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.
Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.
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.
Resumo: O presente artigo pretende contribuir para dois objetivos, um de caráter teórico e outro de natureza empírica, no contexto português em que recentemente o papel dos/as profissionais de saúde se tornou mais relevante na avaliação clínica, apoio e mudança de nome/sexo legal de pessoas transexuais. Deste modo, o primeiro objetivo consiste em rever a literatura e os "standards of care" internacionais no que diz respeito aos cuidados de saúde com pessoas transexuais. O segundo objetivo remete para a apresentação de um estudo empírico qualitativo, que explora as perspetivas de clínicos/as (n=6) e de pessoas transexuais (n=7) sobre as suas experiências em serviços de saúde em Portugal. Os resultados são demonstrativos de certas competências destas equipas clínicas, mas também alertam para a existência de práticas contrárias às recomendações internacionais. Estes resultados são discutidos à luz da literatura respeitante à transexualidade mas também das abordagens relativas à sensibilidade clínica para a diversidade individual e cultural.Palavras-chave: transexuais; cuidados clínicos; competências para a diversidade individual e cultural; estudo qualitativo.
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