Royal Borough of Kingston upon Thames Lesbian, Gay, Bisexual and Transgender (LGBT) Sexual Health Needs Assessment

 
Royal Borough of Kingston upon Thames Lesbian, Gay, Bisexual and Transgender (LGBT) Sexual Health Needs Assessment
Royal Borough of Kingston upon Thames

  Lesbian, Gay, Bisexual and Transgender
 (LGBT) Sexual Health Needs Assessment

                                                              Dee Wang
                                          Research & Performance Officer

        Contributions by Karen Skipper, Oliver Gilbody & Daniel Winstanley
                                West London Gay Men’s Project (WLGMP)
                                                            February 2013
Royal Borough of Kingston upon Thames Lesbian, Gay, Bisexual and Transgender (LGBT) Sexual Health Needs Assessment
Kingston upon Thames LGBT Needs Assessment

1 Executive Summary
The local authority of the Royal Borough of Kingston upon Thames has identified a gap in
knowledge in relation to the health and well-being needs and experiences of lesbian, gay,
bisexual and transgender (LGBT) people living in the borough. The health needs of the
LGBT community are often overlooked at a strategic level and in the design and delivery of
services. Thus, in consultation with the LGBT communities and key health and well-being
organisations in Kingston, the West London Gay Men’s Project (WLGMP) was
commissioned by NHS Kingston to develop the LGBT Sexual Health and Wellbeing Needs
Assessment as a tool to gather reliable information from which to assess and make
recommendations for effective local services going forwards.

Project aims

To understand the sexual health and well-being needs of LGBT people, to explore their
experiences of accessing health services in the borough of Kingston and to make
recommendations that would enable organisations to develop services that are effective,
evidence based, appropriate and sensitive to the needs of LGBT people.

In order to accomplish this WLGMP consulted with the LGBT community and key health
organisations in the design and distribution of the questionnaire. The questionnaire included
a range of question formats from multiple choice to open ended questions in order to gather
both quantitative and qualitative data. A short focus group discussion was held with support
from Kingston LGBT Forum to gather further qualitative information.

The Findings

Sample profile

       A total of 125 LGBT people completed the questionnaire.
       The gender balance was 22 women and 103 men, with 9 identifying as transgender.
       12.0% identified as lesbian, 76.8% as gay men, 8.0% as bisexual and 0.8% each for
       others including men who has sex with men (MSM), heterosexual transgender man,
       not sure and not given.
       Women were more strongly represented in the 20 – 29 age group, whereas men
       were more strongly represented in the 20 – 59 age groups.
       87.2% identified as various white backgrounds and 6.4% from the Black Asian and
       Minority Ethnic (BAME) community

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Royal Borough of Kingston upon Thames Lesbian, Gay, Bisexual and Transgender (LGBT) Sexual Health Needs Assessment
The most popular places for LGBT people to socialise are social gatherings at home
      or visiting friends, general bars and clubs and LGBT exclusive bars and clubs,
      followed by theatre /Cinema /Restaurants and dating/hook up websites.
      96.8% of respondents are out to all or some of their friends, 88.0% are out to all or
      some of their family with only 64.2% out to their GP/doctor.

Health & Wellbeing

      80.8% of the respondents claimed having experienced certain mental health
      problems. The most common issues include stress, anxiety and depression. A high
      number, 29.6%, disclosed having experienced suicidal thoughts.
      28.8% of respondents smoke.
      24.8% regularly binge drink.
      38.4% use drugs.
      33% of gay respondents had more than 5 sexual partners in the past 6 months
      compared to lesbian respondents who had 1 or fewer sexual partners.
      Most respondents do not believe external factors impact their choice to have safer
      sex. Within those who agree that external factors do affect their choice, alcohol,
      drugs, depression and loneliness have had a negative influence when making safer
      sex decisions.
      30.4% had never used any sexual health services in Kingston. The most popular
      sexual health service providers for male respondents are: K2 clinic, GUM clinic(s)
      and the Wolverton Centre’s sexual health service. The most popular sexual health
      service providers for female respondents are: GPs, family planning clinics and GUM
      clinic(s).
      5.6% had never used any sexual health service at all; many of these are female
      respondents. For those who seek services outside Kingston, the most popular
      services are STI screening/treatment, HIV screening/treatment, free condoms (and
      lube) and information/support.

Use of Services

      Only slightly more than a quarter of the respondents used the local LGBT
      services/groups. “I’ve lived in RBK for 40 years and was totally unaware that there
      are LGBT services here now! How can this be? What's gone wrong?”
      84.8% used LGBT services outside Kingston, mainly for social groups, community
      groups and condom (and lube) services.

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Kingston upon Thames LGBT Needs Assessment

Experience with health Care

      42.4% hadn’t come out to their GP/doctor. 77.8% of transgender respondents hadn’t
      been given relevant information by a healthcare professional. 56.8% didn’t think that
      their needs were fully understood by health staff.
      The most important consideration in choosing a service is confidentiality (91.2%),
      opening times (91.2%), comprehensive sexual health screening (88.8%) and location
      (88.8%).
      12 people participated in the focus group discussion and raised issues such as
      bullying in school, assault and physical threat and parenthood that are facing LGBT
      people.
      Homophobia and heteronormativity (presumption of heterosexuality)1 are witnessed
      within health and social care services. Lesbian participants reported more experience
      of heteronormativity and found it harder to find specific health care services for their
      needs.

Recommendations

GP and Primary Care

      It is essential to improve accessibility and appropriateness of mainstream services.
      Mainstream health care providers should revisit diversity training to ensure that it
      raises awareness of how to effectively meet the needs of LGBT people, given that 42%
      of respondents had not disclosed their sexual identity to their doctor, and 78% of
      transgender respondents were offered no relevant information, with 57% saying their
      needs were not fully understood.

      Health and social care staff should be equipped with the skills to work more
      sensitively with their LGBT patients, and adopt a standard of care to ensure that all
      LGBT people are treated fairly, appropriately and respectfully. Health and social care
      professionals should be trained to focus on the health issues that specifically relate to
      LGBT people.

      Mainstream health care providers should review EVERYTHING YOU ALWAYS WANTED TO
      KNOW ABOUT SEXUAL ORIENTATION MONITORING... BUT WERE AFRAID TO ASK,          a practice
      guide to monitoring sexual orientation commissioned by NHS North West, aimed at
      the public sector carrying out monitoring of staff and service users1.

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Mental health and well-being

      Services need to target LGBT people specifically for lifestyle issues, i.e. smoking;
      alcohol and drug use. Treating service users holistically will ensure appropriate and
      effective signposting and service delivery with better health outcomes for individuals.
      An assessment of lifestyle issues at the time of other assessments for risk taking
      behaviours, e.g. sexual risk taking, should be integrated into pathways.

      Increase access and availability to mental health (i.e. counselling) support. Promotion
      should target positive mental well-being across LGBT communities given that 80% of
      respondents experienced mental health issues, with 29% having suicidal thoughts.
      Assessments of clients’ mental health needs could usefully be integrated into any
      assessment of their sexual health need, with robust signposting and referrals
      pathways identified.

