By Samantha Backman
Lesbian, gay, bisexual, trans, and intersex (LGBTI) individuals encounter a myriad of unique challenges when seeking medical care. In March 2016, an EU-funded pilot project named Health4LGBTI was launched in order to gain a better understanding of health inequalities experienced by LGBTI people. The Health4LGBTI project aims to raise awareness of these health inequalities and to develop the tools needed amongst healthcare professionals to reduce them.  Given this initiative’s objectives, a critical first step is to examine the healthcare realities faced by LGBTI individuals in Europe today.
Particularly in Eastern Europe, there is evidence that LGBTI people currently face extensive social prejudice and intolerance. The systemic discrimination and stigma targeting LGBTI people may extend to the healthcare setting. One in ten respondents to the European Union Agency for Fundamental Rights’ (FRA) 2012 European Union Lesbian, Gay, Bisexual, and Trans Survey stated that upon accessing healthcare services in the previous year, they had felt discriminated against by healthcare workers due to the fact that they were LGBT. Fearing stigma or discrimination, LGBTI people may elect to conceal their LGBTI identity when accessing health services. In fact, 42% of respondents to the 2012 FRA survey maintained that they would not be open about their LGBT status with any healthcare personnel at all. Hostile and discriminatory healthcare atmospheres may lead LGBTI people to avoid seeking healthcare, to the detriment of their own health and well-being.
Furthermore, the World Medical Association (WMA) maintains that discrimination and stigmatisation as well as peer rejection and bullying gravely affect the psychological and physical health of homosexual and bisexual people. These social struggles often trigger depression, anxiety disorders, substance misuse, and suicidal ideations and attempts. A 2014 study conducted in England revealed that sexual minorities (limited in this project to gay, lesbian and bisexual individuals) were two to three times more likely to report suffering from a long-term psychological or emotional problem than heterosexual people. The results of this nation-wide study also demonstrated that sexual minorities in England were more likely to report poor or fair health than their heterosexual counterparts. In addition to suffering from worse overall mental and physical health, certain medical conditions are more prevalent in the LGBTI community than in the rest of the general population. For instance, the higher incidence of obesity amongst lesbians (compared to women of other sexual orientations), puts lesbians at a greater risk for type 2 diabetes, coronary heart disease, strokes, osteoarthritis, and breast and colon cancer. Amongst the population of men who have sex with men (MSM), the rate of HIV infection is disproportionately high. There is clearly a need for health practitioners to be adequately aware of such specific health needs amongst the LGBTI population in order to provide the best possible care. Numerous respondents to the FRA EU LGBT Survey contended that their specific needs were not taken into account in the provision of healthcare. The FRA has pointed to the importance of considering the needs of LGBT persons in the drafting of national health plans, policies and actions and in national health surveys.
To improve how healthcare personnel respond to LGBTI people, they must receive appropriate training on the health needs of LGBTI individuals. There still exists medical training material that pathologises homosexuality, propagating discrimination against LGBTI people. The FRA suggests that the training of healthcare professionals emphasize that sexual orientation, gender identity and gender expression are not pathological conditions. The WMA has also specifically pointed to the need to ensure expert training in trans healthcare, a field that is unevenly developed across the EU. Specialist services for trans persons are not universally available in all EU Member States.
A 2013 report released by the Irish College of General Practitioners and the Gay and Lesbian Equality Network outlines several suggestions for good practice, including the creation of supportive or “gay-affirmative” healthcare environments. One example of such an inclusive medical practice is the Danish Stork Clinic, which provides fertility services and counselling to lesbian couples. In the United States, a number of LGBTI health centres have been established, such as the Fenway Community Health Centre in Boston. This centre provides a plethora of services tailored for the LGBTI population, including HIV screening, substance use services, parenting services, and domestic and homophobic violence services. It is undoubtedly through the development of such innovative healthcare arrangements that are free of discrimination and sensitive to LGBTI health needs that the health inequalities faced by LGBTI people can be eradicated.
 “Health4LGBTI: Reducing health inequalities experienced by LGBTI people,” European Commission, http://ec.europa.eu/health/social_determinants/projects/ep_funded_projec....
 Andreas Zick, Beate Küpper, and Andreas Hövermann, Intolerance, Prejudice, and Discrimination: A European Report (Berlin: Friedrich-Ebert-Stiftung, 2011), 66.
 EU LGBT Survey 2012, FRA-European Union Agency for Fundamental Rights, http://fra.europa.eu/en/publications-and-resources/data-and-maps/survey-....
 “Health,” ILGA Europe, http://www.ilga-europe.org/what-we-do/our-advocacy-work/health.
 EU LGBT Survey 2012.
 Professionally speaking: challenges to achieving equality for LGBT people, FRA- European Union Agency for Fundamental Rights (Luxembourg: Publications Office of the European Union, 2016): 14.
 WMA Statement on Natural Variations of Human Sexuality, Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013, http://www.wma.net/en/30publications/10policies/s13/.
 Marc N. Elliott, PhD; David E. Kanouse, PhD; Q Burkhart, MS; Gary A. Abel, PhD; Georgios Lyratzopoulos, MD; Megan K. Beckett, PhD; Mark A. Schuster, PhD, MD; and Martin Roland, DM. “Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey,” Journal of General Internal Medicine 30, 1 (2015):9.
 Fidelindo A. Lim, Donald V. Jr. Brown, Justin Kim, and Sung Min, “Addressing Health Care Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review of Best Practices,” American Journal of Nursing 114, 6 (2014): 26.
 “Background,” LGBTI Health Awareness Raising Meeting, Vienna, 29 February – 1 March 2016, EU Agency for Fundamental Rights (FRA).
 Professionally speaking: challenges to achieving equality for LGBT people, 14.
 Ibid, 11.
 Ibid, 14.
 WMA Statement on Transgender People, , Adopted by the 66th General Assembly, Moscow, Russia, October 2015, http://www.wma.net/en/30publications/10policies/t13/.
 Professionally speaking: challenges to achieving equality for LGBT people, 12.
 Odhrán Allen, Lesbian, Gay and Bisexual Patients: The Issues for General Practice, Irish College of General Practitioners and the Gay and Lesbian Equality Network (2013), 11.
 “About the clinic,” StorkKlinik, http://www.storkklinik.dk/en/fertility-center-denmark/info/about-the-cli....
 Rapid Response: Facilitators and barriers to health care for lesbian, gay and bisexual (LGB) people (Toronto: Ontario HIV Treatment Network, 2014), 4.