Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Normal?
- Julian Kennedy (24 October 2003)
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Mind your language
- Elwyn Davies (24 October 2003)
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Re: Professional?
- Christopher Anton (25 October 2003)
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What Price My Daughter Then?
- Tony Floyd (25 October 2003)
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Nomenclature gone mad !
- Scott Davison (26 October 2003)
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Young men having sex with men, condom use and road traffic accidents
- Marc SHELLY, Cécile Gendre, David Moreau, Ulla Møller Hansen and Dominique Bertrand (26 October 2003)
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Well said...
- Alison Mynett (27 October 2003)
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…..MORE COMMON IN WOMEN WHO HAVE SEX WITH WOMEN?
- Kirsti Malterud (27 October 2003)
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Re: Normal?
- Dr.Jameel Rahman (27 October 2003)
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Re: Young men having sex with men, condom use and road traffic accidents
- Marc SHELLY, Cécile Gendre, David Moreau, Ulla Møller Hansen and Dominique Bertrand (27 October 2003)
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Unhelpful stereotypes
- Louise Theodosiou (28 October 2003)
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Cancer in women who have sex with women (WSW)
- Morten Frisch (28 October 2003)
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Clinical facts
- Dale M Gilbert (28 October 2003)
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Lesbian identity and behaviour
- Jessica M. Robbins (30 October 2003)
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Lesbian health inequalities
- Julie Fish, Jeanelle de Gruchy (30 October 2003)
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Editorial consistency
- Hugh A Fleming (30 October 2003)
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What's in a name?
- Justin S Varney (31 October 2003)
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Re: What Price My Daughter Then?
- Dr Julian Kennedy (1 November 2003)
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Re: Re: Professional?
- Dr Julian Kennedy (1 November 2003)
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Re: Re: What Price My Daughter Then?
- Adam Jacobs (3 November 2003)
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Re: Normal?
- Simon C Dursley (4 November 2003)
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Cervical Screening for Women Who Have Sex with Women
- Julietta Patnick, Catherine M Davison (5 November 2003)
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A simple solution
- Joseph Joseph (6 November 2003)
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Women in prisons
- A.A.W. AMARASINGHE, M.D. (6 November 2003)
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Screening and opening the door
- Justin S Varney (6 November 2003)
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Re: Re: Re: Professional?
- Peter M Rodgers (6 November 2003)
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Re: Normal?
- Ber Doherty (9 November 2003)
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Homophobia in Medicine: Ten Years on And Still Much Work To Do
- Rita Das (9 November 2003)
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I'm Normal
- Bryan S Connor (12 November 2003)
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Lesbian GUM services and lesbian sexual health needs
- Clare Farquhar (18 November 2003)
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lesbians and homosexuals
- manan vasenwala md, mrcp (uk) (20 November 2003)
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Women who have sex with women – further health needs
- Emma K Robinson, Yvonne Young (21 November 2003)
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Towards a Healthier LGBT Scotland
- Alastair E Pringle (24 November 2003)
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Julian Kennedy, doctor Bournemouth
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It maybe normal in your view and that of modern society but according the Creator it most certainly is not...Romans 1:26-27 (excuse the dated language but you will get the gist) ' For this cause God gave them up unto vile affections:for even their women did change the natural use into that which is against nature:and likewise the men, leaving the natural use of the woman,burned in their lust one toward another; men with men working that which is unseemly,and receiving in themselves that recompense of their error which was meet.' All the sequelae of homosexuality are the sad result.