      Younger LGBT respondents report higher levels of eating disorders and self harm and
      identification of these additional issues need to be worked into individual risk
      assessments when working with this group.

      To combat bullying and heteronormactivity, integrate awareness of LGBT rights and
      health and well-being issues into school education. This can be delivered by including
      LGBT specific resources and signposting and including an LGBT element into general
      health and well-being literature.

Sexual Health

      With 26% of MSM having 5+ sexual partners in the last 6 months, and 35% having 2
      to 4 sexual partners, and 12% of MSM HIV positive there are is clear evidence of
      sexual health risk taking behaviour. A one to one behaviour change intervention for
      high risk MSM, designed along NICE guidelines for effective interventions could
      benefit this group.

      Sexual Health Promotion needs to be targeted at lesbian and bisexual women as well
      as gay men, recognising that they may attend different services to MSM. Service
      providers should develop practical strategies that narrow the gap between an
      understanding of safer sex and actual practices. It is important to identify, develop and
      disseminate sexual health information aimed at lesbian and bisexual women as well
      as for MSM

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Kingston upon Thames LGBT Needs Assessment

      Targeted work with the 40% of MSM who use hook up websites or apps to meet other
      MSM. This could be via online outreach (Netreach).

      Local LGBT specific services are perceived to be very limited. LGBT specific health
      promotion in popular venues (including those outside the borough) where LGBT
      people socialise can raise the profile of the local LGBT groups and services, and also
      increase awareness of LGBT health and well-being.

      Integration of HIV testing availability into general activities such as saunas, clubs and
      groups, and faster test results offered.

      Condoms and lubricant are sought outside the borough currently but could be made
      more readily available to Kingston residents via sexual health services and 24s
      condom scheme, both of which were praised by respondents.

      Raise awareness of local LGBT groups and services with LGBT people and other
      mainstream services; develop and strengthen service networks in-between. This can
      be achieved through many different methods including allowing general health
      promotion with LGBT representation and distribution into mainstream outlets/services.

Service Access and integration

      Organisations should undertake sexuality impact assessments to review polices,
      practices and procurement to ensure they are meeting the needs of the LGBT
      community and are not being discriminated against. Anti homophobic/ transphobic
      bullying policies should be enforced in schools and workplaces, and clear
      safeguarding concerns used to promote LGBT concern.
      Confidentiality, timing and location of services is deemed of greater importance to
      LGBT people than having LGBT specific services and all agencies need to review
      their service design accordingly.
      Health care professionals should be trained in order to raise awareness of LGBT
      issues, increase knowledge and skills and to challenge homophobia and
      heteronormativity.
      The rate of mental distress among the LGBT community is significant and services
      need to recognise and develop to suit the needs of LGBT people. Promotion should
      target positive mental well-being across LGBT communities.

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Service Models

      Kingston residents travel outside the Borough to use STI/HIV screening services,
      receive HIV treatment, condoms and lube and information and support. Services
      within the Borough should be supported to promote their services more effectively
      Social groups, LGBT groups, café spaces and counselling services in Kingston should
      be promoted and developed as preferred areas where LGBT people can receive
      services and one to one interventions.
      Intensive one to one behaviour change interventions with those assessed as having
      high risk taking behaviour is recommended. There is clearly unmet need around
      positive and negative factors influencing safer sex practice that could be capitalised
      on to provide positive health outcomes for individuals, particularly MSM.
      LGBT service users should be engaged and consulted with to devise creative
      solutions to problems identified by improving and developing services.

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Kingston upon Thames LGBT Needs Assessment

2 Acknowledgements

Thanks are due to the following individuals and organisations for their assistance with this
needs assessment:

           Iain Runcie-Unger, Screening Officer at WLGMP
           Amy Leftwich, Sexual Health Promotion Specialist; Julia Waters, Public Health
           Programme Lead; Nathalie Wilson, Community Development Worker for
           Marginalised Groups; Helen Terry, Senior Worker for Youth Support Services
           and Nighat Taimuri at Royal Borough of Kingston upon Thames
           Charlie Parker, Chair of Kingston LGBT Forum as well as all members of
           Kingston LGBT Forum
           Joan Coy, Community Health Specialist Nurse at Your Healthcare CIC
           Peter Vittles, LGBT Development Worker at Ealing CVS
           Members of the West London Transgender Drop-in Group
           West 5 pub in Ealing
           K2 Clinic at Wolverton Clinic in Kingston

Special credit and thanks is given to everyone who took time to respond to the questionnaire
and participated in the needs assessment.

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Contents

1      Executive Summary ........................................................................................................ii

2      Acknowledgements ...................................................................................................... viii

3      Introduction .................................................................................................................... 1

4      Methodology .................................................................................................................. 2

5      Findings ......................................................................................................................... 4

     5.1     Respondents Profile................................................................................................ 4

     5.2     Health & Wellbeing ................................................................................................. 9

     5.3     Sexual Health Services ......................................................................................... 13

     5.4     LGBT Community Services ................................................................................... 15

     5.5     Experience ............................................................................................................ 16

     5.6     Needs ................................................................................................................... 18

     5.7     Focus group .......................................................................................................... 20

6      Conclusion and Recommendations .............................................................................. 23

     6.1     Conclusion ............................................................................................................ 23

     6.2     Recommendations ................................................................................................ 25

7      References .................................................................................................................. 28

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Kingston upon Thames LGBT Needs Assessment

List of Table

Table 1 Source of participant recruitment .............................................................................. 4
Table 2 Sexual orientation Vs gender identity ....................................................................... 6
Table 3 Venue of preference and sexual identity (%) ............................................................ 7
Table 4 Venue of preference and age groups (%) ................................................................. 8
Table 5 Whom participants had come out/open about sexual/gender identity to ................... 9
Table 6 Non-prescription drug and Sexual orientation ......................................................... 10
Table 7 Gender of sexual partner and sexual identity.......................................................... 11
Table 8 Use of sexual health services inside Kingston ........................................................ 13
Table 9 Occurrence of issues in the last 5 years ................................................................. 16
Table 10 Criteria for choosing a service .............................................................................. 18
Table 11 Interested in accessing particular service ............................................................. 19

List of Figure

Figure 1Respondents' connection to Kingston ...................................................................... 4
Figure 3 Sexual orientation of participants ............................................................................ 5
Figure 2 Gender distribution of respondents ......................................................................... 5
Figure 4 Age distribution of respondents ............................................................................... 6
Figure 5 Mental health issue and age group ......................................................................... 9
Figure 6 Numbers of sex partners in the past 6 months and sexual orientation ................... 11
Figure 7 Effect on Safer sex choice..................................................................................... 12
Figure 8 Use of sexual health services inside/outside Kingston .......................................... 14
Figure 9 Use of LGBT services/groups inside/outside Kingston .......................................... 15

  x                                                                                                           WLGMP
WLGMP

3 Introduction
Sexual health is not equally distributed among the population. There is a strong correlation between
sex orientation and gender identity and STIs/HIV, sexual behaviour and drug use. LGBT people
(particularly MSM) are at greater risk of contracting an STI; building up longer-term physical and
mental health problems; and becoming addicted to alcohol and drugs. The 2006 UK Gay Men’s
Sexual Health Survey by Sigma Research suggests high levels of risky behaviours among MSM in
Kingston. The incidence of syphilis infection among MSM in Kingston was reported the second
highest in the entire South West London network2. Although there is a lack of detailed data
documenting the prevalence of HIV/STIs and new diagnoses within the LGBT community in
Kingston upon Thames, it is believed that these sexual health concerns are mirrored in the West
London area where there are increasing levels of STIs and an increase in the number of HIV
infections among the LGBT population and particularly amongst MSM.

