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Before the emergence of the scientific and political revolutions, as well as the social movements of the 18th and 20th century, LGBTQ+ persons were (and still are) persecuted for not conforming to sexual and gender norms. From discriminatory laws and practices, to so-called ‘conversion therapy’, LGBTQ+ communities face a host of challenges in accessing healthcare. Historically, it has been difficult for LGBTQ+ persons to find healthcare services that didn’t view the failure to conform to sexual and gender norms as a mental disorder. Dr Perihan Elif Ekmekci, who specialises in medical ethics, argues that LGBTQ+ persons are “among the most vulnerable populations with significant disadvantages related to health and the social determinants of health”, and that fundamental human rights, including the right to healthcare for LGBTQ+ persons should be upheld and protected. Other studies in the early 2000s echo this sentiment, positing that LGBTQ+ persons are at a heightened risk of mental illnesses and psychological distress, such as depression, resulting from minority stress created by stigma and discrimination.
Despite the strides taken within the LGBTQ+ community since the 1970s; from the American Psychiatric Association (APA) removing homosexuality from the list of mental disorders, to the World Health Organization (WHO) doing the same decades later, the gap in LGBTQ+ healthcare services still persists. A systematic literature review conducted in recent years revealed that LGBTQ+ persons experience fear and embarrassment when communicating with healthcare providers, who might make assumptions about their sexual orientations, or dismiss their healthcare needs.
Though the LGBTQ+ community is often grouped together, it is worth noting that individuals under this umbrella term experience unique health needs specific to their sexual orientation, gender identity and expression, and sex characteristics. While continued innovation in the healthcare sector progresses, advocating for inclusivity and transformation to specifically address the unique health needs of LGBTQ+ persons remains an ever important part of LGBTQ+ health movement. This blog post seeks to provide a comprehensive look into LGBTQ+ health movements, how far it has come, where it is now, and what more can be done in terms of change.
The LGBTQ+ community and “Healthcare”
Back in the 1930s, those who did not conform to the sexual and gender norms of the era were seen as having mental disorders. LGBTQ+ persons were seen as ‘deviants’ who engaged in ‘sexual promiscuity’ and ‘perverse’ activities. The pathologizing of those in the LGBTQ+ community as having mental disorders led to the rise of so-called ‘conversion therapy’ (clinical, religious, or otherwise) — the altering of one’s sexual orientation based on the notion that LGBTQ+ persons are in need of ‘cure’, ‘repair’, or counselling. The Human Rights Campaign, the largest LGBTQ advocacy group and political lobbying organization in the United States, explains that ‘conversion therapy’ is conducted under the false pretence of being able to change a person’s sexual orientation, gender identity or expression through inhumane treatment programes that include acts of physical, psychological and sexual abuse, electrocution, and isolation.
Throughout the 1940s and 1950s, a multitude of LGBTQ+ persons were involuntarily committed to psychiatric facilities by their families under the promise of a ‘cure’ for their homosexuality. These patients were routinely held against their will and were subjected to a series of brutal therapy sessions in an attempt to ‘straighten out’ their sexual orientations.
The Declassification of Homosexuality as a Mental Disorder
The 1969 uprising, known as the Stonewall Riots in the United States, acted as a major catalyst for change with the LGBTQ+ movement, and sparked public demonstrations, protests, and confrontations with institutions like the American Psychiatric Association (APA), that would follow in its wake, contributing to the movement’s progress. LGBTQ+ persons constantly faced harassment and persecution, especially in the early years of the movement, and were as a result also discriminated against in bars or restaurants. The Stonewall Riots erupted due to the stigma and brutality by the New York City police throughout the years, causing the protest to trigger a ripple effect.
The increased pressure faced by the APA as a result of these protests, along with the growth in activism in support of the LGBTQ+ movement eventually led to a pivotal milestone and victory for the community; in 1987, the APA removed homosexuality completely from the second edition of its of ‘Diagnostic and Statistical Manual of Mental Disorders’, and in 1990, the WHO declassified homosexuality as a mental disorder. Soon after, countries such as Switzerland, Germany, China and certain states in Australia and the United States decriminalized homosexuality.
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The LGBTQ+ Health Movement Prevails
In the 1980s, the LGBTQ+ movement would face its greatest challenge yet — the outbreak of the HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) epidemic; it would first hit American shores, before inevitably spreading to the local community in Singapore. The first cases of HIV were found in previously healthy gay men who would engage in sexual intercourse with other men, and the prevalence of the disease amongst the LGBTQ+ community saw HIV being coined as the ‘gay plague’, leading to the perpetuation and legitimisation of violence and discrimination against LGBTQ+ persons. Marginalisation and the fear of disclosing their identities, combined with the lack of affirming healthcare providers, led to individuals becoming averse or reluctant to seek necessary treatment.
