Planned Parenthood Toronto serves youth ages 13-29 across the City of Toronto. A number of our programs specifically support lesbian, gay, bisexual, trans, and queer (LGBTQ) youth.
About the author: Planned Parenthood Toronto
Planned Parenthood Toronto is a community health agency serving the needs of youth in Toronto. We provide accessible and inclusive programs and services that promote healthy sexuality and informed decision-making. Our interdisciplinary health team offers primary, sexual and reproductive, and mental health information, services and programming for youth ages 13 to 29.
Through workshops ranging from birth control options to healthy relationships to anti-homophobia education, we give underserved communities of youth the knowledge and skills to make healthy choices. We also offer Teen Health Source, a sexual health information service run for and by youth. We conduct innovative community-based research projects on the sexual and reproductive needs of youth, and we share this knowledge with youth, service providers and academic communities in order to improve the lives of young people in Toronto.
We have a long history of engaging LGBTQ youth as volunteers in anti-homophobia education through the Teens Educating and Confronting Homophobia program, through which we bring anti-homophobia education to over 3000 youth in Toronto each year. We have also been running peer-based sexual health programming for LGBTQ youth since 2012 when LGBTQ youth emerged as a priority population based on a needs assessment conducted by the agency.
It’s been well documented that people who identify as Lesbian, Gay, Bi or Queer (LGBQ), particularly LGBQ youth, face numerous health challenges and barriers to accessing health services.
One barrier to accessing health services that LGBQ people report is a lack of knowledge around non-heterosexual sexualities among service providers, including those who may be well-intentioned. Assumptions around sexual behaviour or relationship status, inappropriate questions, or unsuitable referrals are all common experiences reported by LGBQ people when they access health care services. A negative experience in a clinic might discourage individuals from accessing further care, particularly preventative care. When word of these negative experiences spreads among members of the LGBQ community, it can also lead to a broader culture of distrust of the health care system. By ensuring that service providers have the language, skills, and tools required to create an affirming and inclusive environment, we can help make sure the needs of LGBQ clients are met and that people feel safe accessing the services they need.
As a health service organization that works closely with LGBTQ communities and has built expertise in this area with the support of our staff, volunteers, and clients, Planned Parenthood Toronto is ideally positioned to support other service providers in building this knowledge.
Homophobia, biphobia, transphobia, and other intersecting oppressions impact access for LGBQ people in areas including education, housing, and employment. LGBQ people may also have reduced social networks and fewer sources of individual support as a result of oppression and social stigma. These barriers may lead to high levels of stress, financial instability, reduced service utilization, and social isolation: all of which can negatively impact health.
LGBQ people may be less likely to engage with health services as a result of these structural barriers and experiences of oppression. This lack of access to appropriate health services and supports can also have a detrimental impact on health and wellbeing for LGBQ people.
The above issues have particular implications for sexual and reproductive health. Sexual behaviour is influenced by a number of factors beyond sexual attraction. Why we have sex, when we have sex, who we have sex with, whether or not we use protection, how we feel about the sex that we’re having, our ability to negotiate consent: all of these factors are influenced by the oppressions we experience, the stressors in our lives, and the supports we are able to access.
When attempting to access both physical and mental health services, LGBQ people experience numerous barriers. Many sources of health information are geared towards straight people and fail to acknowledge our identities and experiences. With most health care providers receiving no mandatory training on sexual diversity, they may come to their work with misinformation or biases that impact service provision. Even well-intentioned health care providers make heterosexist assumptions about their clients and the services they require. Bisexual people might further experience biphobia or monosexism, even when accessing health services known for their work with lesbian and gay communities. Our relationships and families may not be recognized by these health care providers as legitimate, which can negatively impact our access to support systems when receiving care. LGBQ-positive clinics may be difficult to access, particularly for individuals living in rural areas or requiring specific services or treatments. Our negative experiences in health care systems, as well as the negative experiences shared among our communities, may make LGBQ people anxious or unwilling to access care. Individuals may avoid preventative care in particular, only accessing health services when an issue escalates or a health emergency occurs.
Based on negative experiences attempting to access health care, many LGBQ people are distrustful of mainstream health care providers. As a result, LGBQ people may avoid health care services. When engaging with health care providers, LGBQ people often feel required to act as educators, correcting misinformation and providing appropriate resources. This can be incredibly difficult to do when sitting on an exam table. Fearing homophobia, heterosexism, biphobia, or monosexism, LGBQ people may also choose not to disclose their sexual orientation or sexual behaviour to their health care providers.
Some health care providers are homophobic, heterosexist, biphobic, or monosexist, carrying their personal biases into their work. Their information on LGBQ communities may be limited, outdated, or based on stereotypes. Some health care providers are well-intentioned, but don’t know how to communicate this to clients who may be LGBQ. Other health care providers and clinics are known specifically for their positive work within LGBQ communities and, as a result, are in high demand.