The West London Gay Men’s Project (WLGMP) works to empower individuals and communities to
make positive, informed choices about their sexual health and overall well-being. In undertaking the
Kingston upon Thames LGBT Sexual Health Needs Assessment, WLGMP began a process of
consultation with the LGBT community in order to produce a detailed profile of their health needs
and experiences. It also represents a significant first step in raising awareness of the identified
health needs and experiences of the LGBT community and in making recommendations that will
improve new and existing services so that they are better able to meet the needs of the LGBT
people who live, work, study or socialise in Kingston upon Thames.

Aims of Kingston upon Thames LGBT Sexual Health Needs Assessment

       Gather information on the use of sexual health services by LGBT people, what type of
       services are accessed and what reasons lie behind their choices
       Identify good and bad experiences of LGBT people in order to determine ways to make
       sexual health services more inclusive and to encourage LGBT people to utilise the services
       offered
       Identify current practises by sexual health providers and identify any gaps in knowledge or
       service provision
       Produce an evaluation report and provide constructive and implementable feedback and
       recommendations as to how good practise can be built and advertised

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Kingston upon Thames LGBT Needs Assessment

4 Methodology
This needs assessment was commissioned by the Royal Borough of Kingston upon Thames (RBK).
The project was undertaken over a period of three months, from mid November 2012 to mid
February 2013.

Quantitative Method

A sexual health needs questionnaire was specially designed. This included 32 questions over 10 A5
pages, which were broken down into 6 sections: demographics, health and wellbeing, sexual health
services, community services, experience and needs. A peer review and pilot survey was engaged
prior to the main survey via a small group of LGBT participants to ensure a suitable and user-
friendly questionnaire design.

The questionnaire was administered for a short period between mid November 2012 and the end of
January 2013. Potential respondents to the questionnaire were contacted through:

       The contact lists and databases of the WLGMP
       Online survey using Google platform, and signposting to the questionnaire via WLGMP’s
       website, RBK website and other websites including social media outlets and gay specific
       chat sites
       Targeted outreach sessions at the Kingston gay club night Escape*, West 5 pub and the K2
       clinic, conducted by outreach workers employed by WLGMP
       Existing social and support groups and services
       Snowballing and word of mouth

*Participants from the outreach sessions were incentivised with a raffle to win a £20 voucher given
out at the end of the night, plus a bag of condoms and lubricant.

Qualitative Method

A special session for the purpose of the needs assessment was held with full support from the
Kingston LGBT Forum on 11 Dec, 2012. The session lasted 30 minutes. All members of the forum
were invited. A total of 12 people participated, with a breakdown as follows:

           Gay, bisexual men and men who have sex with men: 8 attendees
           Lesbian women: 2 attendees
           Not disclosed: 2 attendees, one from local Police force and the other, an employee of
           RBK
                                                                                                      2
WLGMP

During the focus group discussion, three main activities were purposely designed for the needs
assessment, which were:

          Issues facing LGBT people
          The best and worst designed clinics for LGBT people
          Experiences of sexual health services

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Kingston upon Thames LGBT Needs Assessment

5 Findings
125 valid responses to the questionnaire were received (68 via direct submission online and 57
completed paper questionnaires).

Participants were asked how they had first heard about or got hold of the questionnaire. Table 1
details the results.

Table 1 Source of participant recruitment

                                Source                                             Number     %
        Email                                                                         13    10.4%
        Friend                                                                        4      3.2%
        Health professional                                                           1      0.8%
        K2 Gay and Bisexual Men's Clinic at Wolverton Centre                          27    21.6%
        Kingston LGBT Facebook group                                                  1      0.8%
        Kingston LGBT Forum                                                           2      1.6%
        Kingston University LGBT Society                                              1      0.8%
        Online                                                                        35    28.0%
        Outreach worker                                                               27    21.6%
        Staff email                                                                   1      0.8%
        Surrey Comet Newspaper                                                        1      0.8%
        West 5                                                                        10     8.0%
        WLGMP Trans Drop-in Group                                                     2      1.6%
                                 Total                                               125    100.0%

5.1 Respondents Profile

5.1.1 Connection to the borough
The respondents provide a solid base of LGBT community participants who have strong
associations with Kingston upon Thames. 56.8% (n=71) live in Kingston. Among those who live
outside the borough, 16.0%
(n=20) work or study and                          71
                                    80
                                                                 60
21.6% (n=27) socialise in                                                              55
                                    60
Kingston. Another 5.6% (n=7)                                                                   40
                                    40
come to Kingston primarily to
use its health care services.       20                                       7

Figure 1 shows the                   0
respondents’ absolute                       I live here    I socialise   I study  I use    I work
                                                              here         here  health     here
connections to Kingston.                                                        services
                                                                                  here
                                                          Figure 1Respondents' connection to Kingston

                                                                                                        4
WLGMP

5.1.2 Gender
Of 125 respondents, 82.4% were defined as male and 17.6% as female. 7.2% (n=9) stated that they
had a gender variant experience and 2.4% (n=3) preferred not to state the details.

                                       4.0%
                                                  14.4%

                                   Male            Female
                                                          3.2%

                                                                    Female without Transgender experience

                                                                    Female with Transgender experience

                                                                    Male without Transgender experience
                                 78.4%
                                                                    Male with Transgender experience
Figure 2 Gender distribution of respondents

5.1.3 Sexual orientation
12.0% of the respondents identified as lesbian, 76.8% as gay, 8.0% as bisexual and 3.2% as otheri.
Figure 3 demonstrates such a composition of our sample and Table 2 displays the gender of
respondents against their declared sexual identity.

                                                                              Lesbian
                                           8.0%
                76.8%                                       0.8% 0.8%         Gay
                                                   3.2%                       Bisexual
                                                            0.8% 0.8%
                                          12.0%                               MSM
                                                                              Heterosexual
                                                                              Not sure
                                                                              N/A

Figure 3 Sexual orientation of participants

i
    1 each of MSM (Man who has sex with Men), heterosexual, not sure and not available.

