LGBT awareness in AAA screening training presentation

1. NHS Abdominal Aortic Aneurysm (AAA) Screening
programme
LGBT Awareness in AAA Screening

2. o What we mean by LGBT+ people
o Sexual Orientation and Gender Identity
o LGBT people and AAA Screening
o How can services be more inclusive
Aims:

3. A Quick LGBT History Quiz
How well do you know your LGBT
history?
Guess whether each date was higher (more recent) or lower (less
recent) than the last. Your starter is the year 1950…

4. Homosexual activity between two men (aged over 21 and in private) was
decriminalised in England.
Higher or lower than 1950?
Higher, this was the Sexual
Offences Act in 1967.

5. Gay, lesbian and bisexual personnel can serve openly in the armed
forces.
Higher or lower than 1967?
Higher, this has been part of
the Armed Force policy since
2000.

6. The NHS offered aversion therapy as a cure for homosexuality
Higher or lower than 2000?
Lower, this was offered until
1980.

7. Couples of the same sex can have legal recognition of their relationship
in the UK.
Higher or lower than 1980?
Higher, this was the Civil
Partnership Act in 2004.
Bonus point: What year did
same-sex marriage become
legal?

8. Equal age of consent for heterosexual and same-sex couples became law
in England and Wales. Before the age was equalised, it was 21 for LGBT
people and 16 for heterosexual people.
Higher or lower than 2004?
Lower, this came into law in
2001.

9. The repeal of Section 28 (prohibiting local authorities from promoting
“homosexuality” or gay relationships).
Higher or lower than 2001?
Higher, this was repealed in
2003.

10. The UK Government allows transgender people to change their legal
gender.
Higher or lower than 2003?
Higher, the Gender
Recognition Act was passed
into law in 2004.

11. What does LGBT+ mean?
o LGBT+ is an umbrella term
o Often used by people who identify as Lesbian, Gay, Bisexual or Transgender
o “+” inclusive of sexual identities and gender identities which are out of the LGBT acronym
o LGBT+ overarches many terms people use to identify their sexuality or gender
Tip: Access websites such as LGBT Foundation, Stonewall,
The Proud Trust, Mermaids for language glossaries and
definitions

12. Sexual Orientation
Sexual orientation refers to a person’s romantic and/or sexual attraction to another person.
Examples include:
Gay: Someone who is sexually, romantically or
emotionally attracted to people of the same gender
Straight: Someone who is sexually, romantically or
emotionally attracted to people of the opposite
gender
Bisexual: Someone who is sexually,
romantically or emotionally attracted to
people of more than one gender
Lesbian: A woman who is sexually,
romantically or emotionally attracted to
other women
Asexual: The lack of sexual attraction to
others, or low or absent interest in or
desire for sexual activity
Pansexual: Someone who is sexually, romantically or
emotionally attracted towards people regardless of
their sex or gender identity

13. Gender is often expressed in terms of masculinity and femininity, gender is largely culturally
determined and is assumed from the gender assigned at birth in a binary system: male or
female.
Examples include:
Gender
Transgender: An umbrella term to refer to all people
who do not identify with their assigned gender at birth
and/or the binary (male/female) gender system
Drag Queen: Usually a male who dresses in clothing
of the opposite sex and often acts with exaggerated
femininity for the purpose of entertainment or
fashion
Transwoman: Someone assigned male at
birth, but identifies as a woman
Drag King: Usually female who dresses in the clothing of
opposite sex and often acts with exaggerated masculinity
for the purpose of entertainment or fashion
Intersex: A general term for a variety of
conditions in which a person is born with a
reproductive or sexual anatomy that doesn’t
seem to fit the typical definitions of female or
male
Transman: Someone assigned
female at birth, but identifies as a
man
Non-binary: Someone with a gender identity that is
not exclusively masculine or feminine and may be
comprised of elements of either, both or neither

14. A person can change their sexual orientation and
or gender throughout their lives.
Both can be considered on a sliding scale, rather
than fixed.
Tip: Displaying the Genderbread
person (right) or the Gender Unicorn
(below) can give helpful reminders
on the difference between sexual
orientation and gender

15. Trans Status
o Transgender is an umbrella term; it refers to someone’s gender identity not sexual orientation
o Someone might identify as trans when they do not identify with the gender they were assigned/given
at birth
o Important to avoid assuming that trans = transitioning
o Some trans people choose to access gender reassignment treatment such as hormone replacement
therapy, chest reconstruction (top surgery), genital reassignment surgery (bottom surgery)
o Some trans people choose to access some or no gender reassignment options. They still identify as
trans and do not need to choose any of these options to validate their trans status
Transgender Man Transgender Woman Cisgender (Cis) Non-binary
Someone who was assigned female
at birth, but identifies as male
Someone who was assigned male at
birth, but identifies as female
Someone who identifies with the
same gender they were assigned at
birth
Someone with a gender identity that
is not exclusively masculine or
feminine and may be comprised of
elements of either, both or neither.