LGBQ people may specifically try to work with health care providers who have established relationships with LGBQ communities, learning about them through informal or formal referrals. Unfortunately, based on the generally high demand for health care providers and the specific demand for LGBQ-positive health care providers, individuals may encounter long waitlists or service provider unavailability. LGBQ-positive health care may be particularly difficult to access for people living in rural areas, people requiring the care of a health care specialist, or people experiencing intersecting oppressions. As a result, LGBQ people might only access health care in emergency situations or not at all. The absence of ongoing care, including regular screening, means that health issues might go unrecognized or untreated, negatively impacting long-term health.
Given the barriers to income and employment experienced in LGBQ communities, these struggles are exacerbated for those attempting to access services without adequate health insurance coverage. This can include individuals not covered under the public health care plan where they live, individuals who require treatments not included in their coverage, and individuals attempting to access alternative treatment options.
One of the biggest barriers LGBQ people experience when accessing health services is the erasure of our identities. Whether dealing with medical texts, health resources, intake forms, or health care providers, the assumption that all patients are straight is rampant. Even when heterosexuality isn’t treated as the default sexual orientation, many health care providers assume that they can identify a patient’s sexual orientation either by the way that they look or the information that they’ve provided on an intake form.
The conflation of sexual orientation and sexual behaviour also complicates access to care. A person who identifies as gay may be having sex with people of the other sex, a person who tells their health care provider that they’re having sex with people of the same sex might identify as straight, and a person assumed to be either gay or straight might be bisexual. To have a complete understanding of a person’s identity and behaviour, a health care provider needs to explicitly ask for both.
Even knowing a person’s identity and behaviour, health care providers may make assumptions about the kinds of care that LGBQ people want and need. While a few tests or treatments might be specific to a person’s sexual behaviour, almost none are specific to a person’s identity.
LGBQ communities have a long and complicated history with health services, which has included the erasure of our identities, pathologizing our bodies and experiences, treatment without consent, disrespect and abuse. As a result, health care providers must make a particular effort to create affirming health care environments and to understand and meet the needs of each LGBQ client that they see.
While there are many challenges, solutions do exist. Here are some possible scenarios and suggestions to help build positive relationships for healthy bodies, healthy communities and healthy partnerships.
If clinic hours are restricted to regular work hours, getting care might involve losing a much needed paycheque.
Solution: Offer evening and weekend hours, if possible. Provide clients with the ability to receive information and support via phone or e-mail.
Particularly in a hospital setting, it might also mean seeing multiple health care providers in a short period of time. Not knowing if your health care provider will know or respect your identity can be extremely anxiety provoking, particularly in a highly stressful time.
Solution: If you are a health care provider, ask for standard training on LGBQ identities for all staff. Ensure that your clinic/hospital has a clear equity policy that explicitly includes LGBQ people and is available to both staff and clients. Ensure that the language you use to ask about or describe somebody is inclusive and accessible (for example, don’t assume the gender of their partner(s) or their relationship status). If you hear a health care provider using homophobic or heterosexist language, whether or not they are with the client at the time, challenge it.
Emergency health care settings may place restrictions on which support people are allowed to travel with the client, visit a client during particular hours, or make decisions on behalf of the client. These restrictions might not recognize families or support networks other than heterosexual married/partnered couples. A visiting partner might be asked questions such as, “What is your connection to the patient?” or “Are you his brother?” Clients attempting to access support networks beyond their partner might experience additional challenges, as our chosen families are often not viewed as legitimate.
Solution: Avoid making assumptions about who a person’s supports are, following their lead in identifying who is present. Foster discussions with the person receiving care, helping them to identify who they consider a part of their support system. If possible, revise restrictive visitor policies: for instance, modifying a policy that says only a partner or spouse may be present to indicate the maximum number of people allowed at one time, instead.
An emergency call could result in forced treatment or hospitalization. While this challenge may be relevant to anybody, it carries particular weight for LGBQ people, many of whom have had negative experiences in health care settings, including histories of treatment without consent.
Solution: If the person you’re calling on behalf of is able to provide consent, get it. If the person doesn’t consent, or you think they might not, consider whether calling 911 is the best or only available option in that moment. Consider whether it is possible to contact that person’s regular health care provider or an LGBQ-positive clinic instead.
As above, LGBQ people often don’t have their relationships and support networks acknowledged or validated in health care settings. If your relationship to the person in crisis is not recognized or legitimated, you may be unable to follow them to provide support or even receive updates on their health.
Solution: As the person calling 911, identify that you have a relationship to the person requiring care and that you would like to stay with them for as long as possible. Ask the person requiring care who else they would like to be contacted and what information they would like shared. If you are not able to stay with the person, ask where they are being taken and how you can contact them.
