I had a postgraduate seminar earlier this week and Doctor Alexandra Muller spoke to us about her current work in the realm of health care, specifically delving into the LGBT community. I found her talk most interesting. Having friends and acquaintances whom readily identify with the LGBT tags, as well as being an critical student in a particular context of the world where there are issues of violence towards this group of people, I felt it pertinent to blog about the informative nature of Dr. Muller’s presentation.

Lesbian, Gay, Bisexual and Transgender are terms most often used in the discourse of Western health sciences. As the terms are grouped and truncated into the acronym LGBT, they present as being exclusionary, and having their own historical and geographical connotations. High levels of violence against gender non-conforming people has occurred across the world, many making it known that a contradiction occurs in their perception of their religious beliefs and the notions of homosexuality that exist. There is often an umbrella term called “sexual and gender minorities” whose purpose is to avoid the narrowing identity-based distinctions that ordinarily become prevalent.

According to research, LGBT people suffer health disparities, with risks from factors due to social exclusion and stigma. In 2011 the Institute of Medicine said: “Although LGBT people share with the rest of society the full range of health risks, they also face a profound and poorly understood set of additional health risks due largely to social stigma.”

Adequate health care for sexual and gender minorities should involve sensitivity to historical and contemporary stigmatization.

According to the DSM Manual of the APA, until 1973 Homosexuality was considered a psychiatric condition.

It was not until 1990 that Homosexuality was removed from the World Health Organization’s ICD code list.

In the world today, high levels of societal homophobia and transphobia exist, often substantiated by antiquated systems of belief and knowledge, especially in medicine and state policy.

People should be informed about differential prevalence’s of specific risk factors and health conditions, as well as the continued barriers to care. Health care providers, who are ordinary members of society, need to be knowledgeable about “culturally competent” care for sexual and gender minorities. Apparently health care providers have levels of homophobia correlating with general society.

The UN International Covenant on Economic, Social and Cultural Rights (1966) stated that everybody has the right to the highest attainable standard of health. However, there are no guidelines for LGBT-specific health care, and there is a general lack of public health care facilities. In some facilities there is a refusal to provide care to LGBT patients, a violation of confidentiality, unethical and unprofessional behaviour. It’s sad that the health care providers have no knowledge about LGBT sexual health, and therefore provide inadequate care.

And how then, do LGBT patients navigate heteronormative and homophobic health care spaces?

They conform to a heteronormative identity by hiding their LGBT identity, are accepting the exoticised identity ascribed to them by health care workers, and/or they do not seek care anymore.

Creating specialized care should not be something we readily accept as the end-game of health care for the LGBT community. It is necessary to shake the very foundations of medicine from the initial stages of learning that is necessary. The medicine courses present their own prejudices that eventually get taught, and ingrain themselves, in the methodological way Medical practitioners practice medicine. That binary of thinking needs to be altered in such a way that “health care” is the umbrella term that affords EVERY single individual of the world the health care they deserve.

Sources

• Müller & Crawford-Browne. 2013. Challenging medical knowledge at the source – attempting critical teaching in the health sciences. Agenda
• Müller. 2013. Teaching Lesbian, Gay, Bisexual and Transgender Health in a South African medical school: Addressing the Gap. BMC Medical Education 2013; 13: 174

Details of blogpost directly sourced from Alexandra Muller's presentation