16. The importance of pronouns
o Pronouns are the gendered words we use to describe ourselves
o Such as he/him, she/her, they/them
o Pronouns can make up an important part of somebody’s identity
o These seemingly small identifying words can help in a person’s gender affirmation, to
feel respected and to feel valued as a person
o If you accidently misgender a person, apologise, and correct yourself, ensure to use
the correct pronouns for future

17. The importance of pronouns: Tips
Best practice is to;
o Ask – Ask each person which pronouns they use and make a note
o Respect – Respect their pronouns
o Practice – Practice to ask each person their pronouns and respect them
Use yourself as an example; add into email signature, twitter bio, name badge
etc. Helps to create an inclusive environment, familiar to ask, respect and
practice pronouns
o Become familiar that not everyone will use she/her or he/him pronouns
o Other pronouns may include;
o They/them
o Ze/hir
o Ey/Em
o Xe/Xem

18. Why do these labels matter?
Identifying within the LGBT+ umbrella can;
o Provide a sense of belonging
o Group similar people together
o Create a sense of identity
o Relate to others who have similar experiences
o Empower a sense of pride in their identify

19. Are there any disadvantages of
labelling yourself?
Labels can sometimes lead to;
o Discrimination from wider society
o Stereotypes and assumptions made based on these labels
o Feeling of being “put in a box”
o Can feel limiting and restricted
o Might cause confusion if you identify as multiple labels

20. o The Office for National Statistics estimated that 2.5% of the UK population aged 16 or above identified as lesbian,
gay, bisexual or ‘other’ (almost 1.3 million people) (2017)
o The Government Equalities Office estimates that there are between 200,000 and 500,000 trans men and trans
women in the UK (2018)
o All statistics are tentative estimates as sexual orientation or trans status is not routinely monitored in the UK
Being LGBT+ in the UK today

21. o National LGBT Survey (2018): Respondents were less satisfied with their lives than the general UK population,
scoring their life satisfaction on average 6.48 out of 10, compared to 7.66 for the general UK population.
o Trans respondents were less satisfied with their lives, scoring their life satisfaction on average 5.40 out of 10, than
cisgender respondents, who scored their life satisfaction on average 6.67 out of 10.
o 70% of respondents with a minority sexual orientation said they avoided being open about their sexual orientation
for fear of a negative reaction from others. The most commonly cited locations for this were on public transport
and in the workplace.
Being LGBT+ in the UK today

22. Why does this matter?
Health Inequalities for LGBT+ people
LGBT people are disproportionately affected by health inequalities such as;
o Higher rates of smoking
o Higher rates of drinking
o Obesity (also including evidence of eating disorders such as bulimia and anorexia in gay men)
o Less likely to visit GP within 7 days of noticing any symptoms mainly due to fear of being judged,
worries around “coming out” to the GP particularly if they are part of the older LGBT community
o Higher rates of mental health - anxiety, stress, low mood, low motivation to attend screenings

23. Trans Status and AAA Screening Invitations
Currently invitations sent to all patients registered as male at the GPs in the year they turn 65.
Transwomen and Non-binary people (assigned male at birth) registered as female at the GPs
o If have changed gender marker at the GP to female – will not receive invitation for AAA Screening despite having the
same risk as cisgender men
Consequence: Eligible people are potentially missing out on AAA screening, might lead to late diagnosis of aneurysms and
poorer health outcomes
Transmen and Non-binary people (assigned female at birth) registered as male at the GPs
o If have changed gender marker at the GP to male – will receive invitation for AAA Screening, however this is an
unnecessary invitation
Consequence: Patients attending for an unnecessary appointment, might lead to confusion and anxiety for the patient and
for the healthcare provider. Guidance – can opt out but then this involves a conversation disclosing their trans status

24. Trans Status and AAA Screening Procedure
o For a transwoman or a non-binary person, there may be a heightened sense of anxiety for the procedure
o May not be comfortable with exposing their abdomen
o May have a heightened sense of awareness around their chest area – worries that the screener may see or
ask questions around this area of the body
o AAA Screening is seen as a “male” procedure
o For transwomen and non-binary people, there may be concerns or anxieties of attending a “male” clinic
“I was attending for a smear test. Whilst sat in the waiting room, I
was asked three times, by three separate staff whether I was lost
as this clinic was for “women only”. I was so embarrassed. I had
to out myself in a waiting room full of strangers that I was a trans
man who still needed this screen.” [Transmale, 40s]

