Julie Fish

Heterosexism in health and social care

This book anticipates changes in equality agendas promoted by the Commission for Equality and Human Rights, and recent anti-discrimination legislation. Its formulation of heterosexism as a key theoretical concept is groundbreaking, as is its contribution to the assessment of health and social care needs of LGBT people, its consideration of intersecting identities and its discussion of the author’s research findings. Positive reviews have appeared in: British Medical Journal, Health & Social Care in the Community and Critical Public Health. The book led to a Department of Health contract for a series of briefing papers: Reducing health inequalities for LGBT people.

Navigating Queer Street: Researching the Intersections of Lesbian, Gay, Bisexual and Trans (LGBT) Identities in Health Research

Health researchers engaged in the project of identifying lesbian, gay, bisexual and trans (LGBT) health as a distinct topic for study have often emphasised the differences in health and health care from heterosexuals and similarities among LGBT people. This work has sometimes rendered invisible the experiences of disabled, black and minority ethnic and other groups and has contributed towards the homogenisation of LGBT communities. In this paper, intersection theory is used to explore how diverse identities and systems of oppression interconnect. As a theory, intersectionality requires complex and nuanced thinking about multiple dimensions of inequality and difference. Drawing on the work of Crenshaw (1993), I use three types of intersectionality: methodological, structural and political to explore how the meanings of being lesbian may be permeated by class and gender and how racism and heterosexism intersect in the lives of black and minority ethnic gay men and women. Intersection theory offers possibilities for understanding multiple inequalities without abandoning the politics of social movements.

Far from Mundane: Theorising Heterosexism for Social Work Education

Despite social works commitment to diversity and social justice, anti‐oppressive practice in relation to sexuality is afforded little attention in key texts. In comparison to other social divisions, there appears to be little theoretical analysis of lesbian, gay and bisexual (LGB) oppression and few practice models. Drawing on Thompsons work, a framework for understanding the processes and structures which maintain sexuality oppression is proposed. This analysis identifies the legal, social and political inequalities in the everyday lives of LGB people. The paper examines how heterosexism can help to theorise LGB oppression and aims to translate the term into its ‘full richness’ by using three conceptual domains: normalising heterosexuality, compulsory heterosexuality and intersections with other oppressions. (i) The family is a key site in which heterosexuality is normalised. Children and family social workers are likely to encounter a range of beliefs in which LGB families are constituted as inferior: children lack appropriate gender role models, children will grow up gay, children of same‐sex parents are bullied and gay men are a threat to children. (ii) The compulsory status of heterosexuality has depended on the erasure of LGB existence: sexuality issues are not addressed in the academic or practice curriculum; LGB people are represented as ‘just the same’ as heterosexuals (services which meet their needs and circumstances are not considered); and LGB service users remain invisible to social workers. (iii) Heterosexism intersects with racism, sexism and disabilism in processes which include othering, treating everybody the same and invisibilisation. This paper offers a theoretical foundation for heterosexism on which emancipatory practice with LGB people can be developed.

Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE)

Objectives Information about the health behaviours of minority groups is essential for addressing health inequalities. We evaluated the association among lesbian, gay or bisexual (LGB) sexual orientation identity and smoking and alcohol use in young people in England. Design Data drawn from wave 6 of the Longitudinal Study of Young People in England (LSYPE). Setting Self-completion questionnaires during home visits, face-to-face interviews and web-based questionnaires. Participants Data from 7698 participants (3762 men) with information on sexual orientation identity and health behaviours at age 18/19. Outcome measures Cigarette smoking history, alcohol drinking frequency and risky single occasion drinking (RSOD). Results LGB identity was reported by 3.1% of participants (55 gay, 33 lesbian, 35 bisexual male, 111 bisexual female), 3.5% when adjusting for the survey design. Adjusting for a range of covariates, identification as lesbian/gay was found to be associated with smoking (OR=2.23, 95% CI 1.42 to 3.51), alcohol drinking >2 days/week (OR=1.99, 95% CI 1.25 to 3.17) and RSOD (OR=1.80, 95% CI 1.13 to 2.86) more than weekly. Bisexual identity was associated with smoking history (OR=1.84, 95% CI 1.30 to 2.61) but not alcohol drinking >2 days/week (OR=1.20, 95% CI 0.79 to 1.81) or RSOD (OR=1.04, 95% CI 0.71 to 2.86). Conclusions In a sample of more than 7600 young people aged 18/19 years in England, lesbian/gay identity is associated with cigarette smoking, drinking alcohol frequency and RSOD. Bisexual identity is associated with smoking but not RSOD or frequent alcohol drinking.

