Health and Wellbeing Inequalities for LGBTQ+ People with Laura Clarke | Transcript
Find the shownotes here!
Laura Clarke
Trans people know themselves best. They know their own bodies. They know who they are. And if answering a question in a certain way is gonna make you feel bad about yourself or make you feel dysphoric for whatever reason, then there's also something to be said for answering it in the way that you feel most comfortable.
Hannah Witton
Welcome to Doing It with me, Hannah Witton, where we talk all things sex, relationships, dating, and our bodies. Hello, you. Welcome to Doing It. I'm your host and resident sex nerd Hannah Witton. This week I'm joined by Laura Clarke, who is the Stakeholder Engagement Officer for the National LGBT Partnership who work to reduce health inequalities and challenge homophobia, biphobia and transphobia within public services. They do so much important and necessary work, like one to one counselling, peer support groups, helplines, advocacy, youth work, HIV, housing support, drug and alcohol interventions, and putting LGBTQ+ people and their issues on the agenda of decision makers and policymakers. That's a lot of good stuff.
Laura and I cover so much in this episode in terms of the specific issues around the health and wellbeing of LGBTQ+ people, what services are available to them, and how our public services are failing this population. In the UK, we also recently had the 2021 census, which for the first time had voluntary questions about sexual orientation and gender identity, and we talk about that in terms of data and monitoring of LGBTQ+ people and the phrasing of questions asked about gender. We chat about the impact that COVID and the pandemic has had on LGBTQ+ people and specific issues like LBT women's health and trans men and non binary people accessing pregnancy and birth services. We get into so much and it was so interesting to hear about the state of things currently and ways we can make our public services more accessible and inclusive. As usual, you can find more info and links to everything we talked about in this episode in the shownotes over at doingitpodcast.co.uk. And please let us know what you think over on our Twitter or Instagram, which is @doingitpodcast also, Instagram is the place to be if you want to get your questions answered by our guests, because that is where I ask for them. Thank you so much for listening. And here is my conversation with the wonderful Laura Clarke.
Hello, Laura, how are you doing?
Laura Clarke
I'm doing well. Thank you. How are you?
Hannah Witton
Not bad, not bad. I'm really excited to dive into everything that we're going to discuss. I absolutely loved that you sent me like a big old email of like, there's this thing, and then there's this thing, and I'm like, yes, so much stuff to get our teeth into. But I guess we just start with: what is the National LGBT Partnership? And what does it do?
Laura Clarke
The National LGBT Partnership is a collection of LGBT voluntary and community organizations who have formed a partnership in order to tackle LGBT health inequalities. Currently, there are 10 partners, but that is going to be growing soon, it was going to be expanding to over 35 partners. So it's going to be growing by quite a lot. But yeah, the whole point of it is so that we can address LGBT health inequalities within our health systems and sort of barriers to care that LGBT people face.
Hannah Witton
Yeah. And top line, what are those? Because I feel like there might be some people who are like, wait, hang on, why is it - what makes it different? And like, what makes some of those barriers? And like, what are some of those barriers?
Laura Clarke
There's so many. So I think that you can kind of separate it out into LGBT specific issues. So those are kind of the health issues that LGBT people, that pretty much only LGBT people will face. So we're talking things like accessing hormone replacement therapy, we're talking sort of gender affirming surgeries, and things like that. And then there's also sort of the areas that might cover the broader population. So things like mental health or drug and alcohol abuse or even things like diabetes or heart disease, but that disproportionately affect LGBT people for whatever reason. And there's a lot of research into why that might be but suspicions are that it involves some level of homophobia, transphobia, biphobia when people are accessing care.
Hannah Witton
Right. Yeah, the suspicions.
Laura Clarke
The suspicions.
Hannah Witton
Hang on a second, I think something is afoot here.
Laura Clarke
Yeah. And there's also the kind of the fact that, you know, LGBT people have much higher rates of mental illness. Now that isn't because they're LGBT, but it probably is related to the kind of societal factors.
Hannah Witton
Homophobia and transphobia again.
Laura Clarke
Exactly, exactly. So even though even if that's not within the health systems, it's health conditions that are disproportionately affecting LGBT people. There's also things that are health conditions in themselves that are related to poor health or things like homelessness, which is massively [inaudible] for LGBT people, particularly LGBT young people who may have been sort of kicked out of, you know, by parents who aren't approving and then obviously being homeless can lead to an increased risk of other health conditions.
Hannah Witton
And I think what the last year has taught us as well is just like how intertwined social issues and health issues are, like, you can't really separate them like, oh, this is just something that happens to your body and your health.
Laura Clarke
No, absolutely. Absolutely. And when I started this role, it was interesting, because it was from a health perspective and my background is somewhat in health but more generally in kind of the voluntary sector, and I was working with - prior to this, I've worked in mental health, and I've worked with young people on sexual health and you know, other issues like housing, and debt and benefits and things like that. So when I started this role, I was sort of like, oh, we're sort of narrowing it down into health. And then I realized it's not narrowing it down at all, because it's so all intertwined and actually, I've started saying health and wellbeing because I think that the wellbeing side of it, so the social side of it, is just so linked. And it has huge, huge, huge impact.
