Equality and Diversity Data - Sexual Orientation and Gender Reassignment

Definition

Sexual Orientation

The Equality Act 2010 says you must not be discriminated against because you are heterosexual, gay, lesbian or bisexual.

Someone thinks you have a particular sexual orientation. This is known as discrimination by perception.

You are connected to someone who has a particular sexual orientation. This is known as discrimination by association.

In the Equality Act sexual orientation includes how you choose to express your sexual orientation, such as through your appearance or the places you visit.

See the Equality and Human Rights Commission website for further information regarding sexual orientation discrimination

Gender Reassignment

The Equality Act 2010 says that you must not be discriminated against because you are transsexual - that is your gender identity differs from the gender assigned to you at birth.

For example a person who was born female decides to spend the rest of his life as a man.

In the Equality Act it is known as gender reassignment. All transsexual people share the common characteristic of gender reassignment.

Inter-sex people are not explicitly protected from discrimination by the Act, but you must not be discriminated against because of your gender or perceived gender.

For example, if a woman with an intersex condition is refused entry to a women-only swimming pool because the attendants think her to be a man, this could be sex discrimination or disability discrimination.

See the Equality and Human Rights Commission website for further information regarding gender reassignment.

Data

Sexual Orientation

In relation to sexual orientation, local population data is not known with any certainty. In part, this is because until recently national and local surveys of the population and people using services did not ask about an individual’s sexual orientation.  However, nationally, the Government estimates that 5% of the population are lesbian, gay or bisexual communities.

Gender Reassignment

There are no official statistics nationally or regionally regarding transgender populations, however, GIRES (Gender Identity Research and Education Society - www.gires.org.uk) estimated that, in 2007, the prevalence of people who had sought medical care for gender variance was 20 per 100,000, i.e. 10,000 people, of whom 6,000 had undergone transition. 80% were assigned as boys at birth (now trans women) and 20% as girls (now trans men). However, there is good reason, based on more recent data from the individual gender identity clinics, to anticipate that the gender balance may eventually become more equal.

Transitioning is still high risk for most gender variant people. Nonetheless, better social, medical and legislative provisions for gender variant people, coupled with the "buddy effect" of mutual support among them, appear to be driving growth in the numbers who have sought medical treatment.  According to GIRES, organisations should assume that 1% of their employees and service users may be experiencing some degree of gender variance.  Many are unlikely to wish to be detected. The only persons who cannot escape detection are the very few who undergo transition.

National Picture

Lesbian and Bisexual Women

Stonewall’s Prescription for Change in 2008 (> 6000 respondents) showed:

  • Less than half the women surveyed had taken up any screening for STI’s.
  • The percentage of women over 25 who had never been for cervical screening was double that of straight women.
  • The rates of self-harm in this population group are significantly higher.
  • Half of the women in the survey reported negative experiences in the health sector.

Gay and Bisexual Men

Stonewall’s Gay and Bisexual Men Health Survey (2013) (6,861 respondents) and  Mental Health Stonewall Health Briefing showed:

  • One in seven (13%) gay and bisexual men are currently experiencing moderate to severe levels of mixed depression and anxiety compared to seven per cent of men in general.
  • A further 9%  of gay and bisexual men are experiencing moderate to severe levels of depression with mild or no anxiety compared to two per cent of men in general.
  • Bisexual men are more likely to experience moderate to severe levels of depression (26 per cent)
  • Three quarters (74%) of lesbian and bisexual women say they felt anxious or nervous. This increases to 78 per cent of bisexual women.
  • Smoking prevalence is higher in this group compared to straight men.
  • Gay and bisexual men are more likely to attempt suicide, self-harm and have depression than their straight peers. They are more likely to take illegal drugs.
  • There is a lower uptake of cancer screening services.
  • Gay men have indicated concern at coming out to their GPs (more so than their managers, work colleagues and family).

Older People

In Stonewall's Lesbian, Gay and Bisexual People in Later Life (2012) showed that older people face particular inequalities:

  • Many older gay people have experienced, or fear, discrimination because of their sexual orientation and they say this creates a barrier to receiving appropriate care and treatment.
  • They are particularly concerned about facing discrimination in services they may need to access in later life, including residential care services.

Younger People

The Proud Trust published Lesbian, Gay, Bisexual and Trans (LGBT) Young People’s Health in the UK: A literature review with a focus on needs, barriers and practice (2016) highlighting the following health needs for young LGBT:

  • LGBT young people were more susceptible than their heterosexual peers to cancers and poor physical health outcomes partly owing to negative health behaviours such as smoking, drug use, inadequate dietary intake and alcohol misuse
  • It was noted that there were elevated levels of suicidal thoughts and self-harming behaviours in young LGBT people
  • Connected to the suicidal ideation and self-harm, were indications of anxiety, low self-esteem, shame, body image and eating concerns – the latter particularly in young gay men and there was also evidence of elevated levels of social isolation.
  • More than three in four (76%) black and minority ethnic gay and bisexual boys have thought about taking their own life compared to 56%of white gay and bisexual boys.
  • 71% of lesbians and bisexual girls thought the same with no significant difference across ethnic background.
  • Over eight in ten (83%) black and minority ethnic lesbian and bisexual girls deliberately harm themselves compared to 71% of white lesbians and bisexual girls
  • 36% of gay and bisexual boys have self-harmed with no significant difference across ethnic background.

Transgender

  • Trans people report experiences of discrimination from service providers, and harassment and violence from individuals in their day to day lives.
  • Meeting routing health care needs including accurate screening services to meet the biological presentation of the patient.

