) Addressing diversity and intersectionality among LGBT+ older people; 4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; 5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and sub-groups within this umbrella category; 6) Development an (older) LGBT+ health equity model; 7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.

This study aimed to investigate the frequency of spousal violence among Saudi women and document the related health effects and injuries, as well as their attitudes to gender and violence. Structured interviews were conducted with 200 ever-married women recruited from primary-care centres in Jeddah. Nearly half of the surveyed women (44.5%) reported ever experiencing physical violence from their spouse. Although 37 women (18.5%) had received violencerelated injuries, only 6.5% had reported these injuries to a health-care provider. Victims of spousal violence had poor perceptions of their overall health, and reported pain or discomfort, antidepressant use and suicidal thoughts. Women mostly disagreed with the presented justifications for wife-beating. However, the association between gender attitudes and spousal violence was not significant. The results of this study support calls for integration of education about partner violence into health-care curricula to enhance the access and quality of services. ‬ ‫عليهـ‬ ‫ـول‬ ‫احلصـ‬ ‫ـرص‬ ‫وفـ‬ ‫ـات‬ ‫اخلدمـ‬ ‫ـة‬ ‫نوعيـ‬ ‫ـز‬ ‫لتعزيـ‬ ‫ـة‬ ‫الصحيـ‬ ‫ـة‬ ‫الرعايـ‬ ‫ـج‬ ‫مناهـ‬ ‫يف‬ ‫ـزوج‬ ‫الـ‬ ‫ـف‬ ‫عنـ‬ ‫ـن‬ ‫عـ‬ ‫ـف‬ ‫التثقيـ‬ ‫ـاج‬ ‫بإدمـ‬ ‫ـادي‬ ‫تنـ‬Effets indésirables de la violence conjugale sur la santé des femmes consultant dans des centres de soins de santé primaires en Arabie saoudite RÉSUMÉ La présente étude visait à examiner la fréquence de la violence physique infligée par les conjoints à des femmes saoudiennes et de documenter les effets sur la santé et les traumatismes qui y sont liés, ainsi que leurs attitudes vis-à-vis du sexisme et de la violence. Des entretiens structurés ont été menés auprès de 200 femmes ayant déjà été mariées, recrutées dans des centres de soins de santé primaires à Djedda. Près de la moitié des femmes ayant participé à l'enquête (44,5 %) ont déclaré avoir déjà été victimes de violence conjugale. Pourtant, si 37 femmes (18,5 %) ont présenté des traumatismes liés à la violence physique infligée par leur conjoint, seules 6,5 % avaient consulté un prestataire de soins de santé pour ce motif. Les victimes de violence conjugale avaient une perception médiocre de leur état de santé en général et affirmaient souffrir de douleur et de gêne, consommer des antidépresseurs et avoir des idées suicidaires. Les femmes interrogées étaient le plus souvent en désaccord avec les justifications proposées pour la violence conjugale. Toutefois, l'association entre les attitudes sexistes et la violence conjugale n'était pas significative. Les résultats de cette étude confirment la nécessité d'inclure une formation sur la violence conjugale dans les programmes d'études sur les soins de santé afin d'accroître l'accès aux services et leur qualité.

Health researchers engaged in the project of identifying lesbian, gay, bisexual and trans (LGBT) health as a distinct topic for study have often emphasised the differences in health and health care from heterosexuals and similarities among LGBT people. This work has sometimes rendered invisible the experiences of disabled, black and minority ethnic and other groups and has contributed towards the homogenisation of LGBT communities. In this paper, intersection theory is used to explore how diverse identities and systems of oppression interconnect. As a theory, intersectionality requires complex and nuanced thinking about multiple dimensions of inequality and difference. Drawing on the work of Crenshaw (1993), I use three types of intersectionality: methodological, structural and political to explore how the meanings of being lesbian may be permeated by class and gender and how racism and heterosexism intersect in the lives of black and minority ethnic gay men and women. Intersection theory offers possibilities for understanding multiple inequalities without abandoning the politics of social movements.

This article makes a contribution to current debates in human rights-based approaches to lesbian and bisexual (LB) women's health. With reference to concepts embodied in the Yogyakarta Principles, it is proposed that the right to health includes access to health information, participation, equity, equality and non-discrimination. Specifically, the article examines how LB women's health can be considered as a health inequality and discusses international developments to reduce disparities. Drawing on qualitative data collected in an online survey, the article reports on sexual minority women's experiences of health-care. Participants were recruited via a purposive sampling strategy; questionnaires were completed by 6490 respondents of whom 5909 met the study criteria of residence in the UK, sexual orientation and completing the survey once. Analysis revealed four broad themes: heteronormativity in health-care; improving attitudes among healthcare professionals; equality in access; raising awareness and informed communities. The accounts highlight the centrality of human rights principles: fairness, respect, equality, dignity and autonomy. The implications for healthcare policy and practice are discussed including ways to empower staff and service users with knowledge and skills and ensuring non-discrimination in health service delivery.

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Lesbians are less prevention oriented in their health care behavior than heterosexual women and avoid routine screening tests such as Pap smears and mammograms. The reasons for these differences have been partly attributed to beliefs about risk, (for example, lesbians are said to be at lower risk of cervical cancer) and partly attributed to lesbians' poor experiences of health care because of heterosexism. The Lesbians and Health Care Survey was conducted during the 12 month period of 1997-8. The sample consisted of 1066 lesbians living throughout the UK. The study examined whether risk perceptions, experiences of health care and health-seeking behavior were correlated. Data were analyzed using SPSS to determine which variables were associated with participation in screening. While lesbians were less likely than lesbians in a similar US study to report that their risk of cervical cancer was the same as that of heterosexual women, perceptions of risk were not correlated with participation in screening. We assumed that bad experiences of screening would act as a barrier to attendance; instead, good experiences were associated with the increased likelihood of attendance. These findings under-score the need for a pro-active agenda for lesbian health which addresses the need for culturally competent health care, the sharing of best practice amongst health care providers and the creation of systemic institutional change to improve the care lesbians receive.

ObjectivesInformation about the health behaviours of minority groups is essential for addressing health inequalities. We evaluated the association among lesbian, gay or bisexual (LGB) sexual orientation identity and smoking and alcohol use in young people in England.DesignData drawn from wave 6 of the Longitudinal Study of Young People in England (LSYPE).SettingSelf-completion questionnaires during home visits, face-to-face interviews and web-based questionnaires.ParticipantsData from 7698 participants (3762 men) with information on sexual orientation identity and health behaviours at age 18/19.Outcome measuresCigarette smoking history, alcohol drinking frequency and risky single occasion drinking (RSOD).ResultsLGB identity was reported by 3.1% of participants (55 gay, 33 lesbian, 35 bisexual male, 111 bisexual female), 3.5% when adjusting for the survey design. Adjusting for a range of covariates, identification as lesbian/gay was found to be associated with smoking (OR=2.23, 95% CI 1.42 to 3.51), alcohol drinking >2 days/week (OR=1.99, 95% CI 1.25 to 3.17) and RSOD (OR=1.80, 95% CI 1.13 to 2.86) more than weekly. Bisexual identity was associated with smoking history (OR=1.84, 95% CI 1.30 to 2.61) but not alcohol drinking >2 days/week (OR=1.20, 95% CI 0.79 to 1.81) or RSOD (OR=1.04, 95% CI 0.71 to 2.86).ConclusionsIn a sample of more than 7600 young people aged 18/19 years in England, lesbian/gay identity is associated with cigarette smoking, drinking alcohol frequency and RSOD. Bisexual identity is associated with smoking but not RSOD or frequent alcohol drinking.