Hannah Witton
And I guess, one thing that for me comes to mind with accessing health care, that social issues, and like identity have like a really big part in is advocacy. And being your own advocate when you're navigating the health system, or like access to somebody else who could be your advocate, if you're not able to do that yourself, is that -
Laura Clarke
And that's really challenging. I mean, if you're going through, if you're going through a hard time, for whatever reason, with your health, if you're, I don't know - I mean, most recently, I was having a conversation about advocacy, which was involved with, and I'm sure we'll come onto this, trans men and non binary people giving birth, who may be in the process of labour, who might be in the process of giving birth, but having to correct healthcare professionals as to what their pronouns are because they're being misgendered. And when you're, when you're giving birth, when you're five centimetres dilated, that's not a conversation you want to be having. So actually, you know, in those spaces, it is oftentimes so important to have somebody that can advocate for you and can push for your identity to be respected.
Hannah Witton
Yeah, absolutely. And actually, let's get on to that, about trans men and non binary people who, you know, can be pregnant and do give birth. And you mentioned in your email to me about Brighton and Sussex Maternity - their like, guidance for like inclusivity when it comes to that kind of thing. What I guess in the UK is healthcare like? What is - what is it like navigating maternity and pregnancy and birth if you're a trans man or a non binary person?
Laura Clarke
I think I think it's getting better in some places. And I think that Brighton are a really, really good example of that with this new guidance that they've released. But I think it is challenging because I mean, all of us, when we think of pregnancy, we think of being a woman, we think of a woman being pregnant. Because that's so ingrained in us because every image we see of a pregnant person is of a pregnant woman. And that's so ingrained into our brains that for healthcare professionals, you know, even people that are, that are actively working with trans men and non binary people who are pregnant and giving birth, I think it's hard to rewire that. And it's so important that they are doing the work to rewire that. There are lots of other kind of issues that can arise if you're a trans man or a non binary person, and you're pregnant. Now not everybody is going to experience kind of gender dysphoria, but some will, so there's that aspect to it as well of, "okay, my body's is doing something that I potentially, you know, that feels uncomfortable to me or that I have also, because we're all hardwired in this way, I also associate with womanhood in some way and now that's my body doing that and I don't identify as a woman." So there's that element to it, which is difficult, but then there's accessing, you know, accessing care and going into a maternity ward and it being called a maternity ward and seeing images -
Hannah Witton
I hadn't even thought of that! Yeah. Oh my goodness. Oh, wow. Yeah.
Laura Clarke
It's just the name of it and we start trying to think of more gender inclusive language and that's a huge problem -
Hannah Witton
Is there a neutral version of maternity or paternity? Maybe it exists somewhere, I don't know.
Laura Clarke
Maybe parental, parental services?
Hannah Witton
Yeah.
Laura Clarke
But yeah, it's very interesting. And language plays a huge part of it. Because I mean - something - we've been doing work in this area recently and we've actually been engaging in conversations with the Brighton kind of midwifery team that are doing all of this gender inclusive work. And what we've, what we've heard back is that actually, there's so much language that is gendered when you're accessing this care. So breastfeeding, for example, and a lot of trans men and non binary people may instead feel more comfortable using the word chestfeeding.
Hannah Witton
Yeah.
Laura Clarke
Some might not, some will be absolutely fine using breastfeeding. But for some people, that is the terminology they're gonna feel more comfortable with. You know, with things like referring to vagina, having your healthcare professional be aware that you would like it to be referred to as genitals instead, or some people just prefer it to be referred to as their front hole, for example, so that you're removing that gendered language. And I think what's really interesting is that trans men and non binary people are very forthcoming with wanting these things a lot of the time, it's just people being trained, the healthcare professionals and the midwives being trained in a way that they can one, be respectful of that, but two, eventually that we can ask everybody, what is, what are your preferences? What would you like us to refer to your body as? And not just assume.
Hannah Witton
Like if you know, where you're going to be giving birth, all of that information that you gave the team about, like, your birth plan, or whatever? All of your patient details, but like, like you said, like, language to be used, like pronouns to be used, like all of that being in - what's it called, like, your intake form?
Laura Clarke
Yeah, yeah.
Hannah Witton
And like only having to be told once as well.
Laura Clarke
Yeah. So continuity of care is very, very important to the LGBT community. This is something that we've heard time and time again, because if you are, you know, accessing lots of different doctors, that's having to come out repeatedly, over and over and over again, and having to say, "Actually, these are my pronouns. And actually, that's not what I refer to that body part as" over and over and over again. So it's particularly with something as complex as kind of pregnancy and birth, having continuity of care, having a consistent midwife, throughout that process is something that can be really, really, really helpful so that you don't have to keep rehashing the kind of gender issue over and over and over again.
Hannah Witton
Yeah, that's so true. I hadn't even thought of that, because I swear, like, every time I bring up my doctors, I'm just like speaking to a different person.
Laura Clarke
Yeah, speaking to a different doctor, and you know, people - you know, I've heard stories of, you know, women who have sex with women saying that they speak to a different doctor every time and every single time, they're asked what birth control they're using, and they're like, "Well, I'm not using any birth control."
Laura Clarke
Yeah. "Are you in a relationship?" "Yes." "Are you having sex?" "Yes." "Well, you need birth control." "No, I don't." Just things as basic as that that GPs and doctors and health professionals aren't aware of, it's just so - it can be tiring, and I think people don't place enough kind of importance on just how tiring it can be like, obviously, the kind of disastrous, you know, health outcomes and the very blatant homophobia and transphobia is so important to talk about but when you're just getting these little microaggressions every time you're accessing care, it could lead to you not accessing care and then if you're not accessing care then you might not report, you know, something that you're going through health-wise and it could end up being the disaster, you know, the tragic outcome.