Services are often located in urban centres, making them difficult to access for people living outside of these areas. LGBQ people might choose to travel long distances in order to receive services in an affirming environment. Many people don’t have ready access to transportation—whether it’s because public transit is unavailable in their area, physically or financially inaccessible, or will take too long. As such, we may be faced with the choice to either not access help at all or to access it in an uncomfortable environment.
Solution: Develop services that individuals can access more conveniently. This can involve improving the LGBQ-inclusivity of the health services that exist in a community through training, resources, a presence at LGBQ community events, and physical markers indicating inclusivity (such as a statement of inclusion or rainbow poster). It can also involve developing health services that people can access online or by phone.
While online resources can provide valuable information and support, an internet search can also lead us to a lot of inaccurate and potentially harmful health information.
Solution: Develop lists of LGBQ-positive online resources, asking LGBQ people which resources and tools we’ve found most helpful. Make these resources publicly available, and share them with clients in health care settings.
If an LGBQ person needs to see a health specialist or access testing, referrals and requisitions are often required. These services can then be very difficult to access either for LGBQ people without a doctor, or with a doctor who is unwilling to provide appropriate support. A homophobic or heterosexist doctor might deem the assistance/testing/support/tools or resources the LGBQ person is requesting to be unnecessary or inappropriate and, as such, deny access. For example, a woman having sex with other women might be told that she doesn’t need a pap test because her sexual activity is deemed “low risk”.
Solution: As a health care provider, trust your client to be the expert on their own health. Ask which referrals they are looking for and provide them whenever appropriate. If you feel like a requested referral is inappropriate, discuss this assessment with your client and provide appropriate alternatives. If a client is unsure of what support or referrals they might require, provide options and do further research where required.
Every doctor, nurse, therapist, lab technician, or administrative staff is another person whose views and biases we don’t yet know and who we may be required to explain or justify ourselves to. As such, we may delay or avoid accessing the supports that we need in order to avoid these encounters.
Solution: Provide consistent training on LGBQ identities for all staff interacting with patients in a health care setting. If you work in a health care setting, avoid making assumptions about clients’ identities, experiences, or needs. Make it clear in all materials, including online resources, that yours is an affirming environment so that clients feel safe visiting or asking for a referral.
If these posters and materials only acknowledge straight identities, it can be difficult for an LGBQ person to know whether their identity will be recognized and supported.
Solution: Ensure that a wide variety of materials are on display, using resources developed within LGBQ communities where possible. It can be helpful to post a rainbow sticker at the front of the clinic, but remember that this support is symbolic. Representation and inclusion also have to also be carried through the rest of the clinic’s materials and practices.
For example, an intake form might ask about a person’s sexual orientation in order to understand the types of sex the person is engaging in.
Solution: Wherever possible, intake forms should use either open response fields or checklists with a range of options and an “other” field in questions about sexual orientation, so as not to limit options. If knowing a person’s sexual orientation and/or sexual behaviour is clinically relevant, don’t conflate the two. Ask only for the information that is required. As a client, fill in the information that you feel is relevant, even if it isn’t included on the form. Use the back of the paper! Don’t feel that you have to share any information you’re not comfortable with.
While this might mean that the clinic is well equipped to meet an LGBQ person’s needs, it might also mean that a person accessing the space has to worry about running into people they know while they are waiting. Concerns about confidentiality might prevent a person from accessing the space.
Solution: If a client is worried about their confidentiality, offer them a private waiting space (such as an empty clinic room) where available. In printed materials and conversations with clients, make it clear what that clinic does to ensure client confidentiality.
If a person has recently come out or their sexual behaviour has changed, they are faced with a decision either to come out or withhold this information—a decision that could potentially impact treatment.
Solution: As a health care provider, don’t assume any aspect of a person’s health or experience is stable. Ask about a person’s identity and experience at every appointment, where relevant. As a client, decide in advance what information you’re willing to share with your health care provider.
As a result, an LGBQ person might worry about whether the health care provider will maintain their confidentiality—particularly regarding issues of sexual orientation or behaviour. Again, this might impact how much information a client chooses to share.
Solution: Health care providers should be aware of their legal and ethical obligations to maintain privacy, regardless of who they are working with. If you are a client and feel like your privacy won’t be maintained, consider asking for a referral to another provider.
Solution: It can be more difficult to challenge homophobia and heterosexism in people the people that we know than in strangers. If you are a client and your health care provider says something that offends you or makes you uncomfortable, consider whether you want to confront them in the moment or whether you would rather follow up later via phone or e-mail. If you would rather not follow up with the health care provider directly, ask about the organization’s feedback or complaint mechanisms. If you feel like the health care provider’s behaviour violates their professional standards, also consider contacting the professional organization with which they are affiliated.
LGBQ people risk being discriminated against by employers and may be precariously employed, with an inability to take time off. They may feel like paid employment is more crucial to their wellbeing that follow-up care, particularly if they deem the level of care unnecessary or excessive.