It was only more than a decade later that an effective combination drug treatment for HIV became widely available to those who were afflicted. Researchers had formulated a commercial blood test along with the first antiretroviral medication for HIV, which will change the lives of people living with HIV for the years to come — allowing those who had been afflicted to now live normal life spans and without the risk of transmitting the disease through unprotected intercourse. Despite this revelation, LGBTQ+ health movements would still see a disparity of those in the community who would seek treatment or healthcare services. A poll conducted by the Harvard Chan School, NPR, and the Robert Wood Johnson Foundation in the United States revealed that nearly a sixth of all LGBTQ+ persons have experienced some form of discrimination in a healthcare setting, while a fifth avoid seeking out medical care for fear of unequal treatment.
While there are significant efforts made by non-profit LGBTQ+ organizations all around the globe to improve access to healthcare, LGBTQ+ health movements continue to face systemic challenges. From criminalisation of homosexuality, to the legalisation of ‘conversion therapy’ in certain countries and states, it is clear that the road ahead for LGBTQ+ health movements will be a long and arduous one. To begin contributing to the movement, one must first identify the disparities in one’s own community or organization, before taking the steps to stand in solidarity with LGBTQ+ communities. Making sexual and reproductive healthcare accessible and available to all genders and sexual orientations is but the first step in this bigger issue, and it has never been more important to ensure that the youths of our societies are educated and able to make informed choices in this climate.
Alencar Albuquerque, G., de Lima Garcia, C., da Silva Quirino, G., Alves, M. J., Belém, J. M., dos Santos Figueiredo, F. W., da Silva Paiva, L., do Nascimento, V. B., da Silva Maciel, É., Valenti, V. E., de Abreu, L. C., & Adami, F. (2016). Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC international health and human rights, 16, 2. https://doi.org/10.1186/s12914-015-0072-9
American Psychological Association. (2006, June 1). Just the facts about sexual orientation and youth: A primer for school personnel. http://www.apa.org/pi/lgbt/resources/just-the-facts
Bhandari, B. (2019). Conversion Therapy Still Promoted in China, Investigation Finds. Sixth Tone. Retrieved from: https://www.sixthtone.com/news/1003870/conversion-therapy-still-promoted-in-china%2C-investigation-finds
Cochran, S. D., & Mays, V. M. (2006). Estimating prevalence of mental and substance-using disorders among lesbians and gay men from existing national health data. In A.M. Omoto & H.S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 143-165). Washington, DC: American Psychological Association.
Ekmekci P. E. (2017). Do we have a moral responsibility to compensate for vulnerable groups? A discussion on the right to health for LGBT people. Medicine, health care, and philosophy, 20(3), 335–341. https://doi.org/10.1007/s11019-016-9750-1
Fitzsimons, T. (2020). Germany is 5th country to ban conversion therapy for minors. NBC News. Retrieved from: https://www.nbcnews.com/feature/nbc-out/germany-5th-country-ban-conversion-therapy-minors-n1203166
Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64806/ doi: 10.17226/13128
Madrigal-Borloz, V. (2020). Practices of so-called “conversion therapy” (pp. 9-17). United Nations. Retrieved from https://undocs.org/A/HRC/44/53
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697.
Powell, A. (2018). Providers need to understand their patients better, panelists say. The Harvard Gazette. Retrieved from: https://news.harvard.edu/gazette/story/2018/03/health-care-providers-need-better-understanding-of-lgbtq-patients-harvard-forum-says/
Schroeder,M., & Shidlo, A. (2001). Ethical issues in sexual orientation conversion therapies: An empirical study of consumers. Journal of Gay & Lesbian Psychotherapy, 5, 131-166; Shidlo, A., & Schroeder,M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology: Research and Practice®, 33, 249-259.
The Human Rights Campaign. The Lies and Dangers of Efforts to Change Sexual Orientation or Gender Identity. Retrieved from https://www.hrc.org/resources/the-lies-and-dangers-of-reparative-therapy
Wareham, J. (2020). Singapore Upholds Colonial Anti-Gay Laws: Being Gay Remains Illegal for 5.7 Million People. Forbes. Retrieved from: https://www.forbes.com/sites/jamiewareham/2020/03/30/singapore-upholds-colonial-anti-gay-laws-being-gay-remains-illegal-for-57m-people/?sh=bd09aa77ad9e
Wise, S. (2015). ‘Curing Queers’: Mental Nurses and Their Patients, 1935-74 by Tommy Dickinson – Review. The Guardian.
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