Hannah Witton
Lesbianism!
Hannah Witton
Yeah. And like as someone who has accessed a lot of healthcare and like, you know been through all sorts with my health but as a like straight and cis person, even just what I've had to deal with, the admin involved in maintaining your own health and keeping up with appointments and things and then I just can't even imagine on top of that, like, having to justify or explain your identity or like being misgendered, like, on top of all of just the normal admin that's involved.
Laura Clarke
Yeah, and having to do that. And you know, some people are quite, you know, confident when they're, when they're coming out but others, for others, it's gonna be a really nerve-racking experience if you have to rehash that every single time you visit healthcare professional. And if you're always the one to broach it as well, you know, we're gonna talk about monitoring, I think that being asked is so important. Because I mean, I'm a bisexual woman and I'm very confident with coming out but sometimes it's just not knowing when and I recently joined a new doctor and I was in, you know, something completely unrelated to whatever, my bisexuality, and I was just sitting there like -
Hannah Witton
"Oh, by the way, I'm bi!"
Laura Clarke
Yeah, I was just sitting there and I was like, I want my healthcare providers to be aware of my identity, but I just sort of ended up blurting out, "Oh, I'm bisexual, by the way." And they were like, "Okay, and why is that relevant?" So, you know, like actually asking people so that you don't have to take on the emotional labour of coming out and being like, when is the appropriate time? And how is this going to be received? If you're asked then i's just gonna make things so much easier?
Hannah Witton
Yeah. And so you mentioned monitoring? And I think that's like a really good segue into that. Because if it is a case of them asking, is that an official ask, like, is that, is it something that you put on your form, you know, when you say what your gender and your date of birth and your address is, like when you register at a GP or something? What - I guess, like, what is the state of data and monitoring around sexuality and gender in our healthcare system? And then we can get onto the census.
Laura Clarke
So, yeah, so sexual orientation, and trans status monitoring, is what we call it. And part of what the partnership is doing is working with the NHS to get this implemented throughout all of the different NHS services. Now, this isn't just a blanket, "it just goes across the NHS", that isn't how it works. There's so many different aspects to this massive organization that is getting it implemented, so sort of in different departments and different areas. But essentially, yes, what our goal is, is that when you would sign up to a GP - and obviously this, this is completely voluntary, that you would offer this information, nobody's going to force you to - but the idea is that you would be asked, you know, what is your gender identity? You know, what's your trans status? You know, is your gender identity the same as what's assigned at birth? And what's your sexual orientation? And once that information is being given, one, you know, you don't have to have that, you know, emotional labour on "I have to come out to my healthcare professional, how is this going to be received," because it's just being asked.
And if it's being asked a lot of the time, it's - obviously you're going to encounter situations where you're asked, and then there still is homophobia, biphobia, transphobia. But oftentimes, it's a nice indicator that they're, one, acknowledging you, but, two, may possibly accept you as well. So not only that, but then also, if your healthcare provider knows, for example, that you are trans, they might be more aware of the, you know, the different gender affirming treatments that you may require, or may want, so they can have a better idea of, and also just have a better idea of what what health conditions may disproportionately affect you. So we know that LGBT people have much higher rates of mental illness, that's something that your GP can just be aware of. And it may mean that they can offer you a certain service that otherwise they wouldn't have been able to like an LGBT support group or something like that.
Hannah Witton
Yeah, absolutely. And also, I think it's important to know that, that that is obviously entirely confidential. Like it -
Laura Clarke
Yeah, entirely confidential. If you are concerned about how your data is being held, you absolutely have the right to ask, and if you're concerned about it, you should ask. And it is a big concern for a lot of people because, you know, particularly if you're a young person, you're going to your family doctor, that is friends with your mum and dad, and you've been going to since you were little, then, you know, disclosing that and thinking it could get back to somebody, it's gonna be a huge barrier. So, yeah, but being able to ask, you know, "If I disclose this, how is that going to be held? Is this confidential?" And do ask the question, because, you know, you'll be reassured to know that they do have to keep that confidential.
Hannah Witton
Yeah. And I guess, especially if you know that your doctor is also treating your family members. And if they don't know, then yeah, absolutely.
Laura Clarke
Exactly.
Hannah Witton
This actually made me think, what if - because, for a lot of people, figuring out your sexuality, figuring out your gender is not a like, "Oh, I got it! I know what I am!"
Laura Clarke
It's not at all.
Hannah Witton
It's not often that kind of moment. And it might be a long process of questioning, or it might be thinking that you're one thing and then, like, years later being like, oh, wait.
Laura Clarke
Yeah, absolutely. It's all a spectrum.
Hannah Witton
Yeah! And so in this case, like, do any do any GPs have this on the forms yet? Or like so say, in a world where you do put your trans status, your sexual orientation, when you fill out the form, If that changes, do you ring them up in the same way that you would change your phone number or address?
Laura Clarke
Yeah, you should absolutely be able to. You should be able to, you know if that changes, or even if you were previously identified as cis or heterosexual, if that changes, you should be able to go in and change it like you're changing your address. It should be that simple.
Hannah Witton
It should. And it should be that normalized.
Laura Clarke
Yes. It should be that normalized as well. Definitely.
Laura Clarke
Yeah.
Hannah Witton
Okay, so the census, which just happened.
Laura Clarke
Yeah, the census.
Hannah Witton
It just happened, for the first time ever it was collecting data on sexual orientation and trans status.
