SERVICE PROVISION TO THE LESBIAN, GAY, BISEXUAL
SERVICE PROVISION TO THE LESBIAN, GAY, BISEXUAL AND TRANSGENDER COMMUNITY1 Introduction
This fact sheet aims to provide information to improve service provision to Lesbian, Gay, Bisexual and
Transgender people in healthcare settings.
Disclosure of Gender Identity and Sexual Orientation
Healthcare providers have a duty of care to ensure that Lesbian, Gay, Bisexual and Transgender (LGB&T) people are able to access services within a safe, inclusive
environment which enables LGB&T clients to be able to address sexual orientation and gender identity issues comfortably. However, many LGB&T people may be doubtful of the standard of care and the level of knowledge services providers may be able to offer in relation to sexual orientation and/or gender identity issues. As a result of this and a variety of other
personal and environmental factors, feeling comfortable about accessing health care services and being assured of appropriate, timely and understanding care can be difficult for LGB&T people.
1Reference Service Provision to the Lesbian, Gay, Bisexual and Transgender Community LGBT Health Systems Project QLD Association for Health Communities
For further information on Equality, Diversity and Human Rights within Hywel Dda Health Board, please feel free to contact either:-
Jackie Hooper Jane Whalley Equality and Diversity
Equality and Diversity Officer
Hywel Dda Health Board Bwrdd Iechyd Hywel Dda*
Canolfan Gwenog Canolfan Gwenog
Glangwili General Hospital Ysbyty Cyffredinol Glangwili Dolgwili Road Heol Dolgwili
SA31 2AF SA31 2AF
Extension 4097 (Internal)
Factors that can make it difficult for LGB&T clients to access health services:-
• Heterosexism (assuming clients are heterosexual)2
• The lack of service providers knowledge of LGB&T issues
• The fear of breaches of confidentiality
• Expectations of our past experiences of
discrimination/negative attitudes from service providers
• The client’s levels of self-acceptance and comfort with issues of sexual orientation, gender identity or both
• Social isolation experienced as a result of sexual orientation or gender identity
• The levels of homophobia, bi-phobia or
transphobia in the wider community and fear of rejecting within local community
These factors can also affect the willingness of LBG&T clients to address or disclose sexual orientation,
gender identity or HIV/AIDS issues with service providers.
2Also described by some as heteronormative, or applying heteronormative “rules”
Healthcare provider’s use of language:
Whilst people are entitled not to disclose their sexual orientation and/or gender identity if they so wish, the appropriate use of language can assist LGB&T people to feel comfortable disclosing and addressing sexual
orientation and/or gender identity issues with service providers.
Health care providers need to be conscious of using heterosexist language during consultations with clients – they must not assume their client is heterosexist
language is used, LGB&T clients may feel that service providers are not aware, knowledgeable about disclosing these issues and may result in the non-disclosure of sexual orientation and gender identity issues to service providers, which may be relevant to their clinical
treatment. This may also cause the client to feel
pressurised to disclosure their sexual orientation and/or gender identity, when they do not feel comfortable during so in certain circumstances.
APPENDIX 1 – Extract from “The Gender
Recognition (Disclosure of Information) (England, Wales and Northern Ireland) (No. 2) Order 2005
Section 5 of the Regulation states:-
1. It is not an offence under section 22 of the Act to disclose protected information if:-
a) the disclosure is made to a health professional;
b) the disclosure is made for medical purposes; and c) the person making the disclosure reasonably
believes that the subject has given consent to the disclosure or cannot give such consent.
