People who identify themselves as Le***an, Gay, Bisexual, Trans-gender (LGBT) remain invisible to many communities in Uganda as well as many other developing countries. In Uganda these groups are estimated at being as 1 to 1.25 million of every population. However, in spite of that ratio, people who identify as LGBT experience many health disparities as compared with the general population. This arises as a result of specific needs that are different and most important also as a consequence of social discrimination and social isolation.
Many of our healthcare providers still have no formal education or training in dealing with issues concerning LGBT health. This also includes a lack of training that is focused on how to provide more culturally safe care and to help these people meet their specific clinical and other health needs. Most important at the national level, there are significant gaps in policy and research that make the development of comprehensive LGBT’s strategies more difficult.
About Us Uganda there of strives to meaningfully advocate for a recognition and incorporation of specific needs and perspectives of this community in our frame-work and among the activities of health care organizations and policy makers dealing with LGBTs in Uganda. To attain this About Us Uganda has an LGBT Advisory committee, whose work is to engage with health care groups and policy makers in Uganda. It should be categorically put into context that the Government of Uganda cannot realize its HIV/AIDS campaign objectives while continuing to marginalize the LGBT community. This is because LGBT individuals are within every part of our society and beyond.
Our objectives are:
To advocate for change within the community-governed primary health care sector to produce a more accepting environment for members of LGBT communities.
To advocate for the facilitation of increased access to existing resources for those wanting to understand more about providing services to LGBT communities.
To help support a network of providers in community-governed primary health care settings through knowledge, skills and capacity building that will enhance the delivery of care to LGBT clients. Primary health care that is delivered by culturally competent providers trained in working with diverse LGBT issues.
To advocate for health and safety of the LGBT through training and counseling for foster disclosure so as to enable them to fight social stigma due to discrimination and empower them to demand safe practices to reduce their exposure to risks of infections and physical abuse. LGBT people are at increased risks of certain health conditions due to the effects of social isolation, discrimination, poverty and gaps in the health care system. These are always reluctant to come out due to concerns about their safety.
To address common health disparities among LGBTs that may include mental health and substance use, to***co use, certain cancers, body image and nutritional issues, musculo-skeletal problems, STIs and the uptake of screening procedures (Institute of Medicine, 2011).
About Us Uganda therefore believes that, for meaningful systems of planning, and accountability, there MUST be direct engagement of the LGBT themselves so as to explicitly take their needs and perspectives into account in conjunction with other types of marginalization.
For that to be attained our recommendations are:
About Us Uganda recommends that Patients First Proposal (Model) be adopted because it highlights and embeds the importance of health equity as a key element for health system transformation. Because LGBT individuals are within every part of our society, they require a specific focus in planning and accountability to ensure they are not invisible within the system. To facilitate this, the Ugandan Government through the Ministry of Health can implement an intersectional approach to understanding health equity and equity-seeking groups.
It is of significant importance to point out that people who identify as LGBTs are within every part of our society and beyond. The issue of their invisibility is especially relevant as many community members are not recognized as such and are often assumed to be straight. Healthcare workers are always reluctant to ask about sexual orientation and gender identity, thinking that there is something shameful about being LGBT or because they themselves are uncomfortable. This extends to the entire national healthcare system.
About Us Uganda recommends that the context of asking about sexual orientation and gender identity by health care providers, confidentiality should be assured, this will build confidence for LGBTs leading to openness and disclosure. Hence forthwith helping to mitigate health disparities among LGBTs and consequently improve health outcomes.
Further more we recommend “An intersectional lens” approach which will ensure health system planners, funders and providers do not let anyone fall through the cracks of the system and address the complexity of people’s experiences. The Ministry of Health can bench mark with Association of Ontario Health Centres (AOHC) where an evidence-based Inter-sectional Based Policy Analysis Framework has been developed, which can support the Ministry of Health and Long-Term Care and other health system stakeholders in using an intersectional lens in their work.
Instead of living in denial about the existence LGBT individuals with in our communities, it is important that our health system and providers recognize that their health needs are more than just sexual health. The whole person’s needs must be conceptualized so as to be appropriately addressed. As a result, culturally competent primary health care workers will need to be trained so as to understand and deal with, LGBT people and their families who have distinct needs that require care by a range of knowledgeable and culturally competent health care providers. In About Us Uganda this network competent primary health care providers is in formation. However, additional training and support is needed.
The biggest challenge in Uganda is that LGBT health is often viewed through the narrow lens of sexual health or HIV – for example in public health programs. However, the full range of physical, mental and emotional support is required to be put into context.
Trans care needs to be a core function of primary care. According to the World Professional Standards of Care for Transgender Health, most services for transgender health should be provided in primary care or community settings (Coleman et al, 2011). These services commonly include support for trans people and their families, hormone treatment for some, supportive counseling or group programs.
Lastly there is need to put into consideration by government a socio-demographic questions requirement into context. Where it would be consistent to carry out a census so as to understand and plan based on population needs, the LGBT data gap must be filled from the ‘bottom up’ until population-level data becomes available. Finally, Local Health Integration Networks (LHINs) will need to conduct assessments of the health and social service needs of LGBT people and the adequacy of generic services in their regions or sub-regions.
All the above when implemented, the system will help to improve health equity and reduce health disparities and will improve LGBT’s health and wellbeing.
