Celebrating Pride Month
Introduction
Despite homosexual and queer relationships existing for centuries, the social climate the LGBTQ+ community has faced has been an ongoing challenge. Until recent decades, people were seen as a threat to society if they opposed sexual or gender norms[1] with legislation criminalising same sex acts between men dating back as far as the Buggery Act of 1533[2]. Sex between women has also previously been seen as socially unacceptable, although never criminalised.
Between then and now, it has been a turbulent journey for LGBTQ+ rights. Society made it increasingly difficult for LGBTQ+ communities, including an attempt to criminalise sex between females in the 1921 Parliamentary Bill, censorship of LGBTQ+ literature and arts, and police raids of queer clubs and public spaces. In the twentieth century homosexuality was even perceived as a medical illness.
The 50’s saw an increase in prevalence of suicide related to the criminalisation of homosexuality, including the high-profile suicide case of Alan Turing1. This led to a movement towards legal change, and the introduction of the 1957 Wolfenden Report, recommending the partial decriminalisation of homosexuality. Ten years later, sex between men was fully decriminalised; a significant step towards achieving equality. In the 1980’s the emergence of HIV and AIDS and ensuing epidemic disproportionately impacted the LGBTQ+ community due to ignorance and misinformation and the term “gay-related immune deficiency” gained traction[3]. In the height of the epidemic, Section 28 of the Local Government Act 1988 was introduced, prohibiting the ‘promotion of homosexuality’. The subsequent outcry galvanised the LGBTQ+ movement, which then drove the change in attitudes towards homosexuality.
In 2004, the Civil Partnership Act was introduced, followed by the introduction of the Marriage Act of same sex couples in 20131.
Today, LGBTQ+ communities are not only accepted, but embraced and celebrated, particularly during Pride Month. However, there is still widespread discrimination which can result in barriers to accessing services, poorer experiences of health and care services, and ultimately poorer health outcomes.
Health inequalities experienced by the LGBTQ+ community
Health data is key to helping understand population health needs, and organising the provision of preventative health services, giving information about how people may be affected by different health conditions, as well as identifying people most at risk. The 2021 Census included a new question about sexual orientation but there is a still a lack of data for the LGBTQ+ community which makes it more challenging to understand health and wellbeing needs.
Compared to the overall population, the LGBTQ+ community experience increased levels of common mental health problems with one in three LGBTQ+ young people in the UK experiencing mental health difficulties compared to the national average of one in eight.
We know too that LGBTQ+ communities face more barriers to physical activity than the rest of the population due to factors including homophobia, transphobia, limited appropriate changing facilities, gender segregation and gender rules. In Sport England’s 2022 Active Lives Adult Survey report, which highlights the physical activity levels in England, data showed that some groups from the LGBTQ+ community were less likely to feel they had the opportunity to be active and were less likely to seek enjoyment from being active[4].
Sexual health is perhaps the area of disparity most widely associated with the LGBTQ+ community. When HIV/AIDS first presented in humans, it was regarded as a disease only gay men could catch and was highly stigmatised. This perception has improved beyond recognition thanks to the work of organisations including the Terrence Higgins Trust, the British HIV Association and the British Association for Sexual Health and HIV. However, significant sexual health inequalities continue to be faced by the LGBTQ+ community, with the impact of STIs remaining the greatest in gay, bisexual and other men who have sex with men (GBMSM)[5]. DsPH work in partnership with numerous local organisations, together with people with lived experience, to destigmatise HIV and other STIs, and to create safe environments for people to seek diagnosis and treatment.
Reducing health inequalities and improving the health and wellbeing of LGBTQ+ communities around the UK
Croydon’s 2023 Public Health Report focussed on better understanding the health and wellbeing needs of the LGBTQ+ community in Croydon, and celebrated the diversity of the community, whilst highlighting the health experiences and inequalities faced. The report shares people’s personal stories and lived experiences in relation to mental health, social connections, healthy behaviours, and discrimination. Although not an exhaustive overview of the LGBTQ+ needs in Croydon, it provides a helpful starting point to build on in the future.
Cheshire West and Chester council have implemented several initiatives to address the poorer health outcomes of their LGBTQ+ communities. For example, the council works with organisations including Chester Pride, the Proud Trust and Body Positive/Silver Rainbows to enhance the awareness and visibility of the LGBTQ+ community, and Merseyside and Chester have been awarded with the Navajo LGBTIQA Chartermark in recognition of the work that has been done to ensure inclusivity. Chester Pride provides mental health support, information and advice, as well as organising social groups and Christmas dinner for people in the LGBTQ+ community who would otherwise spend the day alone. The council also helped fund the health and wellbeing zone at last year’s Chester Pride event, providing information and advice on Public Health initiatives including smoking cessation and healthy weight.
