Equity in Action: Advancing LGBTQIA+ Health in Wales
June 17, 2024
The LGBTQIA+ represent communities of the Lesbian/ Gay/ Bisexual/ Transgender/ Queer/ Questioning/ Intersex/ Asexual/ Ally, the “+” acknowledges the diversity and fluidity of human sexuality and gender identity, recognising that labels and identities can vary widely from person to person.
The issues:
Health inequalities among the LGBTQIA+ communities in Wales present a pressing challenge. Despite advancements in societal acceptance and legal rights, LGBTQIA+ individuals continue to face significant disparities in mental health, sexual health, and healthcare access. These issues are not isolated to Wales but reflect broader UK and international trends.
The LGBTQIA+ community in the UK, particularly in Wales, faces considerable health disparities in areas such as cancer, HIV, and mental health, worsened by factors like higher rates of risky behaviours, barriers to healthcare access, and systemic discrimination. Mental health outcomes for LGBTQIA+ individuals in Wales are significantly poorer compared to their heterosexual counterparts. This is characterised by higher incidences of depression, anxiety, loneliness, and suicidal thoughts, with many turning to substances like tobacco and alcohol as coping mechanisms. Internationally, the LGBTQIA+ community experiences an elevated cancer burden, with specific subgroups such as gay and bisexual men experiencing higher rates of anal cancer and Kaposi sarcoma, and lesbian and bisexual women more susceptible to breast and cervical cancers. Transgender men are also noted to be more than twice as likely to be diagnosed with cancer compared to cisgender men.
In the context of HIV, Wales has achieved a notable 75% reduction in new HIV diagnoses for the global population and a 77% reduction in new diagnosis in men who have sex with men from 2015 to 2021, due to the extensive availability of Pre-Exposure Prophylaxis (PrEP) and enhanced access to HIV testing. However, challenges such as late diagnoses and persistent stigma related to HIV persist, with the rate of late diagnoses in Wales higher than the rest of the UK. This highlights the need for increased testing and awareness initiatives. Moreover, socioeconomic, and geographic disparities in HIV prevalence persist, with certain groups and regions experiencing higher rates of the virus, underscoring the need for targeted interventions.
Wales’s unique policy environment
The Welsh Government’s 2021 LGBTQ Action Plan, provides a distinct opportunity to address these inequalities. The importance of integrating health equity into public health strategies cannot be overstated, as it directly impacts the well-being of the LGBTQIA+ community and the overall health of the population.
The LGBTQ+ Action Plan for Wales highlighted the experiences of discrimination, harassment, and challenges faced by the LGBTQIA+ community in various aspects of their lives, including the workplace, healthcare, and social interactions. The 2017 National LGBT Survey, conducted by the UK Government is the largest of its kind with over 108,000 participants, offered extensive insights into the experiences of LGBT individuals in the United Kingdom and in Wales. The findings reveal significant challenges including widespread discrimination and harassment, a higher prevalence of mental health issues compared to the general population, safety concerns that affect daily life and social interactions, and a critical need for more inclusive education and greater public awareness about LGBT issues.
The results of these findings underscore the need for targeted interventions to address these issues and promote a more inclusive and supportive environment for LGBTQIA+ individuals in Wales.
How is Wales currently responding to the issue?
First response: Inclusive Mental Health Services in Wales
The “Mind Cymru” initiative exemplifies Wales’s commitment to improving mental health services for the LGBTQIA+ community, especially against a backdrop of significant workplace discrimination and harassment.
The programme focuses on training healthcare professionals in LGBTQIA+ cultural competency and establishing LGBTQIA+-friendly mental health support groups. Collaborating with local LGBTQIA+ organisations, the initiative has significantly enhanced the mental well-being of LGBTQIA+ individuals. This model of inclusive healthcare, addressing both direct health needs and broader social determinants of health like workplace discrimination, could inspire similar initiatives both within Wales and internationally, showcasing a path toward holistic health equity.