Laura Clarke
Absolutely, yeah.
Hannah Witton
And I saw a lot of like LGBT organizations kind of like pushing for people to fill it out, 'cause it felt like this really important, like, momentous occasion.
Laura Clarke
Including us, including us, we were pushing for that as well. And it is, it is a huge step forward in so many ways. There are issues with it. But it's a step forward. And the reason that, you know, the Partnership, and also so many other organizations were pushing for people to fill this in, and to fill it in accurately, is because the census informs policy, it informs funding. So you know, if the government are aware just how many LGBT people they are living in the UK, hopefully, it means that we can get more funding into health services and into support and things like that.
Hannah Witton
Yeah, absolutely. So what are the issues though? I remember when I was filling out - I can't remember the specifics, but I'm sure you'll know, but I was filling out and going, "Hang on the order in which they ask these was a bit confusing." Like, if if I was trans and I was trying to answer this, I was like, "Hang on. That doesn't make sense."
Laura Clarke
So they ask you, they ask you about the - about your sex, first of all. Yeah.
Hannah Witton
If you had gender affirming surgery, then what is your sex? Like, do you know what I mean?
Laura Clarke
Exactly, and not even surgery. So I've seen a lot of trans people saying, you know -
Hannah Witton
Yeah, hormones.
Laura Clarke
- "I've taken so many hormones at this point that I feel like my body is more biologically" - say if they were assigned male at birth - "I feel like my body is now more biologically female than it is male. But I haven't had any surgery. And also, my gender marker hasn't changed on my, on my passport, or my birth certificate or whatever." So yeah, I think that was, that's one issue. And the way that -
Hannah Witton
Because what does that mean, what is your sex?
Laura Clarke
What is your sex? Exactly, what is your sex? And what the census was saying is that you should refer to, you know, your birth certificate, passport, I think they changed the - changed the actual guidance on the things you can refer to a couple of days before, which wasn't helpful, because some people -
Hannah Witton
Oh, wow, yeah.
Laura Clarke
But yeah, it was all about referring to your documentation. But so people who have, you know, gone through surgeries or treatments or whatever, that might not, might not match up. Now, the other thing that I noticed when I was filling in the census was that the question of sex wasn't voluntary. And the questions on gender identity and sexual orientation were voluntary. It's interesting, because, you know, we're very much into consent and only disclosing if you feel comfortable. And some questions might be difficult for people, you know, if you have to answer your gender identity, and you don't know your gender identity, if that's something you're exploring, then you shouldn't have to answer that question. But with the sex question, you did have to answer it, which I found quite, quite interesting. But yeah, I feel like there's there's been a lot of, a lot of discussion among the trans community. I mean, the way that we've sort of done some some research as the LGBT Partnership into the best practice way to ask questions, because it's not just that you're asking questions, it's doing it in the best practice way.
Hannah Witton
What is the best way, then?
Laura Clarke
So, what we found when we were doing it was that you would ask the question on sexual orientation, then you would ask the person - the sexual orientation stuff tends to confuse people less than the gender stuff and the trans status stuff. So the sexual orientation question is one part of it. But then what we would ask is, we would say, what is your gender identity? And we would have, you know, man, and then in brackets, including trans man, we'd have woman and then in brackets, including trans women, or we'd have non binary and then we'd have, you know, in another way, and then we would have a question saying, "Is this the same as what you were assigned at birth?"
Hannah Witton
Yes.
Laura Clarke
So we don't ask, when we're doing monitoring, personally, as the LGBT partnership, we don't ask what is your sex at this point. And I think it's interesting because sex so often is purely just relating to your body parts and to the way that your body works. So it's quite interesting - I'd be interested to know why the census needs to actually know that information.
Hannah Witton
Yeah, it's a weird one because that's how I think of it as well and like the only people who really need to know that information, like yourself and maybe your sexual partners and your healthcare providers?
Laura Clarke
Absolutely. Yeah.
Hannah Witton
Those are the people who need to know. I assume that what the government meant by "What is your sex" is "What was your sex assigned at birth." That's probably what they were going for. But yeah, like I said, like - *sighs*
Laura Clarke
And this is why, you know, the intention can be there but if you're not asking the questions in the best practice way, you're going to make people feel all sorts of confused. Yeah. And essentially, you know, disrespect somebody's identity, which isn't what we want to do when we're trying to gather this information.
Hannah Witton
No, but you also want to be gathering the correct information, like that's the whole point of it.
Laura Clarke
Yeah, exactly. And I know that there were a lot of trans people who were saying that they were going to ignore the guidance that the census was putting out, and that they were gonna select the sex that they most align themselves with, even if that wasn't reflected on their birth certificate or their passport. Now, there's kind of - this is, this is a gray area in terms of what is best because on one hand, the census benefits from the most reliable data. And if they're asking for something in a certain way, then that could potentially skew data if you're answering it in a different way. However, also, trans people know themselves best. They know their own bodies. They know who they are. And if answering a question in a certain way is gonna make you feel bad about yourself, or make you feel dysphoric for whatever reason, then there's also something to be said for answering it in the way that you feel most comfortable. So I mean, I'm a cisgender woman, I very much don't think it's my case to have an opinion on that, but it is interesting in terms of what this will do for this census, and how much the information that they receive is going to be accurate in what they believe - in what they sort of align as being accurate information.
Hannah Witton
Yeah. In terms of what information they were looking for, as well.
