By Dimah
The struggle for equal healthcare in the United Kingdom has been a defining issue for the LGBTQ+ community. In the past century, LGBTQ+ individuals have faced systemic discrimination, neglect and antagonism from the healthcare system. The fight for equal healthcare has not been effortless, but a long journey filled with pain, sacrifices, persistent activism and significant milestones. This blog explores what the queer community went through over the past century, the setbacks, the failures and the successes that the community fought for to be taken seriously and treated just like everyone else.
It is important to remember that it is an ongoing fight in the healthcare sector for LGBTQ+ individuals to receive fair diagnosis and treatments. Queer people still face significant barriers around the world for equal opportunities and getting the medical help they need in order to be happy, healthy and dignified.
Early Struggles
Throughout the 20th century, LGBTQ+ individuals were marginalised by the medical Sector. The American Psychiatric Association (APA) classified homosexuality as a mental disorder up until 1973. Due to change of attitude, scientific evidence and ethical consideration, the APA voted to remove “homosexuality” from their list of recognised psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1973. A major factor in APA’s decision was due to the results published by psychologist Evelyn Hooker, “The Adjustment of the Male Overt Homosexual”. The paper showed that homosexual men are as psychologically “well adjusted” as heterosexual men. However, even after APA removed homosexuality from the DSM, it was not until 1992, that homosexuality was finally withdrawn from the list of mental disorders in the World Health Organisation's (WHO) International Classification of Diseases.
The AIDS Crisis: The Rising of ACT UP
By the end of 1978, HIV had spread rapidly across the USA, and quickly spread worldwide. In England, there were already over 1,000 confirmed HIV cases. Scientists had identified
HIV as the precursor to AIDS, a condition known to be fatal. Public fear intensified when researchers reported that AIDS was more prevalent among gay men than in other demographics, leading to widespread fear, not only of the virus but also of those living with it. The response from the government and healthcare institutions was inadequate and delayed, which resulted in many viewing the epidemic as a “gay disease”, and therefore, occupied a lower spot on the government’s priority list .
During this time, the LGBTQ+ community played a crucial role in responding to the crisis. Established in 1982, the Terrence Higgins Trust became a leading force supporting people with HIV/AIDS, named after one of the first people in the UK to die of AIDS, the organisation advocated for better healthcare and raised awareness about the virus. Organisations like the Terrence Higgins Trust filled the gap made by the lack of action that the government took.
Funding for AIDS patients, as well as research for cure and treatments to slow the health deterioration caused by the symptoms of the disease progressed slowly. Some attributed this delay to the widespread antigay prejudice among many Americans. The inaction spurred the gay community to take responsibility, advocating fiercely for better responses to the crisis. In 1987, ACT UP (AIDS Coalition to Unleash Power), an international direct- action organisation, founded in the United States to address the growing AIDS epidemic. Its main objective was to agitate a better response from the federal government and scientific community. Their main modus operandi included: carrying out daily acts of civil disobedience and nonviolent protests, using vocal and visual demonstration, e.g launching information campaigns and establishing community based systems to care for people with HIV and AIDS. The protests were against news articles, films and news reports that provided misinformation on AIDS. These included myths such as “women can not get AIDS from heterosexual men” and “AIDS could be passed through public bathrooms, pools, drinking fountains”.
London was home to the first chapter of ACT UP. founded in 1989, the organisation aimed to put an end to Section 28 of the Local Government ACT of 1988, which forbade the “ promotion of homosexuality” .
“It's a Sin”, one of the first cultural production shows, set in the 1980s, that follows a group of young friends in London as they navigate the emerging AIDS crisis. The series brought attention to the intense fear, stigma and loss experienced by the LGBTQ+ community during the time. The series demonstrates radical AIDS activism in England centred around the importance of visibility and public displays of resistance to a system that does not take HIV and AIDS seriously.
In 1991, ACT UP London staged a significant march on Trafalgar Square, demonstrating their relentless commitment to raising awareness and driving change. Despite these efforts, the government remained largely unresponsive. In 1992 ACT UP London marched on Downing Street on World AIDS day. This march evolved into an annual event throughout the 1990s as the number of AIDS diagnoses in Britain continued to rise. ACT UP's dedicated activism has driven significant progress since 1991. though there is a significant need for ongoing awareness of HIV and AIDS due to neglect of education that centres around spreading the correct information to the public eye, and by implementing comprehensive educational programs in schools and learning centres, increasing access to accurate resources in communities and leveraging media platforms to spread factual information, will help address this gap.
The long-term impact of the AIDS epidemic on gay men, now aged 54-72, remains a subject of ongoing exploration. Many from this generation have experienced what is referred to as 'multiple loss syndrome', a consequence of the severe devastating mortality rates in their communities. Experienced by individuals who suffer several significant losses within a relatively short period, which leads to the accumulation of grief, followed by complex emotional responses such as difficulty coping with daily life. Their experiences vary widely, influenced by factors such as their involvement in activism, health status, and the support of biological families. For those diagnosed before 1996, the challenges didn’t end with the introduction of better treatments, they continue to contend with financial instability due to lost earnings, limited pension access, ongoing stigma, and the difficulties of ageing with HIV.