Solution: As a health care provider, work with your client to decide what level of care is necessary and avoid scheduling more appointments than are necessary. If follow up can be done remotely via phone or e-mail, make that option available. Offer flexibility in scheduling, including evening and weekend appointments slots where possible.
The LGBQ person might feel like their health care provider has been homophobic, heterosexist, biphobic, or monosexist, while the health care provider might assume that the client is simply being unreliable by not following up.
Solution: As a health care provider, consider why a client might not be following up with you. Is it possible that you did something to create an uncomfortable environment? Contact the client to ask what is preventing them from accessing follow-up care and ask if there is anything you can do to make the environment more comfortable for them. If you are the client, consider contacting the clinic to explain why you are not accessing follow-up care and asking for a referral to another service provider.
Knowing how can be a challenge.
Solution: If you are an LGBQ person who wants to share what you’ve learned with others, look to see if any health care or health advocacy organizations in your area are looking for volunteers. Share information within your social network and online, so that other LGBQ people looking for sexual and reproductive health information can access it.
Sometimes the biggest challenge is that LGBQ people fear and have experienced stigma in clinical settings to such an extent that they simply don’t access health care at all. Improving health care for our communities first means making sure that we’re even coming through the door. By meeting LGBQ communities where they’re at and providing affirmative, responsive care, health care providers can help improve access and health outcomes for LGBQ people.
Some LGBQ people use names or pronouns other than the ones indicated on their health identification. When a client comes in, ask how they would like to be addressed and make sure that this is clearly marked in their file.
An accessible and welcoming space is one that demonstrates inclusivity throughout, not just by pasting a rainbow on the front door. This includes representing LGBQ identities in posters, resource materials, policies, staffing, and conversation with clients.
Identities are intersectional. Being truly accessible to LGBQ communities involves considering other forms of access. Is your clinic anti-oppressive, physically accessible, reachable by public transit, or open outside of regular business hours? If not, this may be impacting access for LGBQ people.
Wherever possible, use either open response fields or inclusive lists with an “other” field on intake forms, allowing clients to write in their responses. This is particularly important around questions of sexual orientation and gender identity, where responses may be more nuanced and individual than a checklist allows.
Don’t assume that you can tell a client’s sexual orientation by the way that they look. Also don’t assume that an existing client’s identity, sexual behaviour, or partner(s) haven’t shifted since their last visit.
Remember that sexual orientation and sexual behaviour are different. A client might be having sex with people of the same sex and identify as straight, or identify as gay but be having sex with people of the opposite sex, or identify as bisexual but not be sexually active.
During intake meetings or assessment interviews, identify yourself as being LGBQ-positive. This can support clients’ sense of safety and self-disclosure.
Only ask for information about a person’s sexual orientation, behaviour, or partner(s) if medically relevant. Otherwise, allow the client to disclose if/when they choose.
Having a visible presence at community events such as Pride can help a health care provider develop a positive reputation within the LGBQ community.
If you make a mistake and/or sense that you have made a client uncomfortable, acknowledge what has happened. At the same time, don’t expect the client to act as your educator: their appointment is not the time for you to learn what it means to be LGBQ. Ask other health care providers, look online, read a book, attend professional development: do your own research.
While many assume that “homosexual” is the most polite term to use for lesbian and gay people, it is a term that has been used to criminalize and pathologize LGBQ communities. Health care providers who use the term may be unintentionally signalling a lack of cultural competency to LGBQ clients, deterring them from seeking care.
When speaking to a client, it’s best to ask them how they identify and how they would like you to refer to them.
When speaking more broadly, it’s best to use terms like lesbian, gay, or bisexual or acronyms such as LGBQ.
Many individuals identify as queer. Queer is an example of reclaimed language: while it was originally a derogatory term, many LGBT people have reclaimed the term and now identify with it. At the same time, this term doesn’t work for everybody: for some, it still has negative connotations. The term should only be used with clients who use it for themselves and have indicated that they are comfortable with you also using the term.
There is no one term that every LGBQ person feels represents them/their community. Be prepared to be flexible with language, changing the terms based on the client or context.
Rainbow Health Ontario, Service Directory
Rainbow Health Ontario, Service Directory links LGBTQ people with affirming health care providers across a range of disciplines.
Sherbourne Health Centre
Located in Toronto, Sherbourne Health Centre is particularly committed to working with LGBTQ communities.
LGBTQ Parenting Network
A program of Sherbourne Health Centre, the LGBTQ Parenting Network promotes the rights and well-being of LGBTQ parents, prospective parents, and their families and children through education, research, outreach, and community organizing. The LGBTQ Parenting Network has a number of handouts on various medical, legal, and social aspects of parenting, available online.
Click the number to dial on a mobile phone.