The following data is form Lesbian, Gay, Bisexual and Trans (LGBT) Young People’s Health in the UK: A literature review with a focus on needs, barriers and practice (2016):

  • Themes of depression and psychological distress were evident in this population
  • Linked with this were high rates of suicidality, with suicidal ideation (84% lifetime prevalence), and attempted suicide (48% lifetime prevalence)
  • Trans young people often need fast and timely health care interventions. The onset of puberty creates mental distress for many trans people and can result in irreversible gendered body changes, if no hormone treatment is received.
  • There is a psychological importance of using a person’s chosen name and pronoun during healthcare interactions, and conversely, the distress caused when health professionals forget or refuse to use the young person’s chosen name/pronoun.

Race

Ethnicity - Stonewall Health Briefing (2012) reported:

Of black and minority ethnic lesbian and bisexual women:

  • A third currently smoke.
  • 70 per cent had a drink in the last week and a third drink three or more days a week compared to a quarter of women in general.
  • More than two in five (44%) have taken drugs in the last year, six times more likely than women in general.
  • Over half (55%) have been screened for sexually transmitted infections.
  • One in five (19%) over the age of 25 have never had a cervical screen compared to 7% of women in general.
  • 7% have attempted to take their own life.
  • A quarter (26%) have deliberately harmed themselves compared to 0.4% of the general population.
  • One in five (21%) have an eating disorder compared to 1 in 20 of the general population.
  • More than half (55%) are not out to their GP or other healthcare professionals.
  • 81% of black and minority ethnic lesbian and bisexual women say they felt anxious or nervous.

Of black and minority ethnic gay and bisexual men:

  • More than a quarter (27%) currently smoke compared to 22%of men in general.
  • Seven in ten (69%) had a drink in the last week and three in ten drink on three or more days per week compared to 35% of men in general.
  • More than half (53%) have taken drugs in the last year compared to just 12% of men in general.
  • One in four (26%) report being in ‘fair’ or ‘bad’ health compared to one in six men in general.
  • 5% have attempted to take their own life. Just 0.4 per cent of men in general.
  • One in twelve (eight%) have harmed themselves in the last year compared to just 1 in 33 men in general who have ever harmed themselves.
  • One in six (15%) have had problems with their weight or eating in the last year compared to four per cent of men in general.
  • More than one in five (22%) have never been tested for any sexually transmitted infection.
  • A quarter (24%) have never had an HIV test.
  • One in three (36%) are not out to their GP or healthcare professionals.

Of younger black and minority ethnic lesbian, gay and bisexual:

  • More than three in four (76%) black and minority ethnic gay and bisexual boys have thought about taking their own life compared to 56%of white gay and bisexual boys.
  • 71% of lesbians and bisexual girls thought the same with no significant difference across ethnic background.
  • Over eight in ten (83%) black and minority ethnic lesbian and bisexual girls deliberately harm themselves compared to 71% of white lesbians and bisexual girls
  • 36% of gay and bisexual boys have self-harmed with no significant difference across ethnic background.

Disability

Of lesbian and bisexual women with a disability:

  • Almost three in ten (29%) currently smoke.
  • More than three in five (63%) had a drink in the last week and three in ten drink three or more days a week compared to a quarter of women in general.
  • Almost a third (30%) have taken drugs in the last year, four times more likely than women in general.
  • Almost half (46%) have never been screened sexually transmitted infections.
  • Thirteen per cent over the age of 25 have never had a cervical screen compared to 7% of women in general.
  • 10% have attempted to take their own life almost.
  • A third (31%) have deliberately harmed themselves compared to 0.4% of the general population.
  • Three in ten (32%) have had an eating disorder compared to 1 in 20 of the general population.
  • Over a third (35%) are not out to their GP or other healthcare professionals.

Of gay and bisexual men with a disability:

  • More than half (55 per cent) have taken drugs in the last year compared to just 12 per cent of men in general.
  • 7% have attempted to take their own life. Just 0.4% of men in general attempted to take their own life.
  • One in six (15%) have harmed themselves in the last year compared to just 1 in 33 men in general who have ever harmed themselves.
  • More than one in five (23%) have had problems with their weight or eating in the last year compared to four per cent of men in general.
  • Two-thirds (63%) have experienced at least one incident of domestic abuse from a family member or partner since the age of 16 compared to 17% of men in general.
  • One in five (22%) have never been tested for any sexually transmitted infection.
  • Over a quarter (27%) have never had an HIV test.
  • One in four (25 per cent) are not out to their GP or healthcare professionals.

What Works

The proud trust reported in Lesbian, Gay, Bisexual and Trans (LGBT) Young People’s Health in the UK: A literature review with a focus on needs, barriers and practice (2016) the following interventions that wre useful to this population are:

  • Services and practitioners who focus on bolstering resilience.
  • Young people's support groups.
  • Training for staff in delivering tailored health services (i.e. sexual health services) and training in reflective and inclusive language use (e.g. not assuming pronouns).

Resources

Websites

Stonewall

Proud Trust (LGBT+ Youth)

The National LGB&T Partnership

The Transgender Zone

Gires (Gender Identity Research and Education Society)

Terrence Higgins Trust

Gendered Intelligence

Antidote - The UKs only LGBT targeted drug and alcohol support service

Mermaids - support for teenagers and children with gender identity issues.

Publications

Stonewall publishes lots of useful research on their website, including:

Lesbian, Gay, Bisexual and Trans (LGBT) Young People’s Health in the UK: A literature review with a focus on needs, barriers and practice (2016) - The Proud Trust

Living My Life -Centre for HIV and Sexual Health

Producing population estimates for the lesbian, gay and bisexual (2017) - Public Health England

Fair care for trans patients (2017) - Royal College for Nursing

Top Tips for Working with Trans People (2013)

Trans Youth Sexual Health Booklet (2012)

Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination (2007)

Trans Mental Health Survey (2012)

Preventing suicide: lesbian, gay, bisexual and trans young people (2015) - Public Health England