2. “Medical purposes” includes the purposes of preventative medicine, medical diagnosis and the provision of care and treatment
3. “Health professional” means any of the following:- a) a registered medical practitioner
b) a registered dentist within the meaning of section 53(1) of the Dentists Act 1984
c) a pharmacist or a pharmacy technician registered in Part 1, 2, 4, or 5 of the register maintained under Article 19 of the Pharmacy Order 2010 or a
registered person within the meaning of Article 2(2) of the Pharmacy (Northern Ireland) Order 1976 d) a registered nurse;
e) a person who is registered under the Health
Professions Order 2001 as a paramedic or operating department practitioner;
f) a person working lawfully in a trainee capacity in any of the professions specified in this paragraph
Further information may be obtained from:-
“Good Medical Practice” – GMC publication
“Confidentiality and Disclosure of Health Information Toolkit” – BMA publication
GIRES (Gender Identity Research and Education Society Team) – “A guide to Trans Service Users’ Rights:
Transgender wellbeing and healthcare”
Stonewall Cymru – for further information on LGB issues www.stonewallcymru.org.uk
Infoline: 09000 50 20 20 LGBT Excellence
Bi Cymru/Wales www.biwales.org.uk SMS 07982 308812 LGBT Cymru helpline www.gayvibes.co.uk
0800 8402069 (7-9 Mon + Wed) Voicemail at other times Email: contact:lgbtcymruhelfdesk.org.uk
Examples of Clients Questioning Gender-Neutral vs Heterosexist
Client could be
heterosexual, bisexual or a lebian
Gender- Neutral Language
Female Are you in a relationship?
Do you have a boyfriend?
Do you have a partner?
Do you have a husband or boyfriend?
Are you having sex with a man, woman or both?
Are you having sex with men?
Sexual Orientation and Sexual Activity
It is important to note that not everyone’s sexual orientation will correlate with their sexual behaviours.
People may identify as being a lesbian, or gay man and still be engaging in heterosexual sex, while others may not identify as a lesbian or gay man or bisexual,
although will engage in same sex sexual practices. It is important for healthcare providers, where relevant to their treatment, to first focus on the sexual behaviours of a client rather than whether they identify as a lesbian, gay man or bisexual.
Gender Identity and Sexual Orientation
Gender identity is an individual’s sense of identity in relation to being a man or a woman. It is not centred around issues of sexual orientation or sexual behaviours.
Transgender people can be offended by health care providers’ unnecessary enquiries about their sexual orientation and sexual practices. Transgender people identify as heterosexual, bisexual, lesbian and gay.
However the distinction between gender identity and sexual orientation is important for healthcare providers to understand. Enquiries regarding a transgender person’s relationships or sexual activities, when
appropriate, should be treated with sensitivity and based upon gender-neutral language.
How comfortable is your client?
It is important to be aware of the client’s personal level of comfort in addressing sexual orientation and/or gender identity issues. An individual’s level of comfort may vary depending on whether they have disclosed this information to other people, if they have support to address these issues and their personal levels of
acceptance and understanding of sexual orientation or gender identity amongst other factors.
Healthcare providers should be aware that some LGB&T clients may not have disclosed information regarding their sexual orientation and/or gender identity to other people. Some clients may experience internal conflicts and negative attitudes towards their own sexual
orientation or gender identity as well as rejection from family and friends, open hostility, social isolation, stigma, discrimination and violence as a result of their
• What would be the purpose of passing on such information – is it medically relevant
• Is there a way of providing information that is relevant, without necessarily referring to the trans identity or history
• Have names and pronouns been chosen so that a person’s transgender status is not inadvertently disclosed.
Improving access to Healthcare Services
We need to ensure that service environments and service provision promote a discrimination free and confidential setting for LGB&T clients to feel comfortable in addressing these issues with service providers. LGB&T clients need to be assured that they are accessing services that are receptive, comfortable, knowledgeable and respectful of LGB&T needs and concerns and that services can meet these needs and concerns. Being able to provide
information for LGB&T people to access appropriate forms of social support or information on sexual orientation and/or gender identity issues is also important.
practice and, in respect of those who are covered by the privacy provisions of the Gender Recognition Act3,
disclosure could amount to a criminal offence.
Furthermore, this information may be irrelevant to their reasons for attending their appointment, since people experiencing gender variance will also seek medical treatment for conditions that are totally unrelated to trans-sexualism.
