Background Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care. Methods A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities. Results LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people. Conclusion Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.
This article introduces the possibilities of transnational feminist queer research as seeking to conceptualise the transnational as a methodology composed of a series of flows that can augment feminist and queer research. Transnational feminist queer methodologies can contest long-standing configurations of power between researcher and researched, subject and object, academics and activists across places, typically those which are embedded in the hierarchies of the Global North/Global South. Beginning with charting our roots in, and routes through, the diverse arenas of transnational, feminist, participatory and queer methodologies, the article uses a transcribed and edited conversation between members of the Liveable Lives research team in Kolkata and Brighton, to start an exploration of transnational feminist queer methodologies. Understanding the difficult, yet constructive moments of collaborative work and dialogue, we argue for engagements with the multiplicities of ‘many-many' lives that recognise local specificities, and the complexities of lives within transnational research, avoiding creating a currency of comparison between places. We seek to work toward methodologies that take seriously the politics of place, namely by creating research that answers the same question in different places, using methods that are created in context and may not be ‘comparable'. Using a dialogue across the boundaries of activism/academia, as well as across geographical locations, the article contends that there are potentials, as well as challenges, in thinking ourselves through transnational research praxis. This seeks complexities and spatial nuances within as well as between places
While the spatializations of social exclusion have long been critically assessed, legislative responses to these exclusions have also been found to be limited. Addressing the exclusions of Lesbian, Gay, Bi, Trans* and Queer people, social inclusions in the form of equalities legislations have been used as a marker of ‘progress’ and development, creating neo-colonial geographic comparisons between the legal and policy regimes of different contexts. Taking a decolonial optic, this paper shows that even in one of the most progressive legislative contexts – England – equalities legislation is differentially implemented, and indeed resisted by some local government organizations creating what we term as an implementation gap. This paper uses liveability as an understanding of the importance of recognition that does not proscribe restrictions, while also seeking ‘a life that is a life’. It works across India and the UK to create transnational thinking that seeks commonalities without negating difference, showing that liveability enables both an articulation of Lesbian, Gay, Bi, Trans* and Queer people’s ongoing unease in England, and a counter-narrative to reductive readings of legislative oppression in India. In both countries, liveability refuses to negate the possibilities of legislation, but neither does it become beholden to them. Liveability, it is argued, has the potential to discursively unlink a naturalized linkage between sexual sub/ab/jects and a progress/backward binary. The paper concludes that liveable lives are fluid, contingent and can be precarious even with recognition. A decolonial optic refuses to place precarity in the ‘Backward Global South’ and recognition in the ‘progressive Global North’. Instead commonalities between Lesbian, Gay, Bi, Trans* and Queer lives query these assumptions and associated hierarchical politics of ‘saving’ ‘backward’ nations. This has the potential to deepen demands for social justice, in ways that do not abandon legislative reforms, but go beyond them to seek lives that are ‘worth living’, including through transnational interconnections and solidarities.
Lesbian, gay, bisexual, trans and intersex people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with Lesbian, gay, bisexual, trans and intersex people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender, and non-intersex by default; second, the assumption that lesbian, gay, bisexual, trans and intersex people people do not experience significant problems (and therefore that their experience is mostly irrelevant for healthcare. On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.
The implementation of lesbian, gay, bisexual and trans (LGBT) equalities is not uniform, but varies locally and regionally as well as nationally. Research has long focused on large metropolises, with the assumption that work to improve LGBT equalities will mostly take place in these areas. However, a growing body of geographic research attests to positive LGBT experiences in rural areas, and calls for further attention to LGBT lives and equalities in hitherto neglected towns. In this paper I detail public sector LGBT equalities work which occurred in the areas of Hastings, Rother and wider East Sussex, through a Participatory Action Research (PAR) project involving a partnership of local public services,LGBT communities, activists and academics from 2010 to 2013. I aim to show that public sector LGBT equalities work is intimately connected with a relational logic of rural/urban, and that this logic can result in some areas being overlooked when it comes to public sector LGBT equalities. Bringing a burgeoning literature on geographies of LGBT equalities together with rural geographies, I advance discussions of progressive public sector equalities work beyond the urban and explore how relational geographies of 'the rural' and 'the urban' might come together with the discourses of public sector equalities work. Acknowledging the continued importance of discursive rural/urban binaries with regard to LGBT equalities in neglected rural areas, I also explore the slippery ways in which such imaginaries adhere and do not adhere to particular areas. These slippery geographies can result in areas being overlooked in terms of LGBT equalities work. Finally, I point out the importance of other alternative geographic imaginaries relevant to LGBT lives and communities which rural/urban binaries may render less visible. In doing so, this paper, explores the complex relational geographies of how the urban and the rural emerge through discourses of public sector LGBT equalities.
Background The health inequalities experienced by lesbian, gay, bisexual, trans and intersex (LGBTI) people are well documented with several reviews of global research summarizing key inequalities. These reviews also show how the health‐care needs of LGBTI people are often poorly understood whilst suggesting that targeted initiatives to reduce inequalities should involve LGBTI people. Objectives To determine what is known about the health‐care inequalities faced by LGBTI people? What are the barriers faced by LGBTI people whilst accessing health care, and health professionals when providing care? What examples of promising practice exist? Design Rapid reviews of grey literature were co‐produced with LGBTI people in 27 countries followed by a thematic analysis and synthesis across all data sets. The review included grey literature from each country that might not otherwise be accessible due to language barriers. Main results Rapid reviews showed that LGBTI people faced various inequalities and barriers whilst accessing health care. Where heterosexuality, binary gender and assumed male/female sex characteristics were upheld as the norm, and where LGBTI people differed from these norms, discrimination could result. In consultations where LGBTI people feared discrimination and did not disclose their LGBTI status, health professionals lacked the information required for appropriate assessments. Conclusion With greater understanding of sexual orientation (LGB people), gender identity (trans people) and sex characteristics (intersex people), combined with access to contemporary knowledge and training, health professionals can work in collaboration with researchers, policymakers and LGBTI people to develop systems that are better attuned to the needs of all service users.
This piece introduces the papers for the Sexual(ities that) Progress special issue. It arises out of two sessions at the 2017 American Association of Geographers Annual Conference, where scholars critically interrogated assumptions of progress and the ideals and models that follow from understanding certain spaces and places as ‘leading the way’ in terms of sexual and gender inclusions. In this paper, we outline some of the key debates and how papers in this special issue address discourses of sexual(ities that) progress and, in particular, the importance of decolonial and postcolonial critiques in such debates. We conclude by noting omissions, the timeliness of the papers and the ongoing need for spatial lenses in exploring the power relationships that reconstitute sexual and gendered lives, cultures, politics and embodiments.
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