Diverse Sexuality, Sex and Gender

1. Diverse Sexuality, Sex and Gender Trish Langdon Executive Director - WA AIDS Council 23rd March 2012

2. Definitions • The terms we use to label ourselves and others both help and limit us. • We use “LGBTI” as a recognisable acronym to collectively refer to a group of identities that includes lesbian, gay, bisexual, trans/transgender and intersex people and other sexuality, sex and gender diverse people, regardless of their term of self-identification National LGBTI Health Alliance www.lgbtihealth.org.au/lgbti • In WA it is also common to use Diverse Sexuality, Sex and/or Gender (DSG)

3. Sexual Orientation Direction of one's sexual interest (feelings, fantasies, desires) toward members of the same, opposite, or both sexes. Sexual Identity Identity or label one assumes for themselves (i.e gay, straight, lesbian, bisexual, queer…). This identity is often but not always indicative of the persons sexual orientation. SL3

4. Biological Sex Sex is the physiological make-up of a person. It is commonly expressed as a binary and used to divide people into males and females. Gender How a person, thinks, acts, dresses and speaks which distinguishes them as masculine or feminine. The sociological construction of one’s maleness or femaleness. SL4

5. Stigma and discrimination have serious health impacts • At a population level, young people with diverse sexuality, sex and gender experience homophobic bullying, abuse and harassment leading to poor mental health compared to their non diverse peers. • This has an impact on physical health including increased risk-taking behaviours, survival sex, alcohol and drug use, self harm etc

6. Homophobia • 75% have experienced some form of homophobic abuse • 61% have experienced verbal homophobic abuse • 18% have experienced homophobic physical abuse

7. Health impacts The prevalence of self harm and suicide attempts increases dramatically for those who have been verbally or physically abused.

8. What does this mean for health services? • Need to understand the serious health impact of homophobic bullying • Historically there has been broad institutional backing for homophobic beliefs • It is harder for those working with young people to challenge homophobic abuse than other bullying such as that based on race or gender. • It is more difficult for young people to access help. • The alienation from homophobic bullying is likely to be more absolute.

9. Young people are ‘coming out’ earlier • Reflects general societal sexualisation of children and young people • Reflects earlier experiences of rites of passages in entire population • General visibility higher and representation in media e.g Glee, Home and Away etc • The internet and social media provide access to peers. Whilst this reduces isolation it is not always helpful.

10. What does this mean for health services? • Young people are likely to assert their rights in health settings • Parents may also assert their children’s rights OR • May demand their children be ‘cured’

11. Some young people are fluid about their sexuality • No self label, regard their sexual orientation and expression as a non-event, don’t feel shame and don’t feel they have to fit a box • Identity does not define their behavior • Little or no emphasis placed on relationship status or experience (don’t have to have had intimate relationship to know they are DSSG)

12. What does this mean for health services? • The young person likely to ‘blend in’ and have access to health services • However professional rapport can be compromised if assumptions are made • Implications for sexual health assessment and screening • Requires objectivity, sensitive questioning, no assumptions, care about labels and language

13. Young gay men are at risk of acquiring HIV • Young men have had limited access to HIV prevention and education through school • Have little or no experience of the HIV epidemic and do not think it will happen to them • Data shows risk taking behaviour • Is there an emerging HIV risk amongst young men? • Our data indicates that there could be.

14. What does this mean for health services? • Access to health services may be compromised because of gay identity (feelings of shame and judgement) • Need to get sexually active young gay and bi sexual men into sexual health services with an emphasis on regular HIV and STI testing  • 50% of our M Clinic clientele are under the age of 30, many of whom are testing for the first time. • Need accessible, non-judgmental and appropriate services

15. Young lesbians have complex health needs • General assumption is that power differentials are related to gender/ heterosexual relationships • Power imbalances are not easily recognized in same sex relationships • Myths about potential sexual health risks for young lesbians – i.e. don’t have sex with men, don’t need pap smears or can’t get STIs • Young DSG people are seeking to and becoming parents – sometimes intentionally sometimes accidentally

16. What does this mean for health services? • Lesbians need sexual health needs met with appropriate service delivery • Maternal and child health services need to be sensitive to growing variety of family structures

17. Young people are identifying as trans* earlier • Growing trend for young people seeking to start gender transition under the age of 18 • Difference between social and physical transition • Currently need to have diagnosis with psychiatric ‘disorder’ in order to have sex affirmation therapies – increases stigma unnecessarily

18. What does this mean for health services? • Evidence that earlier transition will have better longer term outcomes – e.g. not having the need to reverse puberty through use of puberty blockers • Urgent need for coordination between health and legal system, particularly general practice, paediatric endocrinology, surgery and child and adolescent mental health services • Young people experience real barriers because of Medicare and other publicly funded health services

19. What does this mean for health services? • Need for training for staff in health services • Need to develop clinical protocols in WA for multi disciplinary team OR a specific sex and gender team • Need to develop appropriate standards of care

20. Young people with diverse sexuality, sex and gender • May distrust health workers because of their experience of adults and people in positions of power as not supportive • May find physical examinations traumatic • May be offended by language used in forms, medical notes and verbally, i.e pronouns, gender or sex markers. • Computerized records don’t easily allow for change – some people are re-traumatised every time they see physicians

21. Summary • There is an urgent need for the health system to understand how sexuality, sex and genders impacts on young people’s access to and experience of health professionals and services • Flexible and innovative models needed • Professional development and training required