25. Fear of results
o Current demographic of eligible people may make up the Silent Generation (born between 1925-
1945) and the Baby Boomers (1946-1964)
o LGBT people who lived through the time where being gay was illegal, and could have serious
consequences with the law, family and friends
o More likely to still be secretive about their sexual orientation and/or their trans status, still have
concerns they can be prosecuted
o Might not have the “traditional” family support network
o Might avoid attending screenings such as AAA screenings as fear of a serious result or illness may
lead to a conversation around support, which they may not have due to increased likelihood of social
isolation and rejection from family
o May not want to disclose this to GP, Screener, Nurse etc. for fear of being judged or discriminated
against

26. What can services do to
ensure inclusivity?

27. Dignity and Respect
o LGBT people may have heightened anxieties attending appointment
o Fears around having to expose abdomen, attending a “male” clinic, worries about being judged, having to explain
their trans status
What changes can be made in the clinic environment to improve the patient journey?
Examples might include:
o Offering appointments at quieter periods, e.g. at the start or end of a clinic
o Offering to show patients around the clinic before appointments (if time allows during non-clinic hours)
o Having pre-exam discussions with the patient, giving them the opportunity to ask questions – build a relationship
between the screener and the patient to ease anxieties and to increase likelihood of attendance
o Visible LGBT inclusive signs/symbols around the clinic, on campaigns etc.

28. Language
o Use inclusive language, avoid heteronormative assumptions such as;
“partner” rather than assuming “husband or wife”
o Might attend with a partner – can ask “who have you brought with you to support you today?”
o Ask “how would you like me to address you?” – This question can be used for all patients
o Ask “what pronouns do you prefer?” (He/His, She/Her, They/Them, Ze/Zem)
o Ask “what is your sexual orientation?” rather than presume their orientation
o Ask what language would they prefer to use
o Amend demographic forms to include all gender identities and trans status such as;
“women including transwomen” “men including transmen” “non-binary” “other”

29. o Awareness of the needs of all patients that access the clinic
o Raises awareness of all staff that there are LGBT patients therefore reduces heteronormative assumptions
o Gives trans and non-binary patients the opportunity to discuss their screening needs, and ensure they receive the
appropriate invitations
o Healthcare practitioners can support trans and non-binary patients through the screening process – reduces the
risk of trans patients not being invited to screening
o Adds to the evidence base so research can be done to address LGBT+ needs; improve services and drive policy
changes
Monitoring of sexual orientation and trans status

30. o Ensuring a fair representation of the LGBT+ communities are visible; could include LGBT imagery on
noticeboards, local LGBT services advertised, supporting LGBT campaigns
o Staff wearing rainbow lanyards
o Rainbow imagery around public and private areas
o Trans imagery around public and private areas
o Using gender-neutral language on display boards
o Small, practicable steps which shows the practice is LGBT+ inclusive
o An LGBT+ patient is more likely to feel welcome, comfortable and less likely to worry about
prejudices and discrimination
Visibility of LGBT+ communities within the
practice

31. o Gives staff an opportunity to discuss their anxieties in a non-judgemental environment
o Staff become familiar with gender-neutral and inclusive language
o Staff will have the knowledge that anyone assigned male at birth should still be screened
appropriately
o Reduces risk of LGBT+ service users being turned away from screens
o Gives staff the confidence to explain why screenings are important if a LGBT+ patient
believes they do not need screening due to their sexuality and/or trans status
o Understanding about issues which the community may face
o Improve relationships with service users
o LGBT+ people are more likely to attend their screening if they feel they are in a safe and
welcoming environment
LGBT awareness training for all staff

32. References
o Department of Health, (2014), Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people, accessed at;
http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_
consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_078345.pdf (last accessed May
2019)
o LGBT Foundation, (2014), Are you ready for your screen test?, accessed at https://lgbt.foundation/screening
(last accessed May 2019)
o Macmillan, (2018), The Emerging Picture: LGBT people with cancer, accessed at;
https://www.macmillan.org.uk/_images/lgbt-people-with-cancer_tcm9-282785.pdf (last accessed May 2019)
o Macmillan, (2017), No-one Overlooked, accessed at
https://be.macmillan.org.uk/Downloads/CancerInformation/LivingWithAndAfterCancer/MAC15365LGBTNo-
one-overlooked--experiences-of-LGBT-people-affected-by-cancer.pdf (last accessed May 2019)
o Public Health England, (2018), Information for trans and non-binary people: NHS Screening Programme,
accessed at;
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/814364/S
creening_information_for_trans_and_non_binary_people.pdf