In April 2017, the European Court of Human Rights ruled that requiring trans people to undergo sterilisation in order to grant legal gender recognition was a breach of human rights. In the UK, sterilisation has never been a legal requirement for trans people. However, hysterectomy and salpingo-oopherectomy have been strongly encouraged for trans masculine people on medical grounds, although the clinical evidence for current recommendations is weak. Within this article I analyse the issue from a feminist perspective and argue that current presumptions in favour of surgical intervention are influenced by the history of medical interventions to "fix" bodies perceived as female, coupled with a strong social taboo against the pregnant man. As a consequence, medical and legal frameworks are not necessarily facilitating optimal outcomes for the individual. I suggest that practices in this regard should be critically examined, with a view to developing more tailored, person-centred practices and facilitating informed choice.
Anonymization is usually seen as important for research, especially when dealing with sensitiv. topics. This case study describes issues with anonymization which arose in a qualitative interview-based project exploring the health care experiences of older lesbian, gay, bisexual, and trans people. Questions of names, identity, and anonymity often hold particular significance among older lesbian, gay, bisexual, and trans people. Some older lesbian, gay, bisexual, and trans people may want to keep aspects of their identity private, whereas others may see it as important to be open about who they are. In addition, the depth of information gathered regarding participants' personal situations and their community ties meant it was, at times, difficult to strike a balance between retaining anonymity and capturing relevant aspects of individual experiences. Anonymizing very personal experiences is likely to become increasingly challenging as information online becomes more comprehensive and easier to cross-reference. Researchers should consider how best to negotiate questions of identity in a specific context and take into account the potential implications of changing technology.
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The COVID-19 pandemic has had a significant impact on older people's lives on a global scale but for some marginalised communities have seen a marked exacerbation of health and other inequalities. Research has highlighted the impact of the pandemic on lesbian, gay, bisexual and trans (LGBT+) people's lives, but less has been documented about the experiences of LGBT+ older communities and how their specific needs have been mediated. Community-based advocacy organisations are central to promoting LGBT+ human rights in the UK through its social movements, and this paper explores their role and significance during a distinct period of the UK mandatory isolation. Drawing on a case study approach based on qualitative interviews with six key LGBT+ community organisations in the UK, we captured their insights into how they navigated support for older people when faced with limited resources and the challenges posed by mandatory physical and social distancing. We position these events in current discourse about structural and health inequalities for LGBT+ ageing in the UK.
This paper reports findings from a qualitative study into the immediate impact of social distancing measures on the lives of lesbian, gay, bisexual and trans (LGBT+) older people (≥60 years) living in the UK during the first lockdown of the COVID-19 pandemic. It draws on in-depth interviews with 17 older people and 6 key informants from LGBT+ community-based organisations, exploring the strategies used to manage their situations, how they responded and adapted to key challenges. Five themes emerged related to: (1) risk factors for LGBT+ older people and organisations, including specific findings on trans experiences; (2) care practices in LGBT+ lives; (3) strengths and benefits of networking (4) politicisation of ageing issues and their relevance to LGBT+ communities and (5) learning from communication and provision in a virtual world. The findings illuminate adaptability and many strengths in relation to affective equality and reciprocal love, care and support among LGBT+ older people. It is vital UK that the government recognises and addresses the needs and concerns of LGBT+ older people during emergencies.
This paper reports findings from a qualitative study into the immediate impact of social distancing measures on the lives of lesbian, gay, bisexual and trans (LGBT+) older people (≥60 years) living in the UK during the first lockdown of the COVID-19 pandemic. It draws on in-depth interviews with 17 older people and 6 key informants from LGBT+ community-based organisations, exploring the strategies used to manage their situations, how they responded and adapted to key challenges. Five themes emerged related to: 1) risk factors for LGBT+ older people and organisations, including specific findings on trans experiences,;2) care practices in LGBT+ lives,;3) strengths and benefits of networking 4) politicisation of ageing issues and their relevance to LGBT+ communities; and 5) learning from communication and provision in a virtual world. The findings illuminate adaptability and many strengths in relation to affective equality and reciprocal love, care and support among LGBT+ older people. It is vital UK that the government recognises and addresses the needs and concerns of LGBT+ older people during emergencies. What is known: The coronavirus (COVID-19) pandemic, and the wider governmental and societal response, brought health inequalities into sharp focus, exposing the structural disadvantage and discrimination faced by many marginalised communities in the UK and globally. LGBT+ older people are known to experience health inequalities compounded by anticipated or poor experiences of accessing health and social care services. What this paper adds: An exploration of LGBT+ older peple, their communities and social networks and how these were adapted in the COVID-19 context. Trans older people have been affected in very specific ways. The findings illuminate adaptability and many strengths in relation to affective equality and reciprocal love, care and support among LGBT+ older people. It is vital UK that the government recognises and addresses the needs and concerns of LGBT+ older people during emergencies.
