Drugs, alcohol, smoking, depression, self-harm, suicide, domestic abuse, body image issues, eating disorders and cancer risks – when Stonewall put a finger on the pulse of Britain’s gay and bisexual men, it diagnosed a heap of trouble.
And the survey of 6,861 respondents across Britain (making it the biggest study of it’s kind in the world) had another depressing conclusion. Rather than tackling these issues head-on, health services are often overlooking gay and bisexual men, or even actively discriminating against them.
As the UK’s leading lesbian, gay and bisexual campaign organization, Stonewall has the ear of the government. When its chief executive, Ben Summerskill, talks of ‘grave concerns’ and ‘stark messages’, ministers listen.
What Stonewall’s Gay and Bisexual Men’s Health Survey and it’s previous study into lesbian and bisexual women’s health in 2008 indicates is that massive change is needed in the way health services look at gay people and deliver services to them.
The problems are many.
Smoking, alcohol and drugs
A massive 67% of gay and bi men in Britain have smoked, compared to just half the average male population and a quarter of gays are doing it right now. They also drink more regularly.
But the biggest difference is in the number taking drugs. Half of gay and bisexual men have used illegal drugs in the last year, compared to just 12% of men in general.
And these are not isolated findings. A Home Office-funded study two years ago reached similar conclusions and Stonewall’s research into gay and bi women also indicated they were five times more likely to have taken drugs.
Despite this, much of Britain’s drug-prevention, alcohol abuse and smoking cessation messaging is squarely targeted at heterosexuals.
‘The gay scene is predominantly lead by pubs, clubs and bars which don’t necessarily lead to a healthy lifestyle,’ James Taylor, Stonewall’s senior health officer told Gay Star News.
‘Public messages around drinking, smoking and drug taking simply don’t reach them because they are not targeted at them. The no smoking message that “smoking doesn’t attract you to the opposite sex” doesn’t resonate with gay men and lesbians.’
While Dr Sean Cummings of Freedomhealth sees the effects of drug abuse for himself.
‘Very many of our patients have an issue with drug use and very many lose their lives because of it,’ he told us.
‘The reasons for this are quite complex. Gay men are said to be wealthier and better educated than comparative straight men so it seems strange to end up with patters like greater smoking and neglect of their health.’
And the link between these issues and other health problems was clear to the men completing the Stonewall survey. One of them, ‘Carl’, aged 27 and from north west England, commented: ‘Gay men’s culture seems to revolve around getting pissed as often as possible which often then seems to lead to increased drug and tobacco use as well as increased risk of sexually transmitted infections and violence.’
Traditionally gay and bisexual men’s health promotion has focused on sexual health. But even here Stonewall’s research indicates that success is not unlimited.
A quarter of the men they surveyed had never been tested for a sexually transmitted infection and 30% had never had an HIV test.
‘These figures raise grave concerns about the effectiveness with which hundreds of millions of pounds of public money have been spent on HIV awareness and prevention in recent years,’ the report says.
The most common reason for not testing is an assumption that they are not at risk. But a third say they have not tested for HIV because they have not had any symptoms – even though early testing, diagnosis and treatment before symptoms occur is clearly linked to better long-term outcomes.
Others say they haven’t been offered tests, that they don’t know where to go, that the clinics are intimidating or that the testing process is off-putting.
Several people in the Stonewall survey made the link between early sexual education and later problems.
And ‘Trevor’, aged 18, demonstrated in his response that this is not a problem from the past: ‘In school we experienced very little sex education and none of the sex education we did receive mentioned or related to same-sex relationships.’
Depression, suicide and self-harm
Only 0.4% of men in general have tried to take their lives in the last year but 3% of gay and bisexual men have attempted suicide. And the figure is even greater – 5% – for bisexual men or gay and bisexual black men and those from other UK ethnic minorities.
Worse still, one-in-10 young gay and bisexual teens, aged 16 to 19, have attempted to take their own life in the last year, according to the survey.
One 20-year-old from Scotland, ‘Kevin’, told Stonewall: ‘There was a lot of homophobia in my family. I was around 16 and knew I was gay.
‘When my father was drunk he told me that if I ever came out he would pretend to respect me yet would be always laughing at me behind my back. It was comments like those that made me so disgusted with who I was that I was suicidal for a lot of my youth and I suffered mental issues that only now are starting to be resolved as I grow older and more proud of who I am.’
Self-harm is also more common with the survey highlighting men who have cut themselves or swallowed pills or objects.
The gay population is far more likely to self-harm over all and an incredible 21% of 16 to 19-year-old gay and bisexual men have done so in the last 12 months.
At all age ranges, levels of depression and anxiety are far higher with sufferers in the survey citing causes like bullying in school and at work or, in the case of a 72-year-old respondent, feeling lonely in an isolated rural area.
Again, the survey highlights that health professionals don’t always handle these issues competently.
‘Omar’, aged 43, told Stonewall: ‘I was offered group therapy with a bunch of straight strangers, but on the understanding that “some of my issues may be too difficult to talk about in a group setting”.’
While 32-year-old ‘Neil’ said: ‘My therapist made a point of telling me he was straight after I came out to him and then ignored the issue completely.’
Here, at least, British health bosses have started to recognize the problems which is why the Department of Health has prioritized lesbian, gay and bisexual people in its Mental Health Strategy.
The government was also put under pressure this year to monitor the sexuality of suicide victims, with campaigners hoping this would force them to take that particular gay health crisis seriously.
And Britain’s health services have a lot of making up to do around mental health. In 2010 it was revealed by the Independent newspaper that the NHS was funding attempts to ‘cure’ gays of their sexuality.