Laura Clarke
Yes, exactly, yeah. So it's going to be accurate information, because trans people answering and they're answering accurately about themselves, but it's whether or not the government, you know, assumes that to be accurate, based on what they're expecting to receive.
Hannah Witton
Yeah, exactly.
Laura Clarke
So it's all very complicated.
Hannah Witton
Yeah. But yeah, I'm just I'm intrigued to see what happens and what comes of it, because we've never had, like, accurate, like, this kind of scale data on like how many trans people are in the UK, how many LGBT people in general are in the UK, so I think, yeah, it's exciting. Like you said, it's like, it's a step in the right direction,
Laura Clarke
It's a step in the right direction. It is a step in the right direction, and hopefully, you know, next census in 10 years time, we'll see something a little bit better. But it is a step in the right direction. And hopefully, it's going to mean that LGBT people are being seen, and that, you know, the government and healthcare was responding in an appropriate way to those people.
Hannah Witton
Yeah, yeah. Fingers crossed.
Laura Clarke
Yeah.
Hannah Witton
I wanted to talk about COVID.
Laura Clarke
COVID!
Hannah Witton
And its impact on LGBTQ+ people because, yeah, I've seen like, some stuff - we've seen a lot of stuff about how COVID is more impacted Black people, ethnic minorities. And so, and the same for LGBT people. So what I guess, like, what has that impact been in the last year?
Laura Clarke
I think it's interesting, because I think that there's again, you can separate this out into what are the actual risks to your health? And then what are the risks to your more general wellbeing? So there's lots -
Hannah Witton
I guess, like the impact of lockdown as well, like, it's kind of -
Laura Clarke
Yeah, exactly. So there's kind of - LGBT people are more at risk of certain health conditions or health outcomes, I suppose. So, for example, they're more likely to smoke, which isn't going to be, you know, very good if you're, if you have COVID, which is a respiratory infection. That could lead to you having a worse health outcome than somebody who doesn't smoke, for example. There's also, you know, as always, the kind of issues with LGBT people receiving care, there's - I mean, I know somebody who had COVID and was struggling to breathe and still didn't go to the hospital because they were trans and they didn't want to have to deal with -
Hannah Witton
Oof. Yeah.
Laura Clarke
Yeah, it's really heavy stuff. Fortunately, they're okay. But yeah, it is worrying. You've got people who don't want to go and access health services, who, in a time when we need our health services, you know, that's, that's not great. And then you've got the people who will access health services and will receive a whole load of, you know, homophobia, transphobia, in response. So there's, there's, there's so many layers to this, but then in the kind of wellbeing level as well. If you're, for example, a young person, and you're not out to your family, or you're not out to your housemates - and all this goes for older people as well, but I'm particularly thinking of young people who are more likely to live with, with relatives, and then to be confined in a house with those people - I mean, so many LGBT young people rely on sort of going out to social groups and support groups. I know of, you know, when I used to do youth work, I know lots of young LGBT people who the only place that they were out without their support group that they went to weekly, and their parents thought they were going to a friend's house, and now they're trapped inside. Those support groups aren't able to run. So what's that going to do for somebody kind of mental health. It's, yeah, there's so many layers to it. And I think that it's, I mean, it's not been a good year for anybody, but kind of really, really looking into the ways that this is impacting minorities generally is so so so important, because you can't take, you know, a white cisgender straight person's experience and take that as everybody's experience of COVID. You just can't.
Hannah Witton
No, absolutely not. No. And you're so right. It's just like, all of the things that have happened in the last year, it's just then like, exacerbated if you have a minority identity, or minority status, or whatever, yeah.
Laura Clarke
Absolutely, yeah.
Hannah Witton
And the isolation thing is, is so real, I feel like I've heard so many stories of just people feeling like, completely cut off from the LGBT community, and only in that kind of isolation kind of understanding just how much of a lifeline that has like, that is for people.
Laura Clarke
Absolutely.
Hannah Witton
Yeah. We have the internet.
Laura Clarke
Yeah! But older LGBT people as well are, you know, much potentially much higher risks of of loneliness, actually, in older LGBT people for variety of reasons. But, you know, we're thinking about older people who may have lost a partner to, to AIDS back in the 90s. There's, you know, higher risks of older people, particularly older LGBT men, I believe, who live alone and rely on kind of those social attractions for their own wellbeing, their own sort of sanity. So there's that element to it as well. There's the people who, you know, the older - there's the younger end of the spectrum where you're trapped at home with your family, and the older end where you're trapped at home with nobody.
Hannah Witton
Yeah. Oh, wow. Yeah, that's so true. Yeah, it really is. And then I guess, like, not to stereotype, but if you are older, you're probably less likely to be actively involved in maybe like online communities, where they would be other LGBT people.
Laura Clarke
Absolutely. And so much, you know, everything is online now. So - but if that's something if that's a barrier for you, then you're potentially completely cut off at this point. I mean, everything's online.
Hannah Witton
Yeah. Everything. And so a bit of a shift: In March, you did the L - LBT - I keep - I struggle because I'm just automatically, just like LGBT -
Laura Clarke
I know, I do the same thing.
Hannah Witton
LBT Women's Health Week, and we kind of touched on it briefly about, like, doctors asking about birth control. But what are some of like, the specific health issues for LBT women? Because women's health in general is, is something that with like, through The Hormone Diaries stuff is something that I'm well aware of, but then like, on top of that, if you are lesbian, bi or a trans woman, what, what is going on there with the healthcare?