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Kingston upon Thames LGBT Needs Assessment

 Table 2 Sexual orientation Vs gender identity

                                         Female
                                                          Male without    Female with        Male with
                                         without
       Sexual Orientation                                 Transgender     Transgender      Transgender
                                      Transgender
                                                           experience      experience       experience
                                       experience
Bisexual                               4    22.2%         2      2.0%    2     50.0%       2    40.0%
Gay                                    0     0.0%        94      95.9%   0      0.0%       2    40.0%
Heterosexual                           0     0.0%         0      0.0%    0      0.0%       1    20.0%
Lesbian                               13    72.2%         0      0.0%    2     50.0%       0     0.0%
MSM (Man who has sex with men)         0     0.0%         1      1.0%    0      0.0%       0     0.0%
Not sure                               1     5.6%         0      0.0%    0      0.0%       0     0.0%
N/A                                    0     0.0%         1      1.0%    0      0.0%       0     0.0%
             Total                    18 100.0%          98     100.0%   4     100.0%      5    100.0%

 5.1.4 Age
 The age of respondents varied from 17 to 70, with a median age of 32. The majority were between
 20 and 29 (n=44), followed by those between 30 and 39 (n=31) and between 40 and 49 (n=21).

                                                  4.2%
                                                         3.4%
                                        11.8%

                                                                 37.0%
WLGMP

    5.1.6 HIV status
    At the time the questionnaires were collected, 12.0% (n=15) had tested HIV positive, all of which
    self-identified as gay, male. 38.4% (n=48) had tested HIV negative within 6 months and 31.2%
    (n=39) had tested more than 6 months ago. 14.4% (n=18) had never tested for HIV before; among
    which 8 (6.4%) identified as gay male (8% of gay, bisexual men and MSM), 6 (4.8%) as lesbian
    female, 3 (3.4%) as bisexual female and one heterosexual transsexual male. There were also 3.2%
    (n=4) who were not sure about their HIV status and another participant refused to disclose his HIV
    status.

    5.1.7 Disability
    85.6% (n=107) identified as having no disability. Among the 13.6% (n=17) who identified as having
    a disability, including physical illness, such as Arthritis, Dyspraxia, M.E. and Diabetes, and mental
    health problems.

    5.1.8 Ethnicity
    The majority of respondent are from White backgrounds. 49.6% (n=62) were White British; 30.4%
    (n=38) were White European including 26.4% (33) Western European and 4.0% (5) Eastern
    European; 7.2% (n=9) are from other White backgrounds, such as Irish and South Africa. Mixed or
    Minority Ethnic groups were in low numbers with a sum of 12.0% (n=15), which includes 4.8% (6)
    Mixed, 3.2% (4) Asian, 1.6% (2) Black, 1.6% (2) Chinese and 0.8% (1) Latino.

    5.1.9 Social Preferences
    The most popular places for our respondents to socialise and meet people are: social gatherings at
    home or visiting friends (66.4%, n=83), general bars & clubs (62.4%, n=78), LGBT exclusive bars &
    clubs (56.8%, n=71) and theatre /cinema /restaurants (51.2%, n=64). Table 3 and Table 4 display
    comparative analyses of socialising preference between different declared sexual identities and age
    groups.

    Table 3 Venue of preference and sexual identity (%)

                                  Lesbian     Bisexual      Gay     Heterosexual   MSM     Not sure     Total
             Venue
                                   (n=15)      (n=10)      (n=96)       (n=1)      (n=1)    (n=1)     (n=124)ii
Social gatherings at
                                    53.3         70.0        68.8      100.0        0.0     100.0       66.4
home or visiting friends

    ii
         One respondent did not disclose his sexual orientation.

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Kingston upon Thames LGBT Needs Assessment

                                  Lesbian        Bisexual      Gay          Heterosexual    MSM     Not sure      Total
             Venue
                                   (n=15)         (n=10)      (n=96)            (n=1)       (n=1)    (n=1)      (n=124)ii
General bars & clubs                46.7           60.0        64.6             100.0       100.0    100.0        62.4
LGBT exclusive bars &
                                    66.7           60.0        55.2              100.0       0.0     100.0         56.8
clubs
Theatre / Cinema /
                                    46.7           50.0        52.1              100.0       0.0     100.0         51.2
Restaurants
Visit family                        20.0           30.0        38.5              100.0       0.0      0.0          35.2
Dating/hook up websites              6.7           30.0        40.6               0.0        0.0      0.0          34.4
Mobile dating apps                   0.0            0.0        40.6               0.0        0.0      0.0          31.2
LGBT community
                                    20.0           40.0        20.8               0.0        0.0     100.0         22.4
groups/social groups
LGBT online
                                    26.7           50.0        18.8               0.0        0.0      0.0          21.6
communities
Sport clubs & groups                20.0           40.0        13.5               0.0        0.0      0.0          16.0
General online
                                     6.7           30.0        11.5               0.0        0.0      0.0          12.0
communities
General community
                                     0.0           30.0            9.4           100.0       0.0     100.0         11.2
groups/social groups
Prefer to stay at home              13.3           10.0        11.5               0.0        0.0      0.0          11.2
LGBT specific sport clubs
                                    13.3           0.0             8.3            0.0        0.0      0.0             8.0
& groups
Outdoor groups                       0.0           10.0            5.2            0.0        0.0      0.0             4.8

   Table 4 Venue of preference and age groups (%)
WLGMP

    groups
    Outdoor groups                                 0.0          4.5            6.5                4.8        7.1         0.0        5.0
    tea shops and pubs                             0.0          2.3            0.0                0.0        0.0         0.0        0.8

5.1.10             Disclosure of sexual/gender identity
Apart from one transvestite male and one female who both self-identified as bisexual, most
respondents said they had come out to at least one or some members of their family, friend,
colleague, employer and/or their GP/doctors. Table 5 displays whom they had come out to. It is
noted that a large percentage, 28.4% (n=35) chose not to disclose to their GP/doctor.

Table 5 Whom participants had come out/open about sexual/gender identity to

                                 Yes                            No                       Some            Not Applicable             Total
       Family              91         72.8%            15       12.0%           19               15.2%       0          0.0%        125
       Friend              107        85.6%            3         2.4%           14               11.2%       1          0.8%        125
     Colleague             76         61.8%            14       11.4%           26               21.1%       7          5.7%        123
      Employer             83         68.0%            19       15.6%           9                 7.4%       11         9.0%        122
     GP/ Doctor            74         60.2%            35       28.5%           5                 4.1%       9          7.3%        123

5.2 Health & Wellbeing

5.2.1 Mental wellbeing
80.8% (n=101) of the respondents claimed that they had experienced certain mental health issues.
The most common issues include: stress (67.2%, n=84), anxiety (56.8%, n=71) and depression
(54.4%, n=68). Following these, 29.6% (n=37) admitted that they had experienced suicidal thoughts.
Figure 5 demonstrates participants’ mental health issues across different age groups. Younger
respondents had also reported experiences with eating disorders and self-harming.

