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How to fix LGBTQIA+ healthcare inequities: Lessons from PrEP
Health PrEP Lesbian

How to fix LGBTQIA+ healthcare inequities: Lessons from PrEP


During my final year of medical school, a doctor advised me to hide my sexuality once I qualified.

It confused me - how could we make the NHS inclusive for LGBTQIA+ patients if it wasn’t even safe to be out at work?

I had mentioned my (female) partner in passing and this doctor warned me coming out would be a mistake. “The nurses will gossip and your life will be hell”, she said.

It felt like bad advice. I’ve rarely followed it. Sometimes, though, it’s easier not to correct colleagues.

Like the surgeon who advised me a surgical career wouldn’t “suit my husband and children”. It didn’t feel like a good time to announce my lesbianism, so I let it go.

These experiences aren’t the norm - 99% of my colleagues have never been anything but accepting - but they still stick with me.

If LGBTQIA+ NHS staff aren’t always able to be themselves at work, how can we expect patients to feel services are inclusive?

Many LGBTQIA+ people report prejudice and discrimination, which leads some to avoid seeking help.

Inequalities exist in many areas, especially when you look at the unique needs of different parts of our community.

Lesbian and bisexual women are more than twice as likely to have never had a smear test than women in general. 40% of trans people report negative experiences in healthcare settings.

There are inequalities in alcohol intake, physical activity levels, mental health, access to end of life services.

Aphra Luchesa joins Junior Doctor strikes
Aphra Luchesa joins Junior Doctor strikes

It can feel daunting, but I know change is possible. The campaign for PrEP (HIV pre-exposure prophylaxis) demonstrates how public engagement can bring about huge change.

The dedication of activists, research participants, healthcare professionals and scientists led to the enormous milestone of PrEP being made available for free in England in 2020.

We should take inspiration from these successes to tackle other inequalities.

Listening to patients ensures that services can be more inclusive and barriers surmounted. For example, the Trans Gap Project is asking the community to help shape grassroots research on trans healthcare, so that important issues can be identified and addressed.

Though it’s all the press seems to talk about, LGBTQIA+ healthcare is not limited to just sexual health or gender-affirming care.

We will likely all need the NHS at some point, whether it be for cancer treatment, having a baby, or for that strange rash that Google hasn’t helped to identify.

I take solace that we can tell the health service what changes we need to see, and that - as PrEP shows us - that kind of change is possible.

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