Competing interests: None declared |
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Elwyn Davies, GP Cheddar Medical Centre, Roynon Way, Cheddar BS27 3NZ
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Hughes and Evans' editorial deals with an unquestionably important issue fully deserving its place in this week's BMJ. Their insistence, however, on using the full version of the term 'women who have sex with other women' throughout the article was at best clumsy and at times quite comical. There were paragraphs which seemed almost entirely composed of the expression. One function of language is to make distinctions between categories and concepts entirely clear and I fully understand the authors' wish early in the piece to establish a difference between lesbian identity and same sex activity. Language should also, however, be easy on the eye and mind. Surely the point was that sex between women, whether of lesbian identity or not, is associated with special risks. Surely, once the key distinction between identity and behaviour had been made, some other variant could have been used to avoid the endless repetition. Competing interests: None declared |
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Christopher Anton, Personal Birmingham
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Dear Editor There has been much comment this week of the perceived lack of professionalism in the police force because even though it is supposed to reflect society and will contain racists, they seem unable to surpress these views whilst 'on the job' and behave in a professional manner. I suggest that Dr Kennedy is behaving in a similar way and such comments are unprofessional. I shall have to remember never to need emergency treatment in Bournemouth. Also it seems strange that unthinking evangelicals never seem to progress beyond 17th century versions of the Bible. Competing interests: None declared |
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Tony Floyd, Medical Student Newcastle University, Newcastle Austraila
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In the Response entitled 'Normal?' above dated 24th October it has been made unequivocally clear that homosexuality is JUST NOT ON and a quote from Romans is given. One clearly must not question that the scriptures are meant to be taken literally and applied to everyday life. Questions I would like addressed include: Exodus 21:7-11 states that I am allowed to sell my daughter as a slave. How old should she be and how much should I charge? Exodus 35:1-3 states that anybody working on the Sabbath will be put to death. When working in a hospital, should I just turn off my pager and lie low, or am I also required to turn off any life support machines before I leave? On whom is it encumbent to put to death all the staff who do choose to work? Leviticus 15:19-24 instructs that any menstruating women are regarded as unclean and if I was to touch one I would have to bath, wash all my clothes and still regard myself as unclean until the evening. Obviously I could not go near another patient whilst 'unclean'. I could use the spare time to petition the Hospital Board to build the separate wing to house all such afflicted female patients and staff. We could call it the 'Ward of the Unclean'. Deuteronomy 25:11-12 states that you must amputate the hand of a wife that attempts to break up a fight the husband is involved in. If a patient attacks me, and a female colleague intervenes, does this apply? Should I at least have one of her fingers cut off? Deuteronomy 22:5 also forbids any form of cross-dressing. I don't know what sort of Medical Student parties you might have witnessed but I can tell you that such flagrant disregard for the scriptures does occur. Should these students be stoned to death? I am glad you raised this important topic rather than be distracted by the genuine health needs of the population addressed by Clare Hughes and Amy Evans. I'm sure there are countless other examples of health professionals going about their job and yet failing to apply bible passages literally. Stone them! Competing interests: None declared |
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Scott Davison, GP Crystal Peaks Medical Centre
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I eagerly turned to page 939 to find out what this new sub-genre of sexuality was. Imagine my disappointment when I learned that it was in fact one of those occasions (that happen increasingly frequently), where someone has taken it upon themselves to re-name something, utterly unnecessarliy, in an attempt to inject some cachet. Maybe I'm missing something, but surely "sexually active gay women/sexually active homosexual women/sexually active lesbians" would all have served the same purpose. I look forwards to reading articles on the special needs of "men who sometimes have sex with men and sometimes have sex with women" AKA bisexual men (sexually active!), and any other connotations. Please can the editorial team be more critical when accepting these new terminologies of dubious benefit? This is the BMJ, not Marie Claire! Competing interests: None declared |
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Marc SHELLY, AREMEDIA 59 boulevard de Strasbourg 75010 Paris, France and Centre de Dépistage Anonyme et Gratuit,, Cécile Gendre, David Moreau, Ulla Møller Hansen and Dominique Bertrand