Laura Clarke
Yeah, I mean, like you say, women's health is so often just completely neglected, or downplayed, I think is probably the right word to use. I mean, when we think about the fact that, you know, we've - that all of the contraception available, all the hormonal contraception available is for, you know, people with vulvas and people with, you know, uteruses. And then you go back to kind of in the news a while ago, they trialled something for men, but found that men were experiencing mild depression or something and they instantly cut it and women are over here screaming, "That's what we've been dealing with for years." It's just hugely, hugely, hugely downplayed. So you've kind of go that aspect to it, which is that the women's issues are and I say that in inverted commas, "women's issues", are very much downplayed and ignored by health systems. And then you've also got the fact that LGBT identities are also downplayed or ignored, or oftentimes just completely not understood by, you know, by doctors and by healthcare providers. So then you get a really strange crossover. So a huge, huge, huge issue within the LBT community is cervical screenings and lesbian and bisexual women or women who have sex with women are being told by medical professionals that they don't need to get a cervical screening, which is absolutely false. Everyone should be getting a cervical screening.
Hannah Witton
Yeah. Why? Why would they say that? Is there just like this assumption that like, oh, if you're not having sex with someone with a penis, then like, you have zero risk? Like, no.
Laura Clarke
Yeah, the assumption is that you can only get HPV through sex with a penis, which isn't true, you can get it through - it can be transmitted on on fingers, on hands, it can be transmitted through toys. There's lots of ways that you can, you can get it, and lesbian and bisexual women are absolutely at risk. But they're being told by medical professionals that they don't need to get it, which is absolutely disastrous. And actually, it results in them being up to 10 times less likely to have a cervical screening than heterosexual women.
Hannah Witton
Wow! If you've got a vulva, go get your screening.
Laura Clarke
This - there's that aspect of it. And it's people being told that they shouldn't - not that they shouldn't but that they don't need to, you know, "A, you'll probably be fine. You don't need to get it unless you're having sex with someone with a penis." But then you hear kind of stories of when people with vulvas are accessing their cervical screening, and being treated completely and appropriately. So the one that sticks in my mind, which seems like such a small thing, but actually carries quite a lot of weight, is I heard a story of somebody going to get their cervical screening, being up on the bed, sort of legs in the stirrups -
Hannah Witton
And it's such a vulnerable position.
Laura Clarke
- such a vulnerable position - sort of mustering up the courage and then saying, "Oh, by the way, just so like, I feel like I should let you know, I'm a lesbian." And the person who was doing the screening said, "Oh, okay, no worries, I'll use a small speculum and lots of lube." Which on the surface, it seems like a funny joke. But what that person is doing is, when that person's already in a vulnerable position, is making assumptions about the type of sex they're having, what they're putting in their vagina. And it's, it's just so inappropriate, they're making so many assumptions just purely based on orientation, which as we know, does not, you know, it doesn't correlate to the kind of sex that you're having. And it's just, yeah, it's something like that, and having to sort of deal with that inappropriate curiosity or inappropriate comments, it can be really off-putting. And I know that -
Hannah Witton
Whilst you're half naked.
Laura Clarke
- whilst you're half naked, I mean, you know, a cervical smear, it's not comfortable for most of us but if you're then having to have to, you know, to deal with with that, and deal with those kind of comments, it'd be completely off putting, and so many people report experiences like that, and say, I'm never going to go back for another one. And, you know, HPV, cervical cancer, it can kill, so it's so important that you're going to get tested and that we're not going to be putting people off. We need to be making people feel much more accepted in these services, and treat people just appropriately, the same as you would if that was, you know, a heterosexual woman lying there. And, you know, it could have been a really interesting moment where she could have asked, "Oh, okay, is there anything that you know, you want from me? Do you want to use a smaller speculum?" Being given that choice, being given that ownership. It's not that we can't, can't ask these things. It's that when you're doing it in such a kind of flippant, flippant way, but also in a way that you're entirely making an assumption. That's when it's going to, you know, really deter people from coming back.
Hannah Witton
Yeah. And I think you nailed it just then with what you said about not being scared to ask because, like, if you're a healthcare provider, like you - there's information that you're going to need about your patient in order to provide the best care.
Laura Clarke
Absolutely.
Hannah Witton
And when it comes to things like identity, sexual orientation, and all of these, all of these things, people can often get defensive, and then just kind of like not say anything for fear of saying the wrong thing.
Laura Clarke
Absolutely.
Hannah Witton
They're your patient, like you need to you need the information and like you said, like, don't make assumptions, just ask.
Laura Clarke
And also it doesn't benefit, you know, heterosexual people either because there are going to be heterosexual people who are having regular sex, you know, heterosexual people with vulvas who are having regular sex with someone who has a penis, who will also need to use a small speculum. Or a larger speculum.
Hannah Witton
Yeah. Yeah. Or straight people who haven't sex in years or have never had sex, do you know what I mean?
Laura Clarke
Yeah, or people who are in a relationship but not - but are asexual and not actually engaging in sex? There's so many reasons. So it's not doing anyone any good to just assume. We should always be asking. I mean, when I went for my cervical screening, I asked if they could use a small speculum and they were lovely about it, you know, they were absolutely fine. So, you know, if you're just a petite person, or if you're -
Hannah Witton
I also did not know that you could ask for a small speculum. Good information to have.