Psychologists and psychiatrists around the world, including Britain’s leading professional healthcare bodies, have condemned this ‘ex-gay’ movement as at best pointless and at worst dangerous. But calls for the quacks carrying it out to be banned from practicing were dismissed.
For Stonewall, homophobia can often be a big factor in creating the conditions which lead to depression, suicide, self-harm and risk taking – including drug use and risky sex.
Taylor rejects the idea that all this means – as homophobes often claim – that the gay ‘lifestyle’ is unhealthy.
‘First of all it’s their prejudice that leads to this in the first place,’ he told us. ‘Being gay, doesn’t suddenly lead to you being depressed or taking drugs or alcohol.
‘Young people may have had no-one to turn to if they have been homophobic bullying and been ignored by their family. It can be years of homophobia that leads to people resorting to drink and drugs.
‘A lot of it does go back to the sorts of things you learn about at school. There is little real education in schools about looking after your wider health which is something our education department is picking up and trying to get the government to improve.’
Body image and eating disorders
Gay and bisexual men are more likely to be a healthy weight than their straight counterparts. Half the gay and bi male population has a ‘normal’ body mass index and that, in itself, is a real positive because 70% of British men on average are overweight or obese.
Despite this, gay and bisexual guys are actually less likely to do enough exercise – only a quarter work up a sweat on a regular basis, far less than the average for straight men – despite them being fatter!
Perhaps part of the clue lies in the fact that gay guys are four times more likely to be underweight.
Eating disorders and body image worries are more common among gay and bisexual men with people in the survey confessing to starving themselves and to feeling they can’t keep up with the pressure on them to have the perfect gay body.
Gay and bisexual men are not just three times more likely to have suffered from domestic abuse than the average for males, but are actually almost twice as likely to have been abused at home than women.
A massive 49% of gay and bi guys have been abused at home by a partner or family member at some time since they were 16.
The vast majority, according to the report, don’t report the problem to the police but, of those who do, a little more than half are unhappy with how officers respond to the problem.
One victim ‘Tony’, aged 33 and from the Midlands of England, told Stonewall: ‘The front line police officers know nothing about any domestic violence agencies for gay men.
‘It is very hard to talk to them about domestic violence and I was made to feel I was wasting their time. They didn't keep me updated, failed to deal with my complaint and didn't see that the arrest of my partner was important to me and that the delay in doing it added to my worry.’
The problems they face range from being belittled to being prevented from seeing family members, right up to being pushed, slapped, kicked or hit. In some cases the problems continue when they move out of their family home and move in with a partner and even go on when they change partners.
An unhealthy response
One of the main findings of the Stonewall report is that gay and bisexual men are being let down by the healthcare system.
This ranges from neglect of their health issues right the way through to outright discrimination.
A third of British gay and bisexual men who have used healthcare services in the last year have had a ‘negative experience’ because of their sexual orientation, says the study.
You only have to hear the story 40-year-old ‘Ralph’ told Stonewall to realize that some healthcare ‘professionals’ would be sacked even in a less sensitive job.
He said: ‘While having haemorrhoids removed and given that my rectal passage seems to be narrower than usual the practitioner said: “You're so tight. I can tell you’re not gay”. And while I was laying there I confirmed I am. Silence thereafter until I left.’
While ‘David’, aged 23, said: ‘I overheard the reception staff say to a nurse “the poof is here for his appointment”.’
Although there are plenty of good examples in the report too, it’s perhaps not surprising that people are more likely to be out to their friends, family, colleagues or manager than to healthcare professionals.
And all this could be one reason why nowhere near enough men are talking about important issues like heart disease or cancer.
Taylor said: ‘The fact we have one in three with a negative experience in the last year is quite shocking. While we have an NHS which is there for everybody and has a duty to treat everyone equally our research shows for many men that simply isn’t the case.
‘I think there are some really good trusts who are doing this stuff. There are lots who are now understanding sexual orientation in the workplace but that is yet to transfer into services.
‘We need to see the NHS engage a lot more with all lesbian, gay and bisexual people. We typically hear people who have been discriminated against won’t go and complain because they don’t know if they will be treated equally and don’t know what their policy is. They should all have a policy.’
But not everyone agrees the situation is quite so bleak.
The Department of Health agrees that all patients should get the best care from the NHS. But a spokesperson said: ‘The latest GP Patient Survey shows that 84% of gay, lesbian and bisexual respondents described their overall experience of their GP surgery as good.’
And Dr Cummings told us: ‘A great part of the NHS’s staff are gay. It may well be people simply aren’t getting what they want and simply interpret that as discrimination.
‘But as in all other walks of life there are homohostile and homophobic people working in the NHS.’
With this level of health inequality for gay and bisexual men – and similar results found for lesbian and bisexual women around drink, drugs, smoking and healthcare discrimination by Stonewall’s 2008 report – it is clear radical action and long-term effort are needed with everyone involved, from the government to hospitals and GPs, right the way down to the LGBT community and individuals being empowered and informed so they take responsibility for their own health.
The question remains whether the NHS is well placed to do this. Much of Britain’s power over health services is being devolved down to local level and that doesn’t help when it comes to developing best practice or targeted health campaigns for a large, but widely dispersed, gay population.
Taylor says: ‘It’s something they can’t afford not to do. Our top three recommendations are around training. We know that the majority of medical schools might have an hour or two in a five year program on lesbian, gay and bisexual issues and they are going to focus on sexual health. So those are the things we need to tackle.
‘As a public body, no matter what size the NHS trust or GP practice is, it has to abide by the equality legislation. If they have only got a few lesbian, gay and bisexual people in their community, it would be up for them to show how they have engaged with them. Everybody needs to be doing something.’