Under the Gender Recognition Act, it is an offence for a person who has acquired protected information in an official capacity to disclose the information to any other person.
An exemption for the sharing of information between health professionals is provided for if the sharing of information is for medical purposes and the professional making the disclosure reasonably believes the individual has consented. (See Appendix 1 for further details) Good practice recommends that health professionals discuss with the patient what information may be shared and, if it refers to the patient’s trans-gender status, the clinical reasons why it is considered necessary/appropriate to do so.
Healthcare professionals may consider the following when deciding what information should be shared:-
• Is the information regarding the present or past gender status or treatment relevant in the
3Under the Gender Recognition Act, the protected information relates to the fact of the change of gender of a person who has obtained a Gender Recognition Certificate.
sexual orientation and/or gender identity. However, being able to disclose sexual orientation and/or gender issues and have a frank and open discussion in a safe, confidential and non-judgemental environment is an important element in being able to accept ones own identity and reduce the mental health concerns that LGB&T people often confront when addressing sexual orientation and/or gender identity issues. It is
considered a crucial factor in the overall health and wellbeing of an LGB&T person.
However, there are many reasons why it may be
inappropriate for an individual to disclose. For example, it could increase mental distress, family estrangement, loss of accommodation, initial problems with getting employment or within the workplace etc. It is therefore important to note that whilst disclosure can be positive for many, it is not appropriate for all LGB&T people.
Supporting LGB&T Clients
Social isolation is a major concern for the health and wellbeing of LGB&T people, especially in rural areas.
Many LGB&T people do not disclose issues of sexual orientation and/or gender identity due to their fear of experiencing negative reactions or rejection from
friends, family, and the general community. Feelings of social isolation may become more acute when LGB&T people do not know and have support from other LGB&T people or have access to support services to address sexual orientation and/or gender issues.
Healthcare providers need to be aware of the importance of social support for LGB&T clients, especially for those dealing with internal conflicts or who have not yet
disclosed. The inability to share these concerns or
disclose gender identity and/or sexual orientation issues can lead to mental health problems, including
depression, anxiety and distress associated with the fear of being “outed” and the inability to express one’s own identity, which can result in suicide attempts.
THE IMPORTANCE OF CONFIDENTIALITY Healthcare providers are familiar with the duty of confidentiality to clients. However, for some LGB&T clients, confidentiality may be a higher priority than other clients. This is often reflected in and reinforced by the high levels of discrimination encountered on the basis of sexual orientation, gender identity and
HIV/AIDS issues within the broader community. The fear of breaches in confidentiality or being outed, which results in having information relating to sexual
orientation, gender identity or HIV/AIDS status disclosed to other people without the individual’s consent, is one of the main reasons LGB&T people are reluctant to
access services or disclose LGB&T or HIV/AIDS issues to service providers. This is especially relevant if a client has not disclosed these issues to family, friends, or other members of the community.
The consequences of breaches in confidentiality
surrounding issues of sexual orientation, gender identity or HIV/AIDS can result in:-
• Rejection from family and friends
• Loss of partners
• Discrimination and stigma from the general community
• Loss of employment
• Harassment and threats or actual violence
• High levels of stress and anxiety resulting from the disclosure of this information and its consequences
• Having to geographically relocate due to high levels of discrimination, harassment, threats or actual violence within the community
LGB&T clients are more likely to discuss sexual orientation and gender identity issues if they are assured that
confidentiality will be maintained within the service. It is important that LGB&T clients are assured that
confidentiality will be maintained, with service providers offering an understanding of the highly sensitive nature of these issues. Maintenance of confidentiality needs to be assured across all staff that access client files, e.g.
receptionists, file clerks, and other healthcare
professionals within the service. This is of particular concern for LGB&T clients in small communities where staff may know their family or friends or their family or friends work within the service.
N.B. Confidentiality is required for all service users, but it is particularly sensitive for transgender people. Reception staff, nurses, doctors and other healthcare professionals, need to be aware that unnecessary and unwanted
disclosure of the transsexual status of service users is bad