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An editorial in the last week’s BMJ reviews the specific health needs of women who have sex with women .1. Also, numerous studies during the last decade, but none in France, have highlighted an oversuicidality among young men having sex with men (MSM).2.Yet, the relationship with sexual (or other) risk-taking behaviours was unexpectedly not investigated up to now. Within the framework of an exploratory study conducted among young people attending a French annual festival aiming at solidarity with persons living with the HIV, we found a significant difference (p<0.05) in the prevalence of lifetime (at least one) suicide attempts when comparing young MSM with their heterosexual (HS) peers (30% vs. 5.5 %) . These first data on French youth are very similar to those from larger representative studies conducted in other developed countries. 2. Data were collected from 368 young people mainly living in the Paris area, by means of an anonymous computer-assisted self-administered questionnaire. Among male participants (45%; mean age = 22.5 [SD=8]), those reporting having started their sexual activity (84.6%) were divided in men having sex with women only (HS = 67.5%) and MSM (17.1%). Because of the major selection bias related to the study’s setting, MSM are over-represented i.e. at a similar level (18%) as in young men attending the French HIV counselling and testing centres ..3 MSM were compared on the basis of condom use with casual partners (at unknown risk), as this variable might be associated with lifetime suicide attempts. Although not reaching the significant level, probably because of the MSM sample’s lack of power, a relationship between suicidality and sexual risk-taking behaviour was strongly suggested: among MSM “regularly” using a condom we found 20% suicide attempts vs. 60% among those “never or irregularly” using it (26.3% were condom non users vs. 31% among MSM under 24 y.o. living in the Paris area, according to a recent French national study .4). In addition, when compared with HS, MSM seems to be over-involved (50% vs. 20.3%) in repeated (more than two) road traffic accidents (RTAs). Among HS, there is no obvious relationship between a “regular” vs. “never or irregular” condom use and repeated RTAs rate (14.6% vs. 16.6%). Among MSM “regularly” using a condom, only a slight difference appears in repeated RTAs rate when compared with their HS counterparts (20% vs. 14.6%). MSM “never or irregularly” using a condom have a threefold-enhanced rate of repeated RTAs (60 % vs. 20 %) when compared with MSM “regularly” using it. However, the differences between the groups were not significant. In the current context of the “relapse” and the sexually transmitted infections (STIs) recently raising among MSM – and taking into account that RTAs today represent in developed countries the first leading cause of mortality and morbidity among youth (15/24 y.o.), especially males – these preliminary results, if confirmed by future larger representative studies, suggest the need for more global strategies in risk and harm reduction targeting young MSM regularly involved in HIV/STIs risk-taking behaviours. Finally, repeated risk-taking at different behavioural levels (e.g. sexually as well as on the road) could be interpreted as hetero and/or self-aggressive acts working as anti-depressant. Financial support: Direction des Affaires Sanitaires et Sociales and Caisse Primaire d’Assurance Maladie de Paris. 1 Hughes C., Evans A., Health needs of women who have sex with women , BMJ 2003;327:939-940 .[Full Text] 2 Bagley C, Tremblay P., Elevated rates of suicidal behavior in gay, lesbian, and bisexual youth (review), Crisis. 2000;21(3) :111-7 [Pubmed] 3 Adam, P., Hauet E., Caron C., Résultats préliminaires de l’Enquête Presse Gaie 2000, INVS/ANRS/DGS, 2002 [www.invs.sante.fr] 4 Brouard C., Gouëzel P., Laporte A., Desenclos JC., Free and anonymous counselling and testing sites in France : who attends and why ?, paper presented at the 14th International AIDS Co Competing interests: None declared |
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Alison Mynett, Anaesthetic SHO Royal Sussex County Hosp., Brighton
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Here, here Tony Floyd. I do believe that the underlying ethic of Christianity is essentially good but seems to fall down when narrow-minded bigotry and old-fashioned values are perpetually brought to the fore. Whilst on bible quotes, my favourite goes something like this: 'let he without sin cast the first stone'. How about looking at ourselves before casting aspersions about other's behaviour. Of course, working in Brighton, gay capital of the UK, you'd be stoned for having such archaic views, so don't come and work here if you have! Competing interests: None declared |
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Kirsti Malterud, Professor MD PhD Section of General Practice, University of Bergen, Norway
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The health needs of lesbian women clearly deserve more attention. I strongly agree to Hughes & Evans’s statements about the importance s for healthcare providers to understand that lesbianism is within the normal range of sexual behaviour, and to reduce perceived and actual prejudice in medical settings. However, the editorial seems to neglect some essential methodological problems related to the epidemiology of lesbian health, by listing up conditions where lesbians are supposedly at special risk. The Solarz Report from the Institute of Medicine (1) reviewed empirical research about physical and mental health in lesbians. The report concludes that lesbians are vulnerable for the consequenses of specific psychosocial pressure related to marginalisation, and that the health care system do not provide sufficiently culture sensitive care for women who have sex with women. Apart from this, no conclusions can yet be drawn about the relative risk or prevalence of breast cancer and other disorders in lesbian women. As long as we representative population based samples where people give an honest answer to the question of sexual orientation are not available, quantitative comparisons between lesbian and heterosexual women cannot be accomplished or justified (1). I am surprised that the BMJ editor did not question the methodological assumptions underlying the epidemiological conclusions drawn from the studies referred to in this editorial. More research is needed within this field, rather than reforwarding epidemiological myths about lesbian health. 1. Solarz AL, ed. Lesbian Health – Current Assessment and Directions for the Future. Washington DC, National Academy Press: 1999. Competing interests: None declared |
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Dr.Jameel Rahman, Physician, Al-Ain Military Hospital UAE Al-Ain, Abu-Dhabi, UAE.