Sampling Lesbians: How to Get 1000 Lesbians to Complete a Questionnaire

A year ago, when I embarked on a national questionnaire survey of lesbian health aiming to collect a total of 1000 completed questionnaires, I met with two dichotomous reactions. One reaction was that it was an impossible task. The other reaction was that, because I am lesbian and have an established network of con tacts and because lesbian health is an important and desperately under-researched area, lesbians would flock to take part. I had no way of knowing whether lesbians would participate in large numbers or whether, particularly in remote areas of the UK, it would be possible to make contacts. My fears resonated in the words of another lesbian researcher, Mary Mendola: ‘How do you mail questionnaires to people if you do not know who they are – or where they are?’ (1980: 6). The difficulties of researching ‘unknown’ (Oppenheim, 1992) or ‘hidden’ (Martin and Dean, 1993) populations, such as lesbians (or gay men), have been well docu mented (Bradford et al., 1994). There are a number of issues relevant to getting 1000 lesbians to complete a questionnaire, which I explore in this paper. The Lesbians and Health Care Survey forms part of my PhD research on lesbians’ experiences of breast and cervical screening and their perceptions of the risks of these cancers. Lesbians are said to be less likely to attend for routine pre ventive tests (Bradford and Ryan, 1988; Haas, 1994; McClure and Vespry, 1994; Stevens and Hall, 1990; Trippett and Bain, 1990); however, there has been no research which has explored the reasons that lesbians give for their attendance or non-attendance for screening. Compared with the literature on lesbian health issues published in North America (Hepburn and Gutierrez 1988; McClure and Vespry, 1994; O’Donnell, 1979; Stern, 1992; and White and Martinez, 1997), lesbian health in the UK has been much less well researched (although for a recent British exception see Wilton, 1997.) In the USA, Bradford and Ryan (1988) conducted a pioneering national survey of lesbians’ health in the mid-1980s and this survey has provided important first

Conceptualising social exclusion and lesbian, gay, bisexual, and transgender people: the implications for promoting equity in nursing policy and practice

Since the early 1980s, there has been increasing recognition that the health of individuals and communities is affected by social disadvantage. Following the election of the New Labour Government in 1997, social exclusion became a key concept in UK policymaking. Social exclusion approaches consider health outcomes to be linked to living and working conditions rather than, primarily, to healthcare interventions. Social exclusion is thus an important concept for nursing scholarship for understanding how people’s life circumstances may have an impact on their health. This paper analyses some of the theoretical underpinnings which may lead to recognition of the concept of lesbian, gay, bisexual and trans (LGBT) social exclusion. The paper goes on to propose a model of the multidimensional aspects of lesbian, gay, bisexual and trans social exclusion drawing on research evidence of the social, political and global inequalities experienced by lesbian, gay, bisexual and trans people. In conclusion, it considers the implications for promoting health equity in nursing policy and practice.

Using human rights-based approaches to conceptualise lesbian and bisexual women's health inequalities.

This article makes a contribution to current debates in human rights-based approaches to lesbian and bisexual (LB) womens health. With reference to concepts embodied in the Yogyakarta Principles, it is proposed that the right to health includes access to health information, participation, equity, equality and non-discrimination. Specifically, the article examines how LB womens health can be considered as a health inequality and discusses international developments to reduce disparities. Drawing on qualitative data collected in an online survey, the article reports on sexual minority womens experiences of health-care. Participants were recruited via a purposive sampling strategy; questionnaires were completed by 6490 respondents of whom 5909 met the study criteria of residence in the UK, sexual orientation and completing the survey once. Analysis revealed four broad themes: heteronormativity in health-care; improving attitudes among healthcare professionals; equality in access; raising awareness and informed communities. The accounts highlight the centrality of human rights principles: fairness, respect, equality, dignity and autonomy. The implications for healthcare policy and practice are discussed including ways to empower staff and service users with knowledge and skills and ensuring non-discrimination in health service delivery.

Our Health, Our Say: Towards a Feminist Perspective of Lesbian Health Psychology

Although women’s health has been a central concern of feminist psychology, lesbian health has been largely overlooked. Adopting a feminist approach, this article considers the distinctiveness of lesbian health psychology by examining the contexts for lesbian health. Notions of disease and risk have underpinned the endeavour of constituting lesbians’ health as a research discipline. Dominant traditions have established lesbian health psychology along key dimensions of difference from heterosexual women: differences in risk and preventive health behaviours, in healthy behaviours, in experiences of healthcare, in mental health and in experiences of discrimination. In this article, I propose an agenda for a critically informed perspective of lesbian health psychology and for explanations that do not reinscribe pathology.

Equality in sexual health promotion: a systematic review of effective interventions for black and minority ethnic men who have sex with men.

BackgroundOver the past decade, new diagnoses of HIV have increased eightfold among men who have sex with men (MSM) of other or of mixed ethnicity in the UK. Yet there is little intervention research on HIV among black and minority ethnic (BME) MSM. This article aimed to identify effective HIV and sexual health prevention strategies for BME MSM.MethodsWe searched three databases PubMed, Scopus and PsychInfo using a combination of search terms: MSM or men who have sex with men and women (MSMW); Black and Minority Ethnic; HIV or sexual health; and evaluation, intervention, program* or implementation. We identified a total of 19 studies to include in the review including those which used randomised control, pre/post-test and cross-sectional design; in addition, we included intervention development studies.ResultsA total of 12 studies reported statistically significant results in at least one of the behavioural outcomes assessed; one study reported significant increases in HIV knowledge and changes in safer sex practices. In 10 studies, reductions were reported in unprotected anal intercourse (UAI), number of sexual partners, or in both of these measures. Six out of the 13 studies reported reductions in UAI; while seven reported reductions in number of sexual partners. Seven were intervention development studies.ConclusionsResearch into the mechanisms and underpinnings of future sexual health interventions is urgently needed in order to reduce HIV and other sexually transmitted infection (STI) among UK BME MSM. The design of interventions should be informed by the members of these groups for whom they are targeted to ensure the cultural and linguistic sensitivity of the tools and approaches generated.

Health Inequalities at the Heart of the Social Work Curriculum

Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.