Laura Clarke
You absolutely can. I'm five two, five foot two, I'm quite petite. So I was like, "Yeah, please could you use a small speculum," and they were really nice about it. But It's already such a nerve-racking experience. It really is. I mean, I went for my first one last year. And even though I sort of knew everything about it, I knew it'd be fine, I was nervous. And I didn't, you know, even though I am bi I wasn't planning on coming out in that appointment so I didn't have that aspect of it to worry about as well.
Hannah Witton
Yeah, absolutely. Okay, I've got some questions from followers on Twitter. And this is kind of related to like everything that we've been talking about. Somebody asked, as a future queer doctor, how do I get my colleagues to be more inclusive to queer people? So yeah, advice?
Laura Clarke
Yeah, it's so interesting, because yeah, I feel like sometimes, if you're the only queer person, or even if you're the only ally, you know, visible ally, in your kind of service, you can feel a bit like you're banging on a glass cage. And I'm just thinking back, when I used to work in youth services, I was the LGBT lead and something that I noticed was that the sexual healthcare that we were providing was very cis normative, very heteronormative. And I realized that even me as a queer person, I didn't necessarily know all of the ins and outs of what LGBT sexual healthcare looked like. So I went to my manager, and I asked if we could organize some training, and I think that's a really good thing that you can do is, say, "Actually, I don't think that we're providing the right quality of care, we're not providing an equal quality of care to LGBT people as we are with cishet people." Find the training, go looking for it. There's so much LGBT training, you know, contact charities, they'll be willing to come out and, and, you know, or do a Zoom, do some Zoom training, and go to your managers about it. And I think that, that's one way that you can kind of make everyone aware but without being that kind of - without you having to do all of that kind of work of trying to, you know, educate people. Just doing the first step and then allowing -
Hannah Witton
Get the pros in!
Laura Clarke
Exactly, get the pros in. But there's also so many ways that you can show support, and show your inclusivity when you are a service provider. And there's something called the rainbow badge scheme, which is in its I think, second phase now. But basically, it's just, it's really simple. It's just a little NHS badge, sort of like the NHS logo backed onto a rainbow. And healthcare providers website, just to show that they are inclusive of LGBT people. There's also things like pronoun badges that you can wear. And the likelihood is, if you're wearing a badge, you are aware that people are going to have, you know, different pronouns and what somebody might assume about them. And so things like that, you know, can you put up a poster of an LGBT flag? Talking to your colleagues about it and saying, you know, "Oh, have you seen this scheme? Would this be something that would be cool for us to get here so that we can all you know, show our support?" And just start by having the conversation and it can be just sort of casually, sort of, scope out what people what people think about providing a more kind of overtly LGBT friendly service.
Hannah Witton
When you mentioned like posters as well, it made me think of like, all of the different like, pamphlets that you get given and, like, obviously, like, within your hospital within your department, that's not necessarily something that you can change because I am assuming that those are mass produced, right? But you know, if anyone is listening who has power up there with the pamphlets, make them inclusive.
Laura Clarke
You can, you can wear a little badge or a rainbow lanyard, just little tiny visual cues. It means so much to people who may have previously been a bit concerned that they're going to be coming out to somebody that is going to, you know, have kind of stigmatized view of them or is going to be discriminatory. Just to see, okay, this person is an ally, I'm, I'm okay. I'm going to be accepted here. And yeah, just just broach that conversation with your colleagues and say, you know, "Hey, is this something that we could do here? This is quite cool." And see what the responses and yeah, always if you're concerned about the actual care you're providing, and that it's not, you know, equal for LGBT people, then absolutely try and get some some training in. I've been to many, many of the training days and they're all very, very informative.
Hannah Witton
Aw, good. And - but slight spanner in the works. The rainbow has a different meaning now with the NHS and with COVID and everything.
Laura Clarke
Yeah. Yeah.
Hannah Witton
So do you think that like if someone saw NHS staff wearing like a rainbow badge that it would actually be connected to the pandemic? And not that they're LGBT friendly?
Laura Clarke
Hannah, you absolutely said it right. It's a huge, huge spanner in the works. And yeah, I mean, obviously, the - during COVID, kids started drawing rainbows and putting them in their windows. And that was lovely. That was so, so, you know, it brightens up everyone's day and it provided a symbol of hope and that was amazing. But then what started happening is people started kind of capitalizing on the rainbow and symbolizing the rainbow as something associated with the NHS. I think, in, I think it was one of the Pride buses got rebranded as an NHS bus, because it was like their rainbow bus or something like that. And they just completely erased the association that it had with Pride. And I've seen you know, I've seen LGBT Pride flags being sold as NHS flags.
Hannah Witton
Ugh!
Laura Clarke
Yeah, yeah.
Hannah Witton
It's just like - but the pride flag is like, specific colours as well.
Laura Clarke
Yeah, yes. Yeah, absolutely. Absolutely. So it is concerning. And I went for my vaccine about a month ago. And I walked in, and I saw that there were basically - the NHS badge had been sort of printed out and put around the the centre that I was getting my vaccine. Now that might have well been intended to say this was an LGBT safe space. But I didn't know. And that was what concerned me. I didn't know if that was a support for the NHS or support for LGBT people. And that can be dangerous. Because if you're, you know, if somebody is wearing the NHS Rainbow badge, or if they're wearing a rainbow lanyard, and you as an LGBT person, you feel comfortable coming out to them, because you think "Oh, great, they're an ally." And then it turns out that actually no, they are showing their support for the NHS, which is great, but potentially needs a slightly different way of being represented.