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Dear Sir, I fully endorse the views of Dr. Kennedy. It is rare to read and listen such comments in this hip hop world. We have changed the definitions of human behaviour under the pretext of modernism and liberalism. We have won technologically but are in drains on social front. Though it should have been the work of sociologists and social scientists to steer our society, but I strongly believe that owing to the invariable health risks, we as healthcare providers should take the lead, in at least warning our society of impending perils. We have replaced words like wife and husband by 'partners', children by 'offsprings',and almost deleted the word 'marriage'. We have legalised abnormal bahaviours in the name of personal rights and personal freedom. And as the population essentially responsible for all this mayhem lies in age range of under 40s, so in other words the mature views of our thinkers/philosophers have been hijacked by the inexperienced thrill seeking youngsters. Let our society behave human than animals. Let us not encourage abnormal sexual behaviours. Sex is the name of immense pleasure, hence blinding. Yes human, but needs reigns. If we go the way we are,we shall become a race, technologicaly advanced but animals in behaviour. May be we lose the sanctity of brother and sister, father and mother. It is the time to act, NOW. Dr. Jameel ur Rahman FCPS, MRCP(UK) Competing interests: None declared |
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Marc SHELLY, AREMEDIA 59 boulevard de Strasbourg 75010 Paris, and Hôpital Fernand-Widal (AP-HP), Cécile Gendre, David Moreau, Ulla Møller Hansen and Dominique Bertrand
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Editor- In our letter entitled " Young men having sex with men, condom use and road traffic accidents " (26 October 2003), the second paragraph was unfortunately truncated : " we found a significant difference [(p<0.05) in the prevalence of lifetime (at least one) suicide attempts when comparing young MSM with their heterosexual (HS) peers (30% vs. 5.5 %) . These first data on French youth are very similar to those from larger representative studies conducted in other developed countries. 2.]” Thanks for precision
Competing interests: None declared |
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Louise Theodosiou, SpR Child Psychiatry Winnicott Centre, 195-197 Hathersage Rd, Manchester
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I was interested to read the editorial on women who have sex with women, and also in the various quotes that were presented to justify the depictions of these women. Firstly we hear of unstable self harmers who are undoubtedly confused about their sexuality and everything else, and then fat chain smoking beer drinkers. If the BMJ is wanting to address homophobia through the unusual route of reinforcing stereotypes can we expect an article on the healthy lesbian vegetarian cyclists who co-parent their children and frequently hold down valuable jobs in the caring profession, or would that be seen as a ‘medicalisation of the lesbian state’. Competing interests: None declared |
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Morten Frisch, Senior investigator, MD, PhD, DSc Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen S, Denmark
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As correctly pointed out by Clare Hughes and Amy Evans, health care needs among women who have sex with women (WSW) are an underprioritized area of research and public attention. Their editorial in this week's BMJ is therefore welcome. The statement, however, that WSW represent 'a group at greater risk of developing particular cancers than their heterosexual counterparts' lacks empirical support in the literature. Recently, in what appears to be the only population-based cohort study on the subject (1), little support was found for this widely and long held belief. Findings among 1614 Danish women who registered in homosexual partnerships in Denmark during 1989- 1997 and who were followed for cancer over 6656 woman-years showed that being part in a registered homosexual partnership is not associated with increased cancer risk at any site. It may well be that cancer risks differ between WSW who formally register their relationship and WSW who do not register, and between WSW who live in countries like Denmark with a comparatively liberal attitude to the broad and expanding spectrum of sexual relationships between consenting adults and WSW living in areas with less tolerant attitudes. Therefore, although not supported by available empirical evidence from population-based data, high-risk WSW groups may exist. At our current level of understanding, however, there is no convincing empirical evidence to maintain that WSW in general represent a high-risk group for cancer. If high-risk groups of WSW exist, this must be due to factors that increase cancer risk independently of sexual preference, fantasies, behavior or identity. 1. Frisch M, Smith E, Grulich A, Johansen C. Cancer in a population- based cohort of men and women in registered homosexual partnerships. Am J Epidemiol 2003;157:966-972. Competing interests: None declared |
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Dale M Gilbert, Student of Theology Liverpool, L17 8UQ