      60-70        1                     3                                                   4
                                                                                                                          Anxiety
      50-59            4                       6                                     7                       2
                                                                                                                          Depression
      40-49                18                          15                2 3              14             8
                                                                                                                          Eating Disorder
      30-39            18                     18                 6       5                   21              8
                                                                                                                          Self Harm
      20-29            26                 22                6    8                   33                  15               Stress
Kingston upon Thames LGBT Needs Assessment

5.2.2 Substance use

5.2.2.1 Smoking
28.8% (n=36) said they smoke, all of whom were under 50 with a median age of 28. Among them,
16% (n=20) stated that they were smoking more than 10 cigarettes a day. This result is much higher
than the national data which reports that the smoking prevalence in England was 20% in 2010 and it
is decreasing3.

5.2.2.2 Alcohol
Respondents were asked how often they drank to levels exceeding the amount that the government
recommends for occasional alcohol consumptioniv. 19.2% (n=24) never drank beyond the
recommended amount. The majority of respondents claimed that they did so on a monthly basis
(24.8%, n=31) or less than monthly (31.2%, n=39). 15.2% (n=19) drank at levels which exceeded
recommended advice every week and 9.6% (n=12) almost daily. This data suggest that more than
24% of the respondents binge drink on at least one day in the week, which is much higher than the
national finding where the same measurement among male and female were 19% and 12%
respectively4.

5.2.2.3 Drugs
A considerable percentage of respondents (39.2%, n=49) said that they used non-prescription drugs
as part of their social or home life. The 2011/12 CSEW national survey estimated one in three
adults (36.5%) had ever taken an illicit drug in their lifetime and 8.9% had used an illicit drug in the
last year5. Finding from this needs assessment suggests noticeably higher rate of drug misuse
among the LGBT community.

The most commonly used drugs include: Amyl nitrate (poppers), Cannabis (grass, spliff), Cocaine,
Viagra or equivalent and Ecstasy. Table 6 lists the details.

Table 6 Non-prescription drug and Sexual orientation

                      Drug                 Bisexual     Gay       Lesbian      Heterosexual       Total
          Amyl nitrate (poppers)                3        34                           1             38
          Cannabis (grass, spliff)              4         8           3                             15

iv
     NHS recommends not drinking more than 8 units of alcohol for men (equivalent to 3 pints of strong beer)
and 6 units of alcohol for women (equivalent to 2 pints of strong beer) on one occasion.

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                  Drug                Bisexual    Gay      Lesbian      Heterosexual         Total
      Cocaine                             1          11       1                               13
      Viagra or equivalent                2          10                                       12
      Ecstasy                             2           9       1                               12
      Mephedrone (meow meow)                          6                                        6
      Amphetamines (speed)                            3       2                                5
      Crystal Meth                                    3                                        3
      Ketamine                                        3                                        3
      Tranquillisers                                  2       1                                3

5.2.3 Sexual behaviour

5.2.3.1 Sexual partners
34.7% (n=43) had 2 to 4 sexual partners in the past 6 months. 33.1% (n=41) had one sexual partner.
26.4% (n=33) had more than 5 sexual partners (12 among them had more than 11 sexual partners),
of which one participant was a bisexual male and all others were gay males.

        100%
                                                                                      0
         80%
                                                                                      1
         60%
                                                                                      2-4
         40%

         20%                                                                          5-10

          0%                                                                          11+

Figure 6 Numbers of sex partners in the past 6 months and sexual orientation

As shown in Table 7, some respondents who self-identified as homosexual have sex with partners
of the opposite gender, indicating higher behaviourally bisexual practice.

Table 7 Gender of sexual partner and sexual identity

                                                                               Not
  Partner Gender         Bisexual Gay Heterosexual Lesbian MSM                               N/A Total
                                                                               sure
All men                     2       91                                  1       1             1      96
All women                   1                    1            14                                     16
Equally men and
                            4                                  1                                     5
women
Mostly men                  2        3                                                               5
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Kingston upon Thames LGBT Needs Assessment

                                                                                           Not
  Partner Gender            Bisexual Gay Heterosexual Lesbian MSM                                    N/A Total
                                                                                           sure
Not applicable                  1            2                                                                  3
       Total                    10           96      1               15       1              1        1        125

5.2.3.2 Factors affecting safer sex choice
Respondents were given a list of factors that might potentially affect their choice of safer sex
behaviour, i.e. using condoms and/or having less casual sexual partners.

With each of the given factors, the majority of respondents believed that there was no effect at all on
their sexual behaviour. Of those who did note an effect on their sexual behaviour, the top chosen
negative influencing factors, i.e. those which promoted unsafe sexual practices, were: alcohol
(41.6%, n=52), drugs (24%, n=30) and loneliness (22.4%, n=28). Conversely, the top chosen
positive influencing factors, i.e. factors which encouraged participants to practice safer sex, were:
different HIV status of partners (36.8%, n=46), unknown HIV status of partners (30.4%, n=38) and
same HIV status of partners (16%, n=20). Details are displayed in Figure 7.

                                                                                   Alcohol
                                                                                   Drugs

                                       100                                         Depression
                                                                                   Loneliness
                                                                                   My body image
                                                                                   Partner same HIV status as me
                                                                                   Partner different HIV status to me
                                                                                   Unknown HIV status of partner
                                                                                   Pornography I read/watch
                                                                                   Attractiveness of partner
                                        10                                         What I want during sex
                                                                                   What my partner wants during sex
                                                                                   Where we are having sex

                                         1
 Much less safe   Slightly less safe    No affect   Slightly safer    Much safer

Figure 7 Effect on Safer sex choice

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5.3 Sexual Health Services
Respondents were asked how often they used sexual health services provided inside the borough
of Kingston within the past 12 months. 30.4% (n=38) said they never used any of the sexual health
service inside Kingston, 7 of whom never used any sexual health service outside the borough either.
Table 8 displays their answers. According to the responses, the most popular sexual health service
providers for male respondents are: K2 clinic, GUM clinic(s) and Wolverton Centre’s sexual health
service; the most popular sexual health service providers for female respondents are: GPs, family
planning clinics and GUM clinic(s). In addition, three respondents mentioned they had received
sexual health services from Kingston Community Matron HIV, all of whom were HIV positive gay
males.

Table 8 Use of sexual health services inside Kingston

                                              More than 4                               Once in    Over a
     Sexual Health services inside                              2-4 times in the
                                              times in the                              the last    year    Never
                RBKv                                                last year
                                                last year                                 year      ago
Genital Urinary Medicine (GUM)
                                                     6                  15                 8        14       72
Clinic
Sexual health service from a GP                      1                   2                 7         6       96
KU19 Young People’s Clinic                                                                           3       107
Information and Advice on
                                                     1                                     6         5       102
HIV/AIDS (RBK council HIV team)
Pharmacy Emergency
                                                     1                   1                           3       108
Contraception Scheme
Family Planning Clinics                              2                                               4       106
General services @ Wolverton
Centre for Sexual Health (Kingston                   6                  12                12         9       77
Hospital)
K2 Gay and Bisexual Men's Clinic
                                                     6                  25                17         9       62
@ Wolverton Centre
The Point @ Wolverton Centre                                             2                 1         1       109
LARC Contraception Clinic @
                                                                                           2         1       109
Wolverton Centre

The reasons for not using the sexual health services are given below, in order of preference:

               I don’t think I need it
               I use services outside the borough
               Their opening time is not convenient for me

v
    The listed services were identified according to the information provided online.

