LGTBQIA : Important pointers for a safe and healthy sex life

lgbtqia

LGTBQIA: Let’s begin with the numbers

In the US alone, the LGBTQIA population is 11 million according to the latest report which saw an increase of 4.5 % in one year. According to a government survey done in the UK, 1 million people identified themselves as a part of the LGBTQ community, which is 1.7% of the entire population. That means 1 in every 50 persons belongs to this community in Britain. Nothing comprehensive is available to determine their population all over the world but one thing is clear that a number of people are coming out with their gender identities than ever before.

History as our witness, this entire community has been subjected to unfair laws and persecution time and again. They have been outcasted by society as abnormal or perversions of nature. Thankfully times are changing. More and more governments around the globe are accepting this community as a part of society. There are laws being made to protect their rights against oppression and unjustified scrutiny.

International Laws for LGBT+ community

lgbtqiaIn 2017, the United Nations came out with a human rights paper – Free & Equal: United Nations for LGBT Equality. It clearly states that the LGBTQIA community is protected under the United Nations Charter, The Universal Declaration of Human Rights (UDHR). It states that there are no hidden exemptions in any of the human rights treaties that the UN is part of that allows any kind of discrimination against people of different sexual orientation. No State can or should guarantee full rights to some and withhold it from a group of people depending on their sexual orientation.

Moreover, it states that it ‘unlawful’ to make any distinction in people’s rights depending on what their gender identities are.  This document clearly outlines the steps that the governments of the world should do to protect the human rights of the LGBT+ community.

  • Protect individuals from homophobic and transphobic violence and prevent torture and cruel, inhuman and degrading treatment
  • Repeal laws criminalizing homosexuality including all legislation that criminalizes private sexual conduct between consenting adults
  • Prohibit discrimination based on sexual orientation and gender identity
  • Safeguard freedom of expression, association and peaceful assembly for all LGBT people and ensure that any restrictions on these rights are not discriminatory on grounds of sexual orientation and gender identity

Several treaty bodies of the UN like United Nations Human Rights Committee, the Committee on Economic, Social and Cultural Rights, the Committee on the Rights of the Child, the Committee against Torture, and the Committee on the Elimination of Discrimination against Women have time again established UN’s position on this issue.

In the presence of such strong international laws and point of views, one would think that this community would be protected and their rights upheld. But the reality is far from this.

The hate continues

lgbtqia consentThere are still 71 countries in this world where same-sex relationships are banned. The penalty for same-sex relationships in some of these countries is the death penalty. In Afghanistan, Brunei, Mauritania, Yemen, Nigeria, Sudan, Somalia, Saudi Arabia, and Iran same-sex relationships are considered to be at the top of their crime list. In some other countries like Vietnam, Madagascar, and Venezuela, where there are no legal implications of being in same-sex relationships, society strongly and harshly denounces such relationships.

There are only 23 countries out of 195, where same-sex marriages have been made legal. It started with the Netherlands lifting the ban 18 years ago in 2000. India recently in 2018, repealed the archaic law decriminalizing same-sex relationships through the recognition for same-sex marriages is still pending.

Thankfully, in most parts of the world more and more people are getting aware of the injustice and societal isolation this community has had to face. Not only their social needs are being ignored but the primary health concerns of this community are stigmatized by making it an after effect of the so-called ‘unnatural sexual practices’. Centre for Disease Control in the US accepts the fact that “Members of the LGBT community are at increased risk for a number of health threats when compared to their heterosexual peers”. The website states that among other factors contributing to this fact, the primary reason is the “social and structural inequalities” that this community faces.

Most are not aware

When it comes to sex- ed, the same kind of discrimination is found in the curriculum. Even in the US population survey, there are no questions on sexual orientation or gender identities. That brings a huge gap in knowledge about the size of the population and their health needs. Most of the sex education modules restrict themselves to heterosexual humans. There is very little representation or illustrations of the LGBTQIA community found in the current material included in sex education.

lgbtqia female condomAs a huge step in integrating this community safely and lawfully, World Health Organisation changed ‘Gender Incongruence’ listing as a mental disorder to sexual health conditions category. In June 2018, WHO released the ICD or the International Statistical Classification of Diseases and Related Health Problems.  The document states “evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender”. It further recognizes the fact that there are significant healthcare needs of this community that can be best addressed if the stigma is removed.

The Office of Disease Prevention and Health Promotion (US Govt.) runs a 10-year campaign of collecting community data under the HealthyPeople campaign. Back in 2010, it realized that there is a need for more research to understand, document and address the factors contributing to the dismal health conditions of the LGBT+ community. In their campaign HealthyPeople 2020, eight different surveys are being conducted that will collate some substantial data on the sexual orientation of people.

The purpose of such an extensive data collection is to “enhancing efforts to improve LGBT health”. The benefits of these efforts have been stated by the health dept as:

  • Reductions in disease transmission and progression
  • Increased mental and physical well-being
  • Reduced health care costs
  • Increased longevity (for LGBT+ community)

A review done by a few medical practitioners in the US of the existing surveys and researches on LGBT+ community lists the kind of health risks the LGBT+ community is exposed to and why. It was published online on Cureus in 2017:

  • Mental health issues: The youth in the LGBT+ community are more prone to depression and suicidal tendencies. In a survey conducted in a school in Boston revealed that suicidal tendencies in kids identifying themselves as a part of the LGBT+ community is way higher than their heterosexual peers (30% vs 6%). This was attributed to the social isolation of homosexual children at the adolescent age by their classmates or the staff of the schools. They are subjected to regular bullying and violence that brings about in them an existential crisis.

