Supporting young LGBT+ people’s sexual health Eleanor Formby Sheffield Hallam University

Presentation outline Terms Research Context Key themes: Accessibility Language Barriers and fears Safer sex supplies and information Alternative sources of information Summary and implications

Terms LGBT+ ‘Young’ SRE, STIs

Research SRE research; LBW and MSM evaluations (Formby, 2011a, 2011b) Barriers and facilitators project (Formby, 2013) European bullying research (Formby, 2014) Freshers to finals (Formby, 2015a) Sexuality education (Formby, 2015b) LGBT-inclusive SRE in youth settings (Formby and Donovan, 2016)

Context (SRE) LGB invisibility, marginalisation or exclusion within school SRE (Formby, 2011a; Formby, 2014; Formby and Donovan, 2016) “There was nothing about gay people, I switched off” “When it comes to sex education, you don’t do the education you need... we haven’t done anything literally... about other sexualities other than being straight... you need to learn all of this when you’re younger so when you grow up you’re not closed minded, and you can make a proper decision” “They don’t talk about gays” “We don’t expect anything from them”

Context (STIs) Rise in HIV diagnoses among young MSM part of general increase in STI transmission among MSM Participant had not known what HIV was until diagnosed as HIV+ aged 16 “Neither statutory nor voluntary/activist health education interventions have succeeded in identifying and meeting the needs of lesbians” (Wilton, 1997) “They [teachers] didn’t say anything about lesbian and bisexual women at all, so it was just like kind of giving the impression that they’re immune or they didn’t exist”

Accessibility “When I had my first STI scare and I didn’t want to tell anyone… I was worrying, absolutely shitting myself that I’d caught something… I just didn’t do anything about it and then I got crabs… I got a full check-up and that was fine… things that would have perhaps encouraged me to go would be being open on a weekend so I didn’t have to skip school”

Language (appropriateness) LGB young people feel excluded by language use or discussion of sexual activities that renders same-sex practices invisible (Buston, 2004) “It would be great... to not walk into a hospital and have it assumed that you’re straight” “I was embarrassed to explain I was with a woman when I knew the doctor presumed I was heterosexual” “Lack of knowledge in university medical centre and use of transphobic language” Assumed to be heterosexual by health workers -> anger, upset, embarrassment Not ‘family planning’!

Understanding barriers and fears Fear and/or previous experience of ‘ignorance’, ‘judgemental attitudes’, ‘homophobia’ from health care staff Lesbian/bisexual women expect to experience heterosexism - may delay treatment as a result (see also Fish, 2006; Hunt and Fish, 2008) “I have never had my sexual health checked. I’ve been sexually active since I was 17 and I’m now 33” “I dread having any kind of sexual health issue, and however educated I may be I would rather ignore an issue than go and get it sorted out for fear of being treated unfairly”

Safer sex supplies 78% of LBW did not find it easy to get suitable safer sex items locally but 90% would like to be able to “I’ve tried to get dental dams [from health services]... and have had problems from staff not knowing what they are, to being told that I could only have one and then I’d have to buy them from now on” “[I would have safer sex] if I could find the right equipment when I needed it at my chemist”

Safer sex information “Basic information about what sort of sex transmits what sorts of infections between women would be a start! Alongside what actually IS safe sex between women” “Doctors should have more information on the subject. I have come across doctors who seemed to assume STIs cannot be transmitted at all between women” “There should be more information for women on STIs. From my experience, they don’t think they can catch anything because we’re a low risk group. This also means that most won’t get tested for STIs because they think they’re invincible”

Alternative sources of information ‘Rule 34’ - “If it exists, there is porn of it” LGBT organisations/groups, friends ‘Learning from experience’ Online - male participants reported contradictory and confusing information due to reliance on non-specialist websites / search engines e.g. on ‘safety’ of oral sex Noticeable lack of statutory/mainstream service access

Summary Cannot assume LGBT+ youth have ‘basic’ understanding or experience of SRE Sources of sexual health provision not always experienced as accessible or inclusive / appropriate, e.g. timings, visual materials, heterosexist language use Barriers to seeking health care relating to staff attitudes/behaviours and broader fears about mistreatment or discrimination – prejudice does not need to have been experienced to deter access! LBW lacked access to supplies and information Alternative sources of information may not adequately address these gaps

Implications Pronoun use, non-gender binary language (e.g. see Green, 2010) Visible presence of LGBT identities and relationships (e.g. posters, leaflets) Supply of suitable safer sex resources for LBW (e.g. dental dams) Avoid assumptions about people’s sexual desires or practices (e.g. that all lesbians are automatically ‘low risk’ for the acquisition of any STIs) HAPPINESS (adapted from Riley et al, 2013) for LGBT+ youth: For them to be Heard To be Accepted To have Professional access and support To have Peer contact (and this may be online) To have access to current Information Not to be bullied, blamed, punished or otherwise discriminated against To have freedom of Expression, of both their gender and sexual identities To feel Safe And to have Support