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Kingston upon Thames LGBT Needs Assessment

                 I don’t know where to go
                 Their locations are not convenient for me
                 I am too afraid to go
                 Just moved into the area
                 They don’t provide the service I needvi

Many female respondents (50%, n=11) believed that they didn’t need the service. 4 out of the 5
respondents thought there was no in-borough provider for their sexual health needs as a female.

When asked how often they used any sexual health services outside the borough in the past 12
months, the most popular services are STI screening/treatment (44.8%, n=56), HIV
screening/treatment (43.2%, n=54), free condoms (and lube) (38.4%, n=48) and information/support
(23.2%, n=29). Figure 8 demonstrates the overall choice of the respondents.
       Over a year ago                                                                                           60
       Once in the last year
       2-4 times in the last year                                                                                50
       More than 4 times in the last year
                                                                                                                 40

                                                                                                                 30

                                                                                                                 20

                                                                                                                 10

                                                                                                                 0

Figure 8 Use of sexual health services inside/outside Kingston

vi
     Only one respondent detailed the service lacking, which is sexual health physiotherapy for Vestibulodynia
(vulval pain).

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5.4 LGBT Community Services
Only slightly more than a quarter of the respondents (n=32) used the listed LGBT services/groups
provided inside Kingston, which include Kingston University LGBT Society, Kingston LGBT Forum,
Kingston LGBT Support (Mind in Kingston) and Community HIV Matron.

Compared with the above, more responses were gained when asking how often the respondents
used LGBT services/groups outside Kingston. Only 19 (15.2%) claimed they never used any LGBT
services from outside Kingston; 11 of them (8.8%) never used those from inside Kingston either.
Social groups, community groups and condom (and lube) services are slightly more commonly used
than others.

           45
           40
           35
           30
           25
           20
           15
           10
            5
            0

                                                                     Over a year ago
                                                                     Once in the last year
                                                                     2-4 times in the last year
                                                                     More than 4 times in the last year

Figure 9 Use of LGBT services/groups inside/outside Kingston

From those who did not use LGBT services, reasons were given below in order of preference:

            I don’t think I need any LGBT specific service/group
            I don’t know where to go
            The location is not convenient for me
            The opening time is not convenient for me
            I am afraid to expose my sexual orientation
            I don’t want to be seen in the LGBT specific venue
            Not interested

Nearly 10% (n=21) said they didn’t know where to seek LGBT services, especially those inside the
borough.

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Kingston upon Thames LGBT Needs Assessment

          I've lived in RBK for 40 years and was totally unaware that there are LGBT
          services here now! How can this be? What's gone wrong?

5.5 Experience
42.4% (n=53) hadn’t come out to their GP/doctor. 7 out of 9 (77.8%) respondents with transgender
identities hadn’t been given relevant information by a healthcare professional. A large proportion of
respondents (56.8%, n=71) didn’t think that their needs were fully understood by the health staff.
Table 9 lists the details.

Table 9 Occurrence of issues in the last 5 years

                         Occurrence                           Yes             No         Not Sure
  Come out to your GP/doctor                               49 39.2%        53 42.4%      7   5.6%
  Been given information by a healthcare professional
                                                            2   1.6%       7    5.6%
  relevant to your gender identity?*
  Been given information by a healthcare professional
                                                           63 50.4%        44   35.2%     5    4.0%
  relevant to your sexual orientation?
  Felt that your needs weren’t fully understood by the
                                                           31 24.8%        71   56.8%     8    6.4%
  health staff
  Felt that the service you received was negatively
                                                           15 12.0%        87   69.6%     7    5.6%
  impacted by your sexual orientation or gender identity?
  Experienced homophobia from healthcare services?         17 13.6%        90   72.0%     4    3.2%
  Experienced transphobia from healthcare services? *       1   0.8%        7    5.6%     2    1.6%
* Answers from respondents identifying with transgender history only.

Questions around experiences with specific problems (e.g. discrimination, negative attitudes) from
listed health care services because of sexual orientation or gender identity were asked. Most of the
respondents (76%, n=95) didn’t have such problems. However, 8.8% (n=11) had some problems
with GP/local health practices and 7.2% (n=9) with NHS hospitals. Some respondents kindly shared
their experiences with us.

          After becoming aware of my sexuality, they immediately assumed I was
          sexually promiscuous and then started talking about HIV.

          I underwent a dental procedure at a local dentist. When I identified that I
          was HIV+ the dentist decided to wear three pairs of gloves and was
          immensely rude stating: “It may be better if I found another dentist".

          I find that when I mention my sexuality it is either not relevant to the issue
          being discussed, or just isn't talked about whatsoever. Although I've not

                                                                                                     16
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         had a bad experience I find that some doctors have a hard time talking
         about it, especially the more mature ones.

More details were given by lesbian respondents:

         Assumption of a heterosexual relationship. Staff visibly uncomfortable
         when discussing homosexual sexual relationship. Unaware of possible
         different needs of a lesbian relationship. Leaflets and information for
         heterosexual relationships only.

         My sexuality was questioned by a nurse as I was admitted to Kingston
         Hospital for surgery. As I was being admitted she questioned a) why I had
         a girlfriend and b) why I wanted her to be my ‘in case of emergency’
         contact.

         Sexual health services not being very helpful/knowledgeable about lesbian
         sex health issues, GPs not being understanding/reacting badly about me
         being young and gay a few years back, suggesting I might need
         counselling.

On the other hand, good experiences were also shared:

         Access and support from Dean Thompson Community Nurse with
         Medication and other life issues. Easy to contact and approachable. As a
         full time worker I use Kingston Aid evening group which is once a month
         on a Tuesday evening. Access to support and information when I need it.

         Every time I visit here (K2 at Wolverton Centre) it's been great service and
         very informative.

         Community HIV Nurses very supportive and culturally aware, able to be
         very supportive to my specific needs and questions.

         Evening drop in service once a month run in Surbiton provides access to
         advice and support locally to home without taking time off from work.
         Roland and Dean provide support and advice for living and working with
         HIV.

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Kingston upon Thames LGBT Needs Assessment

          GP has good understanding of my HIV status and no breaches of
          confidentiality

          My general practitioner is absolutely excellent. She confided with me that
          she was not familiar with HIV medicine but would do everything to help.
          She also has been great in securing services and as a general support
          resource.

          Staff at K2 are welcoming, polite and understanding

          The (West London) Gay Men’s Project 24's (condom service) and the West
          Middlesex Hospital GUM clinic have excellent staff

5.6 Needs
Respondents were asked how important the given criteria were when choosing a service. The most
important consideration is confidentiality and opening time; both were chosen by 91.2% (n=114) of
the respondents. Comprehensive sexual health screening and location were also very important
and were both chosen by 88.8% (n=111) of respondents. Table 10 displays the full list of results.