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That's what I would expect in the BMJ - clinical facts. Instead, we see the rant of yet another Christian who feels that facts are less important when it comes to the Bible. Typically, Romans 1:26-27 is used, proclaiming that God is against homosexuality (even though it is evident within nature). It's great how you see the same passages repeated over and over again, yet there are others that remain without mention because it would show how hypocritical some Christians are. How about Matthew 6:5-7 5 And when thou prayest, thou shalt not be as the hypocrites are: for they love to pray standing in the synagogues and in the corners of the streets, that they may be seen of men. Verily I say unto you, They have their reward. 6 But thou, when thou prayest, enter into thy closet, and when thou hast shut thy door, pray to thy Father which is in secret; and thy Father which seeth in secret shall reward thee openly. 7 But when ye pray, use not vain repetitions, as the heathen do: for they think that they shall be heard for their much speaking. Doctor, do you jump into a closet to pray or do you join others and pray in public? I'm sure this is one passage that you conveniently ignore or can explain away that this isn't what God really wants. Let's not even go into the eating of prawns, the wearing of man-made fibres etc. How many of these do you do but ignore your scriptures. I'm glad I live no-where near this individual (and the others who like to quote the Bible verses that suit their opinions) as I wouldn't like to rely on him to help me since he's so wrapped up in his own opinion rather than medical facts! Christianity is a fantastic theory - loving each other. But this has no place within a discussion of women's healthcare in a professional medical journal. It's about time Christianity evolved into a modern day religion. Let's face it, it wouldn't be the first time the rules were changed to suit the times (Council of Trent comes to mind). Competing interests: None declared |
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Jessica M. Robbins, Public Health Epidemiologist Philadelphia Department of Public Health, Philadelphia, PA, 19146USA
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While the article is useful, its lead-in is misleading. "The term 'women who have sex with women' describes sexual behaviour while lesbian is a term that describes sexual identity.However, sexual identity does not necessarily predict sexual behaviour —most lesbians have a history of sexual intercourse with men." The fact that most lesbians have a history of sexual intercourse with men, often prior to recognizing or establishing a lesbian identity, does not contradict the proposition that sexual identity predicts (future) sexual behavior. While there are clearly women who identify as lesbians and continue to have sex with men, it is probably misleading to suggest that this is normative. Most women who identify as lesbians do not currently have sex with men. Healthcare providers who assume that they do risk offending their lesbian patients. Competing interests: None declared |
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Julie Fish, Lecturer, Health and Life Sciences De Montfort University, Jeanelle de Gruchy
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We welcome publication of the editorial concerning the health needs of women who have sex with women in this week’s BMJ. The article is important for two main reasons. First, by raising awareness about lesbians’ distinctive health needs it may contribute to increasing the visibility of lesbians in debates about health policy. To date, health policy makers have largely overlooked lesbians’ health concerns: the Tackling Health Inequalities agenda makes only a one word mention of lesbians as service users. This is at a time when the reduction of health inequalities is moving up the policy agenda of the UK government - evidenced in a raft of interventions following publication of the Acheson report – however lesbian (and gay men’s) health issues are not included in any of the 39 recommendations for action (c.f. Gordon et al. 1999). This is noteworthy when some of the evidence presented considers inequalities in breast and cervical screening uptake which Hughes and Evans draw attention to as being of concern for lesbians. By contrast, in the USA, lesbians and gay men are included among groups targeted for reducing inequalities in health outcomes in the US government’s public health strategy: Healthy People 2010 where sexual orientation is specifically included in 29 objectives (Meyer, 2001). Second, the article aims to counter the lack of awareness among health professionals, which may affect the delivery of quality health care to lesbians by ill informed advice and missed opportunities for the prevention of illness. We would however argue strongly that any attempt to redress lesbian health needs to start with a recognition of heterosexism – discrimination arising from the assumption that everyone is heterosexual - within society and the NHS. Heterosexism is evident in history taking; nursing assessments; giving advice about sexual practices; keeping of records; access to information and in the lack of recognition of partners as next of kin (the latter may be changed under the proposed civil partnerships legislation). This conflicts with the values of practice, enshrined in Tomorrow’s Doctors, of care for patients without prejudice, respecting diversity of background. This is crucial for patient satisfaction and improved health outcomes. A recent national study – The Lesbians and Health Care Survey – of over 1000 lesbians living throughout the UK (Fish 2002), found that communication and values were rated as important provider characteristics. Bigoted and judgemental attitudes, typified by the response to the editorial of Dr. Kennedy (Rapid Response: Normal? 24 Oct) violate patients’ rights to dignity, can lead to malpractice by health professionals, poorer health outcomes and increased health inequity. They should find no place in a modern NHS. Fish, J. (2002). Lesbians and Health Care: A National Survey of Lesbians' Health Behaviour and Experiences. Unpublished PhD, Loughborough University. Gordon, D., Shaw, M., Dorling, M. D., & Davey Smith, G. (1999). Inequalities in Health. The Evidence Presented to the Independent Inquiry into Health Inequalities chaired by Sir D. Acheson. Bristol: The Policy Press. Meyer, I. H. (2001). Why lesbian, gay, bisexual, and transgender public health? American Journal of Public Health, 91(6), 856-859. Dr. Julie Fish