Mind Cymru’s programmes, particularly the social prescribing service, have demonstrated significant effectiveness in improving mental health support in Wales. The research methodologies employed have provided a robust evaluation of these programmes, highlighting both their impacts and areas for improvement. The adaptability of the programmes in response to external challenges, such as the pandemic, further underscores their potential to provide crucial support to individuals with mental health needs.
Second response: HIV Action Plan and Cancer Screening Accessibility: A Welsh Response
Wales’s proactive approach to addressing HIV/AIDS within the LGBTQIA+ community is clearly articulated in the recently launched HIV Action Plan and its Fast Track Cymru programme. Developed through extensive consultation with Public Health Wales and LGBTQIA+ advocacy groups, the plan prioritises prevention, accessible testing, and comprehensive treatment. Its implementation underscores the importance of targeted health interventions in reducing HIV transmission rates among LGBTQIA+ individuals. The potential success of these programmes aligns with the global 95-95-95 targets, which aim to end the HIV/AIDS epidemic by 2030. These targets specify that 95% of all people with HIV know their status, 95% of those diagnosed receive sustained antiretroviral therapy, and 95% of those treated achieve viral suppression. This success could illustrate the potential of policy-driven solutions to address sexual health disparities, offering a blueprint for other regions seeking to improve health outcomes for at-risk populations.
Another collaborative action between NHS Wales, health boards, and LGBTQIA+ advocacy organisations has led to the implementation of inclusivity training aimed at improving cancer screening accessibility for LGBTQIA+ individuals across various regions of Wales. This initiative was essential, as many organisations had urged for action on this subject. For instance, the South Glamorgan Community Health Council (CHC) conducted an online survey to gather feedback from the LGBTQ+ community in Cardiff and Vale regarding their experiences with NHS healthcare services. The report’s recommendations focused on improving inclusivity and sensitivity in healthcare services to better meet the needs of the LGBTQ+ community. Consequently, training healthcare providers to be more inclusive and aware of the specific health needs of the LGBTQIA+ community could reduce barriers to screening and treatment. The potential positive outcomes of this initiative, including increased screening rates and early detection, could highlight the effectiveness of community-engaged healthcare solutions in addressing health inequities.
A significant challenge in addressing cancer disparities in the LGBTQ+ community is the lack of comprehensive data. Many national cancer registries and clinical trials do not collect information on sexual orientation and gender identity, which hampers the ability to fully understand and address these disparities. This lack of data leads to gaps in research and may result in healthcare policies and programs that do not effectively address the needs of the LGBTQ+ population.
Third response: Enhancing Workplace Inclusion and Safety for LGBTQIA+ Employees in Wales
A pivotal aspect of advancing health equity for LGBTQIA+ individuals in Wales involves addressing the concealment of identity and improving workplace environments. In response to these challenges, initiatives led by Public Health Wales, in collaboration with local LGBTQIA+ advocacy groups and business leaders, are pioneering efforts to create inclusive and supportive workplace environments. By developing comprehensive anti-discrimination policies, conducting sensitivity training, and fostering open dialogue, these initiatives aim to reduce the need for concealment and mitigate harassment. The goal is to establish workplaces where all employees, regardless of their sexual orientation or gender identity, feel valued and safe. This approach not only benefits individual well-being but also enhances overall organisational health, serving as a model for promoting inclusivity and mental health equity across Wales and beyond.
Conclusion
The initiatives highlighted in this report demonstrate Wales’s commitment to addressing health inequalities among its LGBTQIA+ population through targeted, equity-focused actions especially in workplace and healthcare settings. By drawing on these examples, policymakers and healthcare providers can further incorporate health equity into their practices, ensuring that LGBTQIA+ individuals receive the support and care they deserve. These efforts not only contribute to the well-being of the LGBTQIA+ community but also advance the broader goal of creating a more inclusive, healthy society in Wales and beyond.