Table 10 Criteria for choosing a service

                                              Very                       Not so         Doesn’t
                                                        Important
                                            important                  important      matter at all
Confidentiality                            94 75.2%     20   16.0%     5     4.0%     4     3.2%
Opening time                               77 61.6%     37   29.6%     8     6.4%     1     0.8%
Comprehensive sexual health
                                           77   61.6%   34   27.2%     9     7.2%     3      2.4%
screening
Location                                   68   54.4%   43   34.4%    8     6.4%       2     1.6%
Environment & Atmosphere                   59   47.2%   48   38.4%    13    10.4%      3     2.4%
Accessibility                              75   60.0%   25   20.0%    15    12.0%      8     6.4%
Visibly welcoming to LGBT people           48   38.4%   42   33.6%    18    14.4%     12     9.6%
Specialised Services                       43   34.4%   38   30.4%    31    24.8%      7     5.6%
LGBT specific                              31   24.8%   37   29.6%    37    29.6%     15    12.0%
Staff who are LGBT                         25   20.0%   29   23.2%    43    34.4%     23    18.4%

Respondents were given a comprehensive list of services at the end of the questionnaire, and
asked to select the ones that they would use if provided in the borough of Kingston upon Thames.
Here is the result arranged in order of preference.

                                                                                                    18
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Table 11 Interested in accessing particular service

                                Services                      Number selected    %
     Social Groups                                                  47          37.6%
     Local LGBT groups                                              44          35.2%
     Café Space                                                     44          35.2%
     Counselling                                                    42          33.6%
     Drop In                                                        39          31.2%
     Outdoor activities i.e. walking groups                         30          24.0%
     Health services                                                29          23.2%
     Drama / Theatre / Music                                        28          22.4%
     Volunteering opportunities                                     26          20.8%
     Safe Meeting Space                                             25          20.0%
     Befriending                                                    25          20.0%
     Groups for older people I.e. Over 40, Over 60                  25          20.0%
     Sporting Activities                                            23          18.4%
     Mental Health Specific Programme or events                     22          17.6%
     Carers Support / Advice                                        21          16.8%
     Homophobic / Transphobic Crime Support                         20          16.0%
     Creative Art Projects                                          19          15.2%
     Housing Advice                                                 19          15.2%
     Remote Police Reporting to report homophobic incidents         17          13.6%
     Self Help Groups (alcohol, disability, weight etc)             17          13.6%
     Health Related Workshops                                       16          12.8%
     Alcohol Free Social Space                                      14          11.2%
     Alcohol Education Awareness / Programmes                       14          11.2%
     Health outreach                                                14          11.2%
     Youth Groups / Age specific Groups                             12          9.6%
     Internet access                                                12          9.6%
     Lesbian & Bisexual Women’s Health                              12          9.6%
     Spiritual and/or religious group / support                     11          8.8%
     Support into work                                              11          8.8%
     Erectile dysfunction clinic                                    8           6.4%
     Immigration/ asylum service                                    8           6.4%
     Ethnic Minority Interest                                       8           6.4%
     Adult Literacy                                                 8           6.4%
     Smoking cessation groups                                       8           6.4%
     Dealing with Domestic Abuse                                    8           6.4%
     Advocacy                                                       7           5.6%
     Adult Numeracy                                                 7           5.6%
     Substance Misuse Awareness / Programmes                        7           5.6%

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Kingston upon Thames LGBT Needs Assessment

                                  Services                          Number selected        %
    Transgender Health                                                         5         4.0%
    Others                                                                     4         3.2%

5.7 Focus group

5.7.1 Issues facing LGBT people
The discussion fell into 3 areas: emotional, physical and sexual. More issues were raised when
discussing emotional issues facing LGBT people, which included:

           Bullying in schools
           Assault and physical threat
           Family acceptance / marriage
           Coming out at college / to family / workplace (fear of rejection)
           Facing prejudice and a lack of understanding
           Guilt when living up to family expectations
           Parenthood issues
           Hurt dealing with homophobia
           Battle with religion

Physical issues were discussed around body image and peer pressure to look a certain way and
assault and physical threat.

As is confirmed in Kingston’s 2008 sexual health needs assessment1, the survey found there might
have been a general assumption in the field of sexual health that there has already been plenty of
STI and HIV education; however our participants still expressed concerns about a lack of
appropriate information and unclear answers to certain questions regarding HIV/AIDS stereotypes.
The group agreed to the increasing risk of STI transmission and valued the importance of
awareness of diseases that are specific to LGBT people and the relevant support needed for them.
The discrimination and segregation of LGBT people at clinics, and feeling uncomfortable to discuss
issues with health care professionals were also some of the presenting issues.

5.7.2 The best and worst designed clinics for LGBT people
The suggestions were given as follows:

Best

                                                                                                     20
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        Free healthcare including antibiotics
        Integrating testing into society (saunas, clubs, coffee shops)
        Social, friendly space
        Walk-in/ drop-in counselling (no waiting list)
        Give results quicker, e.g. lab on site
        Home testing/sampling kits more freely available
        24/7 clinics
        HIV specialist always on site to offer advice and Post-exposure prophylaxis (PEP) / Pre-
        exposure prophylaxis (PrEP)
        More HIV clinics
        PEP/PrEP easily available (only for high risk if no other choices)

Worst

        Non person-centred (hidden agendas – e.g. targets)
        No website
        No drop-in
        Judgemental/ blaming staff
        Hetero-centric magazines
        Difficult to access
        Aligning HIV and gay all the time (there’s more to being LGBT than sexual health)
        Charging for healthcare
        Homophobic / not-aware staff
        Assumptions about genders and relationships
        Non-trans friendly toilets
        Poor confidentiality, not discrete
        Just offering one type of condom – no dental dams or lube
        Limited opening hours
        Badly groomed staff
        Dirty/smelly setting
        Bad customer service
        No outreach
        No specific nights

21
Kingston upon Thames LGBT Needs Assessment

5.7.3 Experiences of sexual health services
The experiences shared in the group discussion echoed the responses from the questionnaires.
Lacking LGBT awareness is still a common phenomenon among health care services, especially for
lesbians; and homophobia is still experienced.

Both lesbian participants had experienced staff at GPs not being sensitive to the fact that they are
lesbian (with GPs notes reflecting this) and still being asked questions about the possibility of being
pregnant and being recommended contraceptive medication and devices. One woman said that it is
very difficult to find a clinic specifically for lesbians.

One gay man was treated rudely with unhelpful comments from staff after he disclosed his sexual
orientation. Another gay man was told he should attend the clinic on an alternative night specifically
for MSM and was refused entry.

3 people experienced poor confidentiality in the clinic reception areas: being asked their name, date
of birth and sexuality in public.

One man reported when registering with a local GP service that when he spoke of his partner he
was asked his wife’s name. Participants also found it difficult to put down a member of the same sex
as next of kin on medical forms as it is often questioned since it implies not a relative.

                                                                                                       22
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6 Conclusion and Recommendations
This report aims to convey the health and well-being needs of a sample of the local LGBT
population and establish whether existing health and other services are meeting identified needs,
and to make recommendations on how current service provision could be improved and/or
enhanced. It must be acknowledged that, due to the small numbers of respondents, this
assessment only provides a snap-shot of evidence, which the following conclusions and
recommendations are based on.