Dr. Jeanelle de Gruchy
Competing interests: None declared |
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Hugh A Fleming, Retired 12 Barrow Road, Cambridge CB2 2AS
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Dear Sir, Editorial consistency Long retired, I cast my eye at your first editorial on 25th October entitled,” Health needs of women who have sex with women” solely to see if my ignorance of modes of transmission might be met. Having read it I was little the wiser but I did note that the phrase, “women who have sex with women”, was repeated rather a lot. Over twenty times in fact! This occupies several inches of valuable space. Surely the editor should have tidied this up, perhaps even introduced an abbreviation. On the other hand Stephen Lock’s important contribution is pushed into second place and unduly shortened. Incidentally it does contain the abbreviation “COPE” which is nowhere explained in the text. Perhaps the present editors should try a little harder. Yours sincerely Hugh A Fleming Competing interests: None declared |
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Justin S Varney, SpR Public Health South East London Public Health Network
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I strongly welcome the BMJ editorial on women who have sex with women, it marks a shift in editorial policy in the UK which acknowledges the growing recognition of the health needs of the lesbian, gay, bisexual and transgender community. The comments on the term 'women who have sex with women' raises interesting memories from the classification of gay men into gay men and 'men who have sex with men' or MSM for short. The MSM trend was driven by the health surveillence profession who felt that by using the term gay, individuals felt excluded or did not relate to the term, yet were still engaging in same sex intercourse and hence needed to be included in statistics. I support the efforts of the authors to acknowledge that not all women who have sex with women will identify as lesbian, nor will those that identify as lesbian all be exclusively same sex in their partner choices. However the term MSM or WSW has only a place in statistics, the community has fought hard to win recognition and acceptance and for individuals to be able to stand up and say 'i am a gay man' with self awareness and confidence. Rebranding sexual identity for a community that has fought hard to establish an identity may not be a welcome move. 'i am an WSW' would be unlikely to mean anything to anyone outside the surveillance sheet and does not reflect anything other than the sexual act where sexual identity extends well beyond what happens in the bedroom and while the term may have relevance for the minority for the majority it stands the risk of undermining their identity as lesbians and dykes. A lot of debate has raged on this list, illustrating the terrifying homophobia present in the medical profession, yet I admire the bigotted for their readiness to stand up and admit their views. At this years BMA conference a proposal was made to make racism a disciplinary offense for medical students and doctors in training and I would be keen to see the BMA pushing this foreword to include all type of discrimination in line with both EU and UK legislation. From December this year when the sexual orientaton bill comes into force, discrimination such as the above may well become illegal and if displayed in the workplace would be subject to disciplinary proceedings. Finally to the epidemiological studies. It is widely acknowledged that research into sexual orientation minorities is difficult, individuals have to feel comfortable to admit sexual preferences and to then go on to admit further health risk or percieved deviant behaviour is an additional hurdle. Whether there are true pathologies associated with same sex intercourse as an act is debatable, however there is significant work done around the psycho-social aspects of homosexuality and the impact of 'coming out' and developing a sexual identity that is percieved differently from the norm during adolescence. The repeal of Section 28 will hopefully allow schools and youth workers to start to redress this imbalance and bring support and acceptance to a new generation. Medical schools would also be wise to start intergrating LGBT and other diversity issues into the agenda and the RCPsych SIG into LGBT Mental Health have already started to develop such a learning tool for medical students. For those of us past schooling it is important to recognise that homosexual individuals may percieve barriers actual or real which prevent them accessing services and to look at their own practice to make it LGBT friendly. In the UK the Gay & Lesbian Association of Doctors & Dentists have published guidelines for Dignity at Work which were taken up by both the BMA and the GMC and in the USA the equivalent organisation has provided a document (1) which helps agencies to look at their own services and think about the LGBT need. As we enter the new millenium it is time that medicine in the UK stopped being about white, able bodied, heterosexual men and started to recognise that the communities we live in have value in their diversity and the challenges that come with them can be worked together and overcome. 1 Gay and Lesbian Medical Association. Clinical guidelines: creating a safe clinical environment for lesbian, gay, bisexual, transgender and intersex clients. Available at: http://www.glma.org/medical/clinical/lgbti_clinical_guidelines.pdf (accessed Apr 2003). Competing interests: None declared |
