Many still face barriers to sexual health care

Tuesday, April 7th, 2009

A vital component of sexual health is access to health care, but barriers still exist for some looking for such services.

Marilyn Evans, assistant professor of nursing at Western, said numerous factors must be in place before young people will seek the help of a health professional, especially on issues about their reproductive health.

Students must feel they won’t be judged and, most importantly, that their visit is kept confidential.

Evans also said some women feel disempowered vis-a-vis health care professionals and unable to make decisions about their health.

Thomas MacFarlane, director of Western Health Services since 1987, said he’s never heard any complaints about the clinic’s staff. He said the quality of the staff’s performance is proven in the number of users: Health Services had 59,411 visits in 2005-06.

MacFarlane believes Health Services’ staff is sensitive to the needs of all visitors, noting “Our staff is encouraged and required to be non-judgmental in its approach.”

But barriers to health care need not involve outright discrimination explains Susan Knabe, lecturer in the department of women’s studies and feminist research.

“Some... barriers include assumptions of heterosexuality [for instance a focus on heterosexual sexual activity which makes it less likely for a person to come out, and therefore access appropriate care] and assumptions about sexual identity and sexual activity being synonymous.

“[For example, the] assumption that lesbians are not at risk for STIs because they don’t sleep with men " wrong on both counts, since some lesbians do have sex with men, and since there is female-to-female transmission of some STIs like HPV and herpes,” Knabe said.

Knabe said other barriers include a lack of regular access to health care " many lesbians don’t get regular screening like paps, pelvic exams, or mammograms " because they don’t routinely visit the doctor for birth control.

She added lesbians are at higher risk for some cancers because of other risk factors.

“Breast cancer is associated with not having been pregnant, obesity, smoking " all higher factors in the lesbian population on average,” Knabe cited as an example.

Out-right homophobia is problematic, as it still exists in some health-care situations.

“This also operates as a barrier, both in terms of that specific interaction, but also in terms of making [lesbians, gays, bisexuals and transgendered] people less likely to access health care in the future because of this and therefore putting their health at risk,” Knabe said.

Walking into a health-care setting takes courage on the part of someone who is transgendered, says Greta Bauer, assistant professor of epidemiology and biostatistics at the Schulich School of Medicine & Dentistry.

Some physicians won’t see transgendered individuals for routine medical services based on a concern about adequate training to meet transgendered needs.

“One recently completed needs assessment of transgender and two-spirit people in Manitoba and Northern Ontario found that over 20 percent of trans people had relocated to find trans-competent health care,” Bauer says.

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