6.1 Conclusion
There was under representation of the bisexual population as the national data suggests that the
bisexual population is over half of the gay and lesbian population6. The Lesbian population might
have been underrepresented with a ratio of 12%. However, it is generally acknowledged to be
difficult to predict the size of this group and the proportion of it. The proportion of respondents with a
transgender history was also small, reflecting the lack of visibility of this population.

Black, Asian and Minority ethnic LGBT people (7.2% in total) are underrepresented; however this
reflects the general ethnic composition of Kingston. There might be a lack representation of White
British and a slight over representation of White European groups as the latest national census data
suggests 63% of the Kingston population is White British7.

The needs assessment highlighted the need to work closely with the current services i.e. GUM
clinics, GP and family planning services, in addressing concerns expressed by LGBT service users.
The main concern was that the health needs of LGBT people is not fulfilled within the current
service structure and clinical pathways.

Due to the defined remit and limited amount of time available no data was collected from service
providers in this study.

Most LGBT respondents were ‘out’ to their friends and fewer individuals were ‘out’ to their GPs or
health care professionals.

There is a general assumption that gay and bisexual men have already received HIV education,
however there were still 8% of gay, bisexual male and MSM respondents who had never tested for
HIV before.

More than 80% of LGBT respondents had experienced mental health issues. There is strong
evidence of a need to support mental well-being amongst this community.

23
Kingston upon Thames LGBT Needs Assessment

The findings regarding high rates of smoking; binge drinking and drug use support the findings in
similar research8. However, given the small size of the sample of the survey it is not possible to
interpret the data in any further depth.

The needs assessment highlights that the majority of LGBT people within Kingston have not heard
of many of the services available, despite many of them being sure of the type of services they
require.

Most LGBT people within this study clearly wanted a higher profile of services. However it is worth
noting that the majority of respondents had previously made use of at least one of the services, with
many respondents indicating that they had used a number of services.

Heteronormativity (presumption of heterosexuality) seemed to be a common negative experience
for service users. Such assumptions/reactions were further highlighted with some experiences from
lesbian respondents. Service providers should re-visit diversity training to be able to better identify
issues that affect LGBT people as required by the Equality Act 2010.

LGBT people socialise in a variety of settings where direct client contact work could be done
successfully, for example bars, clubs and social groups. There is a strong need for services to offer
confidential and comfortable environments for LGBT clients to discuss health issues and
experiences. The respondents raised the importance and value on simply meeting and talking to
each other, gaining support and confidence from others through sharing their experiences.

Use of local LGBT specific services was low with evidence suggesting that people did not want to
engage with LGBT specific services as they did not want to be treated differently. However, low
levels of awareness do suggest a gap in the profile of local services.

Some respondents raised concerns about access to services. It was clear that services needed to
be accessible outside normal working hours i.e. 9am-5pm, particularly sexual health services and
support services. Offering services outside these times will help to increase accessibility for some
potential clients.

There is the possibility that the discrimination in health services not only reduces the control people
have over their own lives; it also reduces access to services and compromises the effectiveness of
services. It is important to remember that no matter how free of prejudice professionals may be, it
may still be rational for LGBT clients to have expectations of inequitable treatment because of a
history of such treatment9.

                                                                                                       24
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6.2 Recommendations
The following recommendations were derived from the findings:

GP and Primary Care

      It is essential to improve accessibility and appropriateness of mainstream services.
      Mainstream health care providers should revisit diversity training to ensure that it raises
      awareness of how to effectively meet the needs of LGBT people, given that 42% of
      respondents had not disclosed their sexual identity to their doctor, and 78% of transgender
      respondents were offered no relevant information, with 57% saying their needs were not fully
      understood.

      Health and social care staff should be equipped with the skills to work more sensitively with
      their LGBT patients, and adopt a standard of care to ensure that all LGBT people are treated
      fairly , appropriately and respectfully. Health and social care professionals should be trained
      to focus on the health issues that specifically relate to LGBT people.

      Mainstream health care providers should review EVERYTHING YOU ALWAYS WANTED TO KNOW
      ABOUT SEXUAL ORIENTATION MONITORING... BUT WERE AFRAID TO ASK,        a practice guide to
      monitoring sexual orientation commissioned by NHS North West, aimed at the public sector
      carrying out monitoring of staff and service users.

Mental health and well-being

      Services need to target LGBT people specifically for lifestyle issues, i.e. smoking; alcohol and
      drug use. Treating service users holistically will ensure appropriate and effective signposting
      and service delivery with better health outcomes for individuals. An assessment of lifestyle
      issues at the time of other assessments for risk taking behaviours, e.g. sexual risk taking,
      should be integrated into pathways.

      Increase access and availability to mental health (i.e. counselling) support. Promotion should
      target positive mental well-being across LGBT communities given that 80% of respondents
      experienced mental health issues, with 29% having suicidal thoughts. Assessments of
      clients’ mental health needs could usefully be integrated into any assessment of their sexual
      health need, with robust signposting and referrals pathways identified.

      Younger LGBT respondents report higher levels of eating disorders and self harm and
      identification of these additional issues need to be worked into individual risk assessments

25
Kingston upon Thames LGBT Needs Assessment

      when working with this group.

      To combat bullying and heteronormactivity, integrate awareness of LGBT rights and health
      and well-being issues into school education. This can be delivered by including LGBT specific
      resources and signposting and including an LGBT element into general health and well-being
      literature.

Sexual Health

      With 26% of MSM having 5+ sexual partners in the last 6 months, and 35% having 2 to 4
      sexual partners, and 12% of MSM HIV positive there are is clear evidence of sexual health
      risk taking behaviour. A one to one behaviour change intervention for high risk MSM,
      designed along NICE guidelines for effective interventions could benefit this group.

      Sexual Health Promotion needs to be targeted at lesbian and bisexual women as well as gay
      men, recognising that they may attend different services to MSM. Service providers should
      develop practical strategies that narrow the gap between an understanding of safer sex and
      actual practices. It is important to identify, develop and disseminate sexual health information
      aimed at lesbian and bisexual women as well as for MSM

      Targeted work with the 40% of MSM who use hook up websites or apps to meet other MSM.
      This could be via online outreach (Netreach).

      Local LGBT specific services are perceived to be very limited. LGBT specific health
      promotion in popular venues where LGBT people socialise can raise the profile of the local
      LGBT groups and services, and also increase awareness of LGBT health and well-being.

      Integration of HIV testing availability into general activities such as saunas, clubs and groups,
      and faster test results offered.

      Condoms and lubricant are sought outside the borough currently but could be made more
      readily available to Kingston residents via sexual health services and 24s condom scheme,
      both of which were praised by respondents.

      Raise awareness of local LGBT groups and services with LGBT people and other
      mainstream services; develop and strengthen service networks in-between. This can be
      achieved through many different methods including allowing general health promotion with
      LGBT representation and distribution into mainstream outlets/services.

Service Access and integration
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