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Dr Julian Kennedy, Staff Grade A/E Wessex First Aid Limited,BH7 7BD
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It is pointless quoting Old Testament verses to poke fun at evangelical Christians who believe that Scripture is God's word. God has worked and continues to work under different dispensations and we are now in the New Testament era and are not bound by statutes given to Old Testament Israel and it is from Jesus and the New Testament that we get our morality for today.Romans 1:18-29 and 1 Corinthians 6:9,10 make it abundantly clear that homosexual practices are immoral and those who indulge in them face the consequences which may well be damaged health-so from a preventative stance what we say has sense. Competing interests: None declared |
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Dr Julian Kennedy, Staff Grade A/E Wessex First Aid Limited,BH7 7BD
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My professional integrity and ability are totally independent of my religious convictions and it is mischievous to suggest otherwise. Competing interests: None declared |
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Adam Jacobs, Director Dianthus Medical Limited, London SW19 3TZ
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Dr Kennedy seems to quote rather selectively from the Bible in order to justify his homophobic prejudices. Leaving aside Old Testament mentions of slavery, shellfish, and bacon sandwiches, if he had carried on reading 1 Corinthians beyond Chapter 6, he would have come across a passage admonishing us 'For a man indeed ought not to cover his head' (1 Corinthians 11:7). Now, correct me if I'm wrong, but doesn't the Pope generally wear a hat when seen in public? For all I know, Dr Kennedy may be a supremely gifted biblical scholar, but let's face it, who am I going to believe when it comes to how much notice we should take of the instructions in 1 Corinthians? Dr Kennedy or the Pope? If Dr Kennedy had carried on reading Romans past Chapter 1, he might also have come across 'Therefore thou art inexcusable, O man, whosoever thou art that judgest: for wherein thou judgest another, thou condemnest thyself; for thou that judgest doest the same things.' (Romans 2:1). Competing interests: I own several hats. I am also rediscovering the joy of bacon sandwiches after recently emerging from 17 years of vegetarianism. |
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Simon C Dursley, Trust Secretary Royal Bournemouth Hospital BH7 7DW
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The comments of Dr Julian Kennedy have been drawn to my attention as they were originally posted as an employee of The Royal Bournemouth and Christchurch Hospitals NHS Trust. On behalf of the Trust, I wish to make clear that Dr Kennedy's personal views do not reflect any policy of the Trust and we would not want to be associated with them in any way. Competing interests: None declared |
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Julietta Patnick, Director, NHS Cancer Screening Programmes The Manor House, 260 Ecclesall Rd Sth, Sheffield S11 9PS, Catherine M Davison
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Dear Sir we should like to stress that the NHS cervical Screening Programme offers cervical screening to all women without enquiring about their sexual behaviour. We would agree that many women who have sex with women have, at some time, also had a sexual relationship with a man and their risk is no less than for the majority of the population. Women who have never been sexually active with a man are equally entitled to cervical screening and may wish to discuss their situation with their GP or sexual health advisor before making an informed decision about whether to participate in the programme or not. Competing interests: None declared |
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Joseph Joseph, Consultant Physician and Rheumatologist Nicosia Polyclinic,Cyprus
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Consider women as being at risk of conditions that affect women.This would make both the editorial and the (unnecessary in this instance) dissection of female sexuality, redundant. Competing interests: None declared |
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A.A.W. AMARASINGHE, M.D., Consultant Psychiatrist Metro State Prison( female )Atlanta Georgia. USA
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Women who are incarcerated in prisons provide a readily accessible sub group to study the subject, " women who have sex with women ". Is there any literature? Competing interests: None declared |
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Justin S Varney, SpR Public Health SE London PH Network SE10 8EX
