Malachai O’Hara Mental Health Development Officer

1. Malachai O’Hara Mental Health Development Officer Obstacles To Accessing Health Services for Gay & Bisexual Men

2. Aims of Training. • Sexual Orientation Awareness • Homophobia and Heterosexism • Health and Well Being Issues • Obstacles to Accessing Services and Support • Practical Suggestions for Improvement of Practice

3. What is Sexual Orientation? Sexual Orientation is a person’s attraction, whether emotional, psychological and/or sexual, to people of the opposite or same gender. This includes Feelings Behaviour Identity

4. The Language of Sexual Orientation • Bisexual – A person attracted to embers of both sexes. This may not be in equal proportions nor at the same time. • Gay Man – A man that is attracted to other men. • Heterosexual – A person that is attracted to members of the opposite sex. • Lesbian – A woman that is attracted to other women.

5. How many LGB people are there? • It is estimated that between 6% - 10% of the UK population are Bisexual, Gay or Lesbian. • This would mean that between 168,500 and 101,100 people in Northern Ireland fit into this group • Based on National Statistics 2006, estimated population for NI of 1,685,000.

6. Homophobia Please list some of the • Names • Stereotypes • Labels • Terms • Phrases associated with people who are Bisexual, Gay and Lesbian.

7. Experience of Homophobia in Every Day Life • Experiencing Homophobia • In an open place (including from strangers) • Visiting Bars • Visiting Youth Club • Being provided health services • Voluntary Community organisations • At school from other students • At school from staff • At work from staff/colleagues • At home from neighbours • At home from other tenants (family, housemates, etc) • Visiting restaurants and other eateries (source: Out On Your Own, McNamee, 2006)

8. Self-Identification • Awareness of Sexual Orientation • Average age for males - 12 years* • Average age for females – 14 years* • Age they told someone • Average age for males – 17 years • Average age for females – 18 years (source: The shOUT Report, 2003) *recent surveys indicate this can be as young as ages 8-10

9. Homophobia and Heterosexism Homophobia • An irrational fear of, aversion to and/or discrimination against people who are gay, lesbian or bisexual Heterosexism • The invisibility and lack of understanding of gay and bisexual people and their needs as a result of the assumption by society of heterosexuality.

10. Fear of Homophobia Reluctance by individuals to admit to being gay, lesbian or bisexual in certain situations and/or to access the services or support they need as this might involve “coming out”. This is often the result of negative experiences in the past or anecdotal evidence of negative experiences other gay, lesbian and bisexual people have received.

11. Internalised Homophobia When a gay, lesbian or bisexual person has learned to accept heterosexuality as the correct way to be, due to the absence of positive depictions of gay people and experiences of homophobia. This can manifest itself in: • Self-harming behaviour including alcohol, drugs and unsafe sex; • Low self-worth increasing risk of domestic abuse; • Anxiety, depression, suicide ideation and eating disorders; • Reluctance to access appropriate support or services as people do not consider themselves worthy.

12. Heterosexist Exercise • How do the following environments reinforce heterosexist messages? • Family • Peer Groups • School • Media • Society

13. Effects of Homophobia and Heterosexism on Mental Health Young people who identify as LGB are – • At least 2.5 times more likely to self harm.. • 5 times more likely to be medicated for depression.. • At least 3 times more likely to attempt suicide • 20 times more likely to suffer from an eating disorder than their heterosexual counterparts. • Information taken by the “Shout Report 2003”

14. Effects of Homophobia and Heterosexism on Mental Health • 27.1% attempted suicide • 71.3% had suicide ideation • 30.7% had self-harmed • 65.3% experienced difficulties at school • 33.9% at experienced negativity at work *Out on Your Own – An examination of the Mental Health of Young Same-Sex Attracted Men. McNamee 2006

15. Effects of Homophobia and Heterosexism on Sexual Health • Chlamydia – 4% msm • Gonorrhoea – 29% msm • Syphilis – 52% msm • Herpes – 4% msm • Warts – 3% msm • HIV – 52% msm

16. LGB Sexual Health • Mainstream sexual health promotion programmes targeted at heterosexual people (DHSSPS, Family Planning Clinics , Government Ads etc.); • Sexual health programmes in schools often negative about gay sex(if they cover it)and do not provide information; • Getting the correct information often requires “Coming Out”; • Heterosexual parents unsure what information to provide; • Internalised homophobia and risk-taking behaviour; • People who are not “Out” and in opposite-sex relationship are more likely to take risk to have sex; • Use of alcohol and drugs increases the likelihood of engaging in unsafe sex; • Difficulty accessing appropriate services and safer sex materials.

17. Effects of Homophobia and Heterosexism on Physical Health Alcohol and Drugs • The use of alcohol and drugs as inappropriate coping strategies when dealing with internalised homophobia; • Frequenting gay bars , where the use of drugs and alcohol is socially acceptable, when looking for safe environment to socialise Domestic Violence • Increased risk factors due to internalised homophobia, fear of being outed by the perpetrator, reluctance to acknowledge the existence of domestic abuse in the gay community and investment by the victim into the relationship as acknowledgment of being gay. • Additional obstacles to accessing support services including fear of homophobia or being outed accidentally or on purpose by police and lack of understanding by the police about same-sex couples.

18. Obstacles to Accessing Services and Support The GP Exercise • Homophobia • Fear of Homophobia • Internalised Homophobia • Heterosexism

19. Practical Improvements • Creating a LGB friendly environment • Gender neutral terminology • Images of same sex couples • Collation of data on SO • Consultation events • Confidentiality and Training • Bisexual people • Training for staff

20. Questions & Answers • This is the opportunity to ask any questions that you feel may not have been covered in the training. • Evaluation and Close

21. The Rainbow Project2- Commercial CourtBelfastBT1 2NBTel: 028 9031 9030malachai@rainbow-project.orgwww.rainbow-project.org