A survey conducted in 2016 called the Youth Risk Behaviour Survey shows results that are shocking. 34% of the LGBT+ youth are subjected to severe bullying. 18% were subjected to forced sex and 23% were victims of sexual violence.

  • Cancer: Dejected and isolated, the youth of this community are more likely to get into substance abuse at a very early age. The youth of this community has been found to be at high risk of getting different kinds of cancer.
  • STDs: Members of the LGBT+ community are 2 times more likely to get infected by STDs. The possible reasons for this could be lack of awareness of safe-sex practices, premature sexual encounters, and multiple unknown partners.

Limited access to health care

lgbtqia condomsThere are systemic gaps and discrimination in terms of health services available to the LGBT+ community. They find it difficult to access healthcare and insurance services than their heterosexual counterparts. Insurance companies discriminate against the LGBT+ community and have different coverage policies for them. This makes it difficult for same-sex partners or spouses to access insurance claims.

The identities of members of this community are still debatable. Recently, in July 2018, one mainstream medical online publication Healthline in collaboration with GLSEN and Advocates of Youth in the US, came out with a safe-sex guide for the LGBTQIA community. A huge social media controversy erupted out of that because of the redefining of certain biological terms like ‘vagina’ as the ‘front hole’.

Subsequently, Healthline has published a lot of explanations for the reasons for using the terms that they have in the document but they have stood by their initial decision.

This document recognizes the fact that not enough is available as a guide for the LGBT+ community to ensure they don’t fall prey to the dangerous diseases that have become synonymous to their community. LGBTQIA Safe Sex Guide has tried to define the different gender identities and their preferred terminologies with respect to sexual practices and biological aspects. Few highlights of this guide are:

  • Sex and gender are different: It states that the sex determination of an individual at birth is not synonymous with the gender they identify with. These two words are often replaced for each other in conventional texts, however, gender is only to do with the behavioral or psychological aspects of people that define them.
  • Sexual orientation is just that: Sexual orientation has nothing to do with what sexual practices an individual indulges in. It only defines who an individual is attracted to romantically or sexually irrespective of whatever biological organs they might have.
  • Consent is important: It raises the crucial issue of sexual consent, which is not an exception just to same-sex relationships. The document states that “the absence of a no doesn’t mean yes”. It also points out that asking for consent at every stage of sexual interaction is important. This is extra important with respect to this community because of the less amount of biological or medical information available about the sexual practices in this community.

A guide to having safe sex

lgbtqia lubeIn 2016, researchers from Florida State University came out with a document detailing different aspects of safe sex for the LGBTQ community. It emphasizes the need for such a guide due to the lack of representation and awareness in this community. The document states that as a result of lack of information, the health hazards faced by this community are on a rise.

Avoiding unwanted pregnancy: While a person is going through Hormone Replacement Therapy, it is possible to get pregnant. Sperm production can continue despite increased levels of estrogen and ovaries can still release eggs without being on a menstrual cycle. There are ways of getting pregnant in a planned way. It is especially crucial for members of the LGBT+ community to plan pregnancy well because of the lack of benefits they get in certain societies.

Regular examination of certain parts: Though advised for heterosexual people as well, it is more essential to do these exams because of the hormonal or physical alterations that members of this community go through.

  • Breast Self Exam: The Florida Uni document ‘Healthy Bodies Safer Sex’ states that there is very less information on the breast health on Transgenders because of which most references are drawn from generic guides adapted from National Breast Cancer Organisation and American Cancer Society. These guidelines can be followed to exam any breasts including the ones which have been surgically enhanced or reduced. In the case of implants, the surgeon can be consulted on where the breast tissues start.
  • Prostate Exam: People with prostrates should get an annual exam done, especially people who are over 50 years of age. The examiner checks for any abnormality in the rectal cavity particularly in the prostates.
  • Testicular Self Exam: People with testicles should do a monthly self-exam by checking their testicles for any smooth bumps, hard lumps or any discoloration in the testicles.
  • Cervical Exam: People can contrive STDs or HPVs irrespective of the kind of sexual behavior they have. This exam is more essential for people who are altering their cervix either by creating one or by removing it.

 

Protection to be used

For safer sex in generic terms also, it is advised that some kind of contraception be used. For the members of the LGBT+ community, it is more essential because of the health hazards faced by them.

  • External Condoms: Trans women who haven’t gone through any surgical changes can use this on their genitalia. It is used mostly for penetrative sex and is readily available. The user should check external condoms for expiry or any damage.
  • Internal Condoms: This is useful for people who are not comfortable with external condoms. The only type of condom should be used at a time. Since this is placed in the vaginal cavity or cervix it is often latex free and can be used with any water or oil based lubricant.
  • Dental Dams: These are usually used for oral sex. It is usually placed on the vaginal opening, clitoris or anus. There is a misconception in a lot of people that STIs can be transmitted only through penetrative sex however that is untrue. It is essential to use protection during oral sex too as STIs could spread through cuts or wounds.
  • Capes: Trans men who haven’t gone through any surgical changes can use capes as the conventional external condoms usually don’t come in their sizes. A cape can be made out of a normal hand glove.

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