This paper reports findings from a qualitative study into the immediate impact of social distancing measures on the lives of lesbian, gay, bisexual and trans (LGBT+) older people (≥60 years) living in the UK during the first lockdown of the COVID-19 pandemic. It draws on in-depth interviews with 17 older people and 6 key informants from LGBT+ community-based organisations, exploring the strategies used to manage their situations, how they responded and adapted to key challenges. Five themes emerged related to: (1) risk factors for LGBT+ older people and organisations, including specific findings on trans experiences; (2) care practices in LGBT+ lives; (3) strengths and benefits of networking (4) politicisation of ageing issues and their relevance to LGBT+ communities and (5) learning from communication and provision in a virtual world. The findings illuminate adaptability and many strengths in relation to affective equality and reciprocal love, care and support among LGBT+ older people. It is vital UK that the government recognises and addresses the needs and concerns of LGBT+ older people during emergencies.
There are a number of obstacles to the inclusion of research in LGBT+ health inequalities and social support in national and international policy initiatives including attitudinal (ranging from disbelief that differences exist to discriminatory views [5]), the relative dearth of robust data (due to lack of measures about SOGI in existing data-sets), and the lack of large-scale data-sets (due to challenges in random sampling). Of concern at a global level, is the unequal provision of rights for LGBT+ people. In six UN member states, the death penalty can be imposed for consensual same-sex sexual behavior and in 26 countries a penalty of 10 years to life imprisonment can be imposed [6,7]. Some jurisdictions separately penalize diverse gender expression and many countries have no framework for allowing trans people to access ID documents or state recognition; further, they impose requirements that are a breach of human rights, such as sterilization (https://www.humandignitytrust.org; accessed 30 March 2021). The Office of the High Commissioner for Human Rights (OHCHR) has noted the violation of the human rights of intersex people in many jurisdictions, e.g., non-urgent sterilizing surgeries performed on children without capacity to consent. By contrast, protections for sexual orientation and gender identity are explicitly included by nine jurisdictions; moreover, in the constitutions of 123 UN member states consensual same sex acts are legal. Several international jurisdictions have implemented legislative ordinances to protect the rights of their LGBT+ citizens, there is increasing recognition by governments of the need to understand and address LGBT+ health and social care inequalities and a number are implementing policy initiatives to promote well-being including adoption, equal marriage, protections in employment, housing and access to and use of health and social care. Globally, (although important omissions remain) there are legal frameworks to support the implementation of evidence-based policy to embed these legislative developments in everyday life. In this Special Issue, we aim to contribute to the substantive field of LGBT+ research, highlight methodological developments and new approaches to evaluation and implementation to support the work of Governmental and Non-Governmental Organizations (NGOs) and other bodies across the world in their LGBT+ equality work.This Special Issue is partly shaped by a recent agenda-setting paper which called for greater and more robust data to inform international policy developments. To this end, the authors advocated seven criteria on which to build a robust field of research to support international and national government initiatives aimed at tackling LGBT+ health inequalities. We endeavored to include studies which meet these criteria in the following ways: (1) large datasets (Li, Hickson, Kattari, Tan); (2) comparative data collection (Hickson); (3) addressing diversity and intersectionality among LGBT+ people (Daly, Hickson, Levin, Kattari, O'Shea, Toze); (4) investigating the delivery of healthcare services capacity o deliver LGBT+ affirmative healthcare (Levin); (5) identification of effective health promotion and/or treatment interventions and for sub-groups (Li, Toze); (6) development of a health equity model (Daly, Henrickson); (7) utilization of social justice concepts to ensure change-oriented data (Kattari, Mulé, McDermott).
Health inequalities are differences in health experiences and outcomes which arise through the everyday circumstances of people's lives and the appropriateness of the systems put in place to support them. Such differences stem from social inequalities. As they can be alleviated through social policy, they are a key concern for global public health. Worldwide, they are the focus of governmental efforts to reduce avoidable differences in health (e.g., in the UK, Health equity in England 2020 [1] and in the USA, Healthy People 2030 [2]). The salience of health inequalities in public life cannot be over-emphasized; for example, it has informed policymaking since Engels' [3] 1845 ground-breaking text on the condition of the working class in England and numerous policy initiatives since then (e.g., in the UK, The Black Report 1979, The Acheson Inquiry 1998, Fair Society, Healthy Lives 2010).
Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people's capability to achieve good health. We draw upon 36 older LGBT people's qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants' accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.
Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people's capability to achieve good health. We draw upon 36 older LGBT people's qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants' accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.
Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people's capability to achieve good health. We draw upon 36 older LGBT people's qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants' accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g. longevity and physical health), but also more holistic considerations (e.g. emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.
Lesbian, gay, bisexual and trans+a (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: a) social inequalities, including 'minority stress'; b) associated health-risk behaviours (e.g. smoking, excessive drug/alcohol use, obesity); c) loneliness and isolation, affecting physical/mental health and mortality; d) anticipated/experienced discrimination and e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: 1) Production of large datasets; 2) Comparative data collection; 3) Addressing diversity and intersectionality among LGBT+ older people; 4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; 5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and sub-groups within this umbrella category; 6) Development an (older) LGBT+ health equity model; 7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.
Lesbian, gay, bisexual and trans+ a (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: a) social inequalities, including 'minority stress'; b) associated health-risk behaviours (e.g. smoking, excessive drug/alcohol use, obesity); c) loneliness and isolation, affecting physical/mental health and mortality; d) anticipated/experienced discrimination and e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: 1) Production of large datasets; 2) Comparative data collection; 3) Addressing diversity and intersectionality among LGBT+ older people; 4) Investigation of healthcare services' capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; 5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; 6) Development an (older) LGBT+ health equity model; 7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.