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I welcomed the response that says that screening is open to all women however as we know from current debates, saying that something is open to all is not the same as ensuring that everyone has equal access appropriate to need... the equality versus equity debate! One of the issues that the authors had raised and one which is key when talking about national programs is accessability. A significant proportion of national health service access material is targeted using predominately white heterosexual imagery. There is limited research into how non-white or non-heterosexual individuals relate to these images and if they would still access a service which used predominately irrelevant imagery to their cultural references. Work around HIV in the african communities in south london has shown the importance of working with communities with recognised need to develop culturally specific literature and images to improve uptake of services. There is significant work to be done with local initiatives and voluntary sector groups in partnership to develop appropriate information resources and culturally relevant material to encourage access where it is needed and available. The second issue which needs to be addressed before any service can be said to truly open to all is the cultural competancies of the staff. Although the Diversity & Equality agenda's are high on the HR side of the NHS they have been slow to infiltrate the medical hierachy and papers in the past have illustrated how strongly percieved or actual disapproval of lifestyle can act as a barrier to accessing care. In some areas of London, specific well-women/gum services have been set up to cater for lesbians and bisexual women - the anecdotal reports being that these clinics cater for a much wider range of needs than straight foreword GUM. Wider focusing of the D&E agenda and a strong move by medical schools and nursing colleges (who have already led the way in this areA) would help instill confidence in lesbians and dykes that when they see a health professional their sexuality will be recognised and accepted, not ignored or rejected. The issue of lesbian health are wide ranging and many relate to the perceptions embossed during adolescence and childhood. With the rise in Children's Trusts and much greater working between local authorities, voluntary sector groups and primary care trusts I hope that this vulnerable group is recognised and supported appropriately. At the other end of the spectrum work by Age Concern has highlighted the importance of sexuality awareness in older people and the poor state of neglect that many older lesbians and gay men find themselves in. Perhaps it is time that we followed a more American model of public health which has developed recognising the importance of these vulnerable groups and where in larger cities such as Boston and Chicago there are consultants in Lesbian & Gay Public Health? A new specialty developing for a new age of cultural awareness? Competing interests: None declared |
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Peter M Rodgers, Consultant Radiologist Leicester Royal Infirmary, Leicester. LE
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Homophobia was commonplace in Medical Schools and Hospitals during my training in the 70's and 80's. I attended an Equal Opportunities Training Day a few years ago, during which a Consultant Obstetrician expressed doubts about his willingness to "employ" a gay man as a colleague. Many Gay and Lesbian trainees and colleagues are reluctant to be frank about their orientation because of their perceptions of homophobia. This is an important issue of justice but also joy. Diversity should be enriching not threatening. However, I do not think a witch hunt against Dr Kennedy would be helpful. Biblical literalists desparately look to scripture for certainty in a rapidly changing secularist world. I feel a bit sorry for Dr Kennedy who has been given these opinions from others responsible for "shepherding" all God's children. I trust that in clinical work, he practises what he doesn't preach i.e that we are all children of a loving God, who made everything and is pleased with his creation. He could clearly do some thinking on separating acts from individuals, but we have a responsibility to be out and proud about our Gay identities so that those like him are confronted by the conflict between poor scriptural interpretation and the reality of gay and lesbian lives. Competing interests: I am a Gay Catholic |
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Ber Doherty, GP London
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Very sad to see that bigots are alive and well and practising medicine in the 21st century in Bournemouth. If you're a gay medic and feeling vulnerable, please don't think that such attitudes are the norm in medicine - in my experience the vast majority of folk find these views as repellent as racism or antisemitism or any other 'ism'. Competing interests: Out and Proud; Recovering Catholic. |
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Rita Das, Specialist Registrar In Emergency Medicine Norrth East Thames, London
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Ten years after researching Homophobia within Medical Education as my intercalated BSc in Medical Sociology, I was delighted to see the Editorial about the health needs of women who have sex with women. In 1993, I sampled 118 medical students in 8 London Medical Schools looking at their attitudes and knowledge about lesbians and lesbian health care needs. Although 93% felt that felt that it was important to give "high quality non-jugemental care to all their patients" a significant number failed to extend this ethos to lesbians as a patient group. There were serious misconceptions regarding the aetiology of lesbianism: 50% agreed that "high testosterone levels in utero is a cause of lesbianism". The majority failed to see the relevance of sexuality to health care, and 21% said they would feel uncomfortable if a patient told him/her that she was lesbian. Worryingly, 4% said they would "rather not treat a lesbian patient". Acknowledgement of lesbians as a patient group with specific needs within undergraduate training was