Birmingham City Council Public Health Communities Team have developed four LGBTQ+ Community Health Profiles: bisexual profile, gay men and other MSM profile, lesbian profile and trans+ profile. The profiles move beyond treating the LGBTQ+ community as a homogenous group and provide detailed summaries of the existing evidence and data on the health inequalities experienced by specific groups throughout the life course. The profiles aim to equip local authorities and wider health and social care systems with the evidence to make culturally competent decisions when developing policies and services.
In 2022/23, the Communities Team collaborated with Birmingham LGBT Centre as their Lesbian and Trans Engagement Partner to disseminate the profiles and deliver engagement activity and health interventions with these communities. Through this work, Birmingham LGBT delivered training to GPs and health professionals across the city about the health inequalities faced by lesbian women and a GP Symposium on gender affirming care for trans people. They also ran focus groups with lesbian and trans people about improving the inclusivity of breast and cervical cancer screening campaigns, producing a series of posters that were put up around venues in the city’s Gay Village.
To address poor access to physical activities, they delivered dance classes for the lesbian community, led by a local drag queen and dance tutor, providing a positive and inclusive space for exercise.
The city has also developed An End to Be Proud Of, part of the Creative Health Programme which, through partnership with B:Music, Birmingham Hospice and Birmingham LGBT, engaged older LGBTQ+ people in a series of song writing, poetry and performance workshops, which opened up conversations, reduced stigma and improved health literacy around healthy ageing and dying.
In February this year, Birmingham hosted the PrideWell Summit, consisting of 20 webinars discussing LGBTQ+ health topics, highlighting inequalities, and celebrating the community and emerging best practice. The city recognises there is still more work to do and will be commissioning more engagement partners to deliver a comprehensive programme to improve LGBTQ+ health.
The Manchester City Council Annual Public Health Report for 2023/24 explores the work that has been done to promote sexual health in the city since the start of the HIV/AIDS epidemic. The council work with George House Trust which was established by, and for people living with HIV, to provide advice, support and information. They also work to destigmatise HIV infection, through positive speaker sessions in schools, workplaces and recently, training in the hair, beauty and barbering sector, to tell the real stories and lived experiences of people living with HIV and spreading awareness of ‘U=U; Undetectable = Untransmittable’.
Formed in 1990, BHA for Equality was developed to ensure that Black communities had access to accurate and culturally appropriate information on HIV. BHA now supports Manchester’s Black and minoritised communities to improve knowledge and understanding of sexual health issues and uptake of sexual health services through multi-lingual resources and by offering a range of services including HIV and STI testing, condoms, and community outreach.
In response to the growing demand for PrEP, the council has increased the capacity of sexual health clinics, who also work in partnership with the LGBT Foundation (LGBTF) to deliver PrEP initiation and STI testing at the G-A-Y nightclub in Manchester. Elsewhere in the city, the Northen Trans and Gender Diversity Clinic was formed with the aim of improving care for trans patients. Patient and public involvement has been key to shaping the service, which has led to an increased number of trans attendance and an increased uptake of PrEP.
Our Room (formerly Men’s Room) was also set up in Manchester as a creative community for male, trans and non-binary sex workers. Whilst providing a rich and varied programme of creative activities and projects, the organisation provides a safe space to offer advice and support for issues including substance use, housing, sexual health, mental health and emotional wellbeing.
These are just some of the many initiatives underway in the UK to improve the health and wellbeing of the LGBTQ+ community. Meanwhile, DsPH across all four countries and the dependant territories are working in partnership with local and national organisations to promote and protect the health and wellbeing of LGBTQ+ communities so that the places we live in are more inclusive and enable everyone to live healthy, happy lives.
References
[1] The National Archives. LGBTQ+ Rights in Britain. Available online. [Last accessed: June 2024]
[2] Historic England. Pride of Place: England’s LGBTQ Heritage. Available online. [Last accessed: June 2024].
[3] G Ayala and A Spieldenner. HIV is a Story First Written on the Bodies of Gay and Bisexual Men. American Journal of Public Health. 2021 July; 111(7): 1240-1242. doi: 10.2105/AJPH.2021.306348 [Last Accessed: June 2024].
[4] Sport England. Building our LGBTQ+ action plan. Available online. [Last accessed: June 2024].
[5] UKHSA. Sexually transmitted infections and screening for chlamydia in England: 2023 report. Available online. [Last accessed: June 2024].