Openness may not completely disarm prejudice, but it’s a good place to start, believes Jason Collins who’s the first openly gay athlete in US pro sports. The LGBTQ are an ever-increasing community worldwide with India being no exception. The acronym LGBTQQIAAP is an umbrella term and stands for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Asexual, Allies and Pansexual. As per the GOI in 2012, there are about 2.5 million gay people in India based on individuals who self-declared to the Ministry of Health. There have been several recent political movements in favour of LGBTQ rights with the Supreme Court of India decriminalising homosexuality by declaring Section 377 of the IPC unconstitutional. Yet, there remains a significant prejudice, discrimination and violence against the community.
The repercussions of disclosure such as rejection and bullying at school, home and society, limited access to education, employment and social functions, loss of employment or discrimination, denial of rights and all-encompassing social stigma have a great impact on their quality of life. Homophobia exists in the fundamental cultural fabric of our country. Hence, many remain undisclosed and closeted. Homosexuality had been included in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association until 1973. However, in the later editions, it has been removed as a mental disorder.
Immunocompromised
‘Health for all’ is the universally accepted objective globally. Stigmatisation and discrimination have precluded them from accessing health care services. The health issues in the community may be directly related to sexual preferences or may be exaggerated by the non-utilisation of preventive health services, or compounded by mental health issues and substance abuse and social factors such as homelessness and unemployment. In the current pandemic, the community has had to face further challenges. The already existing challenges with economic independence are increasing. Also, many community events such as Pride events have been cancelled all across the globe. There is a lack of medical insurance and reduced access to healthcare facilities in this community. The members of this community are more likely to be immunocompromised and are more likely to have mental health problems and substance abuse problems such as smoking. These factors increase their risk of Covid-19 infection.
Constant fear and anxiety, confusion (especially in gender-fluid individuals), depression, low sense of self-esteem, and a 2 to 3 times higher risk of suicidal tendencies are some of the mental health issues in this community. Substance abuse and addiction are more prevalent in these communities. Domestic violence is also prevalent amongst individuals with other sexuality due to non-conformity to social norms.
Ostracisation often leads to homelessness and unemployment. Most of these issues arise not as a direct result of their sexuality but as a response to the differences faced in the world.
Shy away from seeking help
Lesbians are less likely to seek gynaecological help and screening for various cancers such as breast and cervical cancer due to fear of discrimination, judgemental behaviour, breach of confidentiality and privacy. In fact, lesbians tend to have the exact set of high-risk factors for breast cancer. Gay men are at a higher risk of HIV/AIDS, HPV related diseases like warts and penile cancer. In general, obesity is also very prevalent in the community. Elderly LGBT are exposed to life-long suppression and discrimination which may lead to crisis hardiness at this age. All the health ailments may exacerbate during the current pandemic both due to the associated stress and anxiety and also limited availability of health services. Health professionals also face several challenges in dealing with LGBT issues due to lack of training, lack of knowledge about the physical and psychological issues, and discomfort in communication and counselling.
Healthcare provision for LGBTQ should ensure qualified, equipped health services with the requisite training for professionals. The training should ideally be introduced in undergraduate curricula and reinforced at various levels. A holistic approach towards their social, cultural, emotional and physical aspects has to be adopted. Elicitation of history should be open-ended with questions like — ‘Are you in a relationship?’ ‘Do you have a partner?’ Confidentiality and privacy must be established and communicated at the outset. Apart from a non-judgemental and spontaneous open consultation, provision of longer appointments for a detailed history and addressing all the concerns thoroughly is important. Comprehensive services should include an appropriately trained gynaecologist, dermatologist with expertise in sexual health, psychologist/ psychiatrist and a dedicated non-judgemental staff.
The provision of annual sexual health screening is of paramount importance. This includes HIV, syphilis, Chlamydia, gonorrhoea screening. The frequency may be increased if there is high-risk behaviour with multiple unknown partners. Screening for mental health issues and substance abuse must form a part of the initial consult by any health professional to ensure and facilitate appropriate referral. Affirmative counselling and advice about healthy choices help in a positive experience. On a positive and encouraging note, many doctors have been able to provide online teleconsultation for a wider audience in the current pandemic. Accessing online modes of consultation can be more discreet and reassuring to the members of this community too.
Existing LGBTQ+ communities in liaison with health service providers can form a good support system for individuals to break barriers and help them find their identity and innate strength.
Since the community is growing, albeit mostly closeted, the onus is on the government, healthcare providers and the society at large to provide them with the right to equality in healthcare to help them flourish as productive citizens of the country.
(The author is a senior consultant in obstetrics and gynaecology.)