Hannah Witton
It needs a different symbol!
Laura Clarke
It needs a different symbol, it needs a different symbol, absolutely.
Hannah Witton
But how do you change it now?
Laura Clarke
Exactly, yeah. And it just means that, you know, a lot of LGBT people, are now seeing these visual kind of cues that, okay, there's a rainbow, it might be safe, this might be a safe space for me. But then second guessing themselves and being like, is that for me? Or is that for the NHS? Is this actually a safe space? Which is potentially, again, it's going to cause barriers to accessing care, it's going to cause people to not want to come out to their health professionals, because they don't actually know if that's an ally or not.
Hannah Witton
It's so tricky!
Laura Clarke
It is.
Hannah Witton
Moving on slightly to a question that somebody else had that I'm curious about, because I hadn't really thought about how this works together. But do you know the impacts of being aromantic or asexual has on health care? Is there any specific stuff for the ace community?
Laura Clarke
I think this is really interesting, because I don't think that there is an awful lot of research in this area. I mean, research into kind of, you know, the L, the G, the B and the T is already lacking. But then once you go into the plus identities -
Hannah Witton
Q, I, A, plus, yeah.
Laura Clarke
QIA+, you - there just really isn't research in that area. In terms of accessing healthcare if you're aromantic or asexual, I mean, if you can, if you feel comfortable letting your healthcare providers know what your orientation is, then that's great. I'm just trying to think of the kind of the issues that you may encounter. And I'm wondering, obviously, asexual people may still be having sex, for whatever reason, but if you're an asexual person who doesn't have sex, it may be a similar scenario to women who have sex with women whereby you're kind of having to explain over and over and over again that you don't need birth control, even though you're in a relationship.
Hannah Witton
There also could potentially be the assumption like if you if you're asexual and you do come out to your doctor or healthcare provider, and then they assume that because of your asexuality that you don't have sex, so it's like -
Laura Clarke
Yeah, absolutely. I think I think with no kind of the lesser recognized identities, I think a lot of the burden that fallsupon the person accessing care is actually explaining what that is. And what that means. And the professionals not actually knowing or understanding what that orientation is, like, "Oh, okay, we know, okay, it's fine. What does it mean if somebody is genderfluid? What does it mea if somebody is aromantic? You know, demisexual? What does that actually mean? How does that influence the care I provide?" And it means that the person sitting in the doctor's chair is having to, again, sort of explain to every healthcare professional that they come across what that actually means in terms of their identity and in terms of their care.
Hannah Witton
Yeah. And I think it just comes back to again, that not making assumptions and asking the questions for which you need the information of that specific question in order to provide that care.
Laura Clarke
Yeah, if you don't know something, ask the person sitting in front of you. And if you find that consistently, you don't know something, you know, if you find that consistently, you're coming up against questions regarding LGBT identities that you aren't aware of, then go off and do some research, source some training. You know, it's all about being able to - and there's going to be things that we don't know, and there's going to be people that we come across that we don't fully understand, you know, their identity or it's something we haven't heard of. And it's just so important that if that happens, that you educate yourself, and that you ask the questions, and that you don't make any assumptions.
Hannah Witton
Yeah, absolutely. One of the things that this made me think about, actually, is that for the sexual orientation stuff, it's not exactly the orientation itself that would give information to the healthcare provider about what they need. It's actually like, what sexual behaviours you're engaging in. And so that question is relevant to absolutely everyone. And yeah, like we've been saying, like, even if someone does disclose what their orientation is to you, like, not making assumptions about what that means, in terms of like, who they're sleeping with, as well. Yeah,
Laura Clarke
Absolutely. And it's, it's, you know, for so many reasons, people who may identify as say a lesbian, for example, may be having sex with men and may be able to get pregnant. But if that's being, you know, if the assumption is being made that by a healthcare professional that "Okay, they're a lesbian, so therefore, they can never have a man and they never will have sex - or sex with somebody with a penis," then potentially, something's going to be missed there. And actually, teenage pregnancy rates are so much higher in lesbian and bisexual girls than they are in heterosexual girls.
Hannah Witton
Oh, wow. I didn't know that. Because I guess like people don't think that the information is relevant for them?
Laura Clarke
Well yeah, that's - I don't know if there's 100%, you know, if we know 100% why that is. But yeah, I mean, it's theorised is that that is one reason that we just assume that this information doesn't apply to them. But you know, this, there's so many angles, so many - I think one example is, you know, lesbian women who may be doing sex work and having sex with with people with penises, who are going to be exposed to potentially unwanted pregnancy. But that doesn't change they're orientation, it's just the sex that they're having.
Hannah Witton
Yeah, absolutely. Well, Laura, thank you so much. This has been like such an enlightening conversation.
Laura Clarke
You're welcome.
Hannah Witton
Where can people find the national LGBT partnership and the work that they do? And then also, of course, where can people find you online as well?
Laura Clarke
Yeah, great. So you can find us on Twitter. So our Twitter username @LGBTpartnership, and it's the exact same on Instagram. And then my Twitter and Instagram handle is @thelauraclarke and that's clarke with an E.
Hannah Witton
Lovely, well, thank you so much. And thank you all for listening. Bye.
Thank you so much for listening to Doing It. If you enjoyed it, I would really appreciate it. If you left a rating and a review. You can find show notes at doingitpodcast.co.uk and do go follow us on social media and I'll catch you in the next episode. Bye.
This was a Global original podcast