Legal and Policy Advances: Current Healthcare Inequalities in the UK
The 1990s and early 2000s showed significant policy advances for LGBTQ+ healthcare in the UK. A major milestone was the repeal of Section 28 in 2003, which had prohibited the "promotion" of homosexuality by local authorities. This meant that a major barrier to LGBTQ+ health education and awareness has been lifted and can now be taught in school, where information about this can now be included in school curriculums. By using education, spreading a positive image of the LGBTQ+ community, young adults, who identify within the community, can feel more accepted, empowered and confident in their identities, fostering a more inclusive society that values diversity.
In healthcare, the NHS began to take modest steps to address the needs of LGBTQ+ patients. This included the creation of gender identity clinics and NHS gender dysphoria clinics (GDCs), which are commissioned by NHS England. The Equality Act 2010, which prohibits discrimination on the grounds of sexual orientation and gender identity has provided a crucial legal framework for protecting LGBTQ+ individuals in healthcare settings. However, challenges still remain. According to LGBTQ+ Foundation, lesbian women are still facing “unconscious bias” and assumptions with fertility services.
More recently, the UK has moved towards banning conversion therapy, a harmful practice that has long been condemned by medical professionals. However, despite various government commitments, it has not yet been banned. The UK government first promised to ban conversion therapy in 2018 as part of its LGBT Action Plan, it aimed to improve the lives of LGBTQ+ individuals. However, despite this commitment, progress has been slow, with multiple delays and consultations that have frustrated advocacy groups.
The introduction of PrEP (pre-exposure prophylaxis) as an HIV prevention tool in the mid-2010s was another significant milestone. After years of advocacy from LGBTQ+ organisations, PrEP was made available on the NHS in England in 2020, following earlier rollouts in Scotland and Wales. PrEP has been a game-changer in reducing HIV transmission rates, particularly among gay and bisexual men, and its availability on the NHS represents a major victory for LGBTQ+ health advocacy.
Ongoing Struggles: Mental Health, Trans Healthcare and Beyond
Despite the advances, significant challenges remain in ensuring equal healthcare for LGBTQ+ individuals in the UK. Mental health is particularly a pressing issue, with LGBTQ+ people facing higher rates of depression, anxiety, and suicide compared to the general population. According to Stonewall (a UK based charity who campaign for the rights of LGBTQ+ people), as much as half of the LGBT population says that they experienced depression in the last year, while one in eight LGBT people who are aged 18-24 said they've attempted to take their own life in the past year. LGBTQ+ people are at a higher risk of experiencing common mental health problems and an even higher proportion who experienced a hate crime based on their sexual orientation and/or gender identity. The result of discrimination and social isolation has contributed to these disparities and access to LGBTQ+-affirming mental health care remains limited, with long waiting lines, denial and undermining the struggles faced by those who suffer.
Transgender healthcare continues to be a major area of concern. Long waiting times for gender identity services, limited access to hormone therapy and surgeries, and lack of training for healthcare providers have left many transgender individuals struggling to access the care they need. Advocacy groups continue to push for reforms to improve the availability and quality of gender-affirming care across the NHS.
LGBTQ+ people of colour often face compounded discrimination as a result of their sexual orientation and their race or ethnicity. Most have also encountered systemic barriers to healthcare, such as language barriers. The lack of cultural competence among healthcare providers can lead to mistrust in the healthcare systems and reluctance to seek care.
LGBTQ+ individuals with disabilities face a great deal of physical barriers to healthcares, many public spaces still are inaccessible and there is still a lack of accommodations, combined with the shortage of healthcare providers who lack training due to limited funding leading to inappropriate care.
The Hopeful Road to Better Future for LGBTQ+ Healthcare in the United Kingdom
As we look to the future, it is crucial to continue advocating for policies and practices that prioritise the health and well-being of LGBTQ+ people. There must be ongoing education and training for healthcare providers, along with increased funding for LGBTQ+-focused services, and the promotion of inclusive and affirming healthcare environments. By teaching young adults of the successes of the past and addressing the challenges of the present, we can work towards a future where all LGBTQ+ individuals in the UK have access to the care and support they need to live healthy and fulfilling lives.
Equal healthcare for the LGBTQ+ community in the United Kingdom has been a long and arduous journey, marked by significant achievements and ongoing challenges. From the dark days of systemic discrimination, stigma, and the AIDS epidemic, to the slow but vital progress in legal protections, mental health awareness, and access to gender-affirming care, the queer community has persistently advocated for their right to health and dignity.
While milestones like the repeal of Section 28, the introduction of PrEP, and the increasing availability of gender identity services mark crucial advances, the battle for fully inclusive, affirming, and accessible healthcare continues. Issues surrounding mental health, transgender healthcare, and intersectional discrimination remain pressing concerns that need urgent attention.
Support:
As we hope for a better future, driven by the resilience of activists, healthcare professionals, and allies who continue to push for comprehensive reforms. The journey is not over. By being persistent and advocating for your healthcare rights, the UK can create a healthcare system that must truly meet the needs of all its LGBTQ+ citizens.
For more support:
The LGBT Foundation offer support and information on how to get the right healthcare https://lgbt.foundation/
For more information on LGBTQ+ health and wellbeing visit LGBT+ Health and Wellbeing | Age UKPrEP Impact Trial - https://www.prepimpacttrial.org.uk/
PrEP Impact Trial - https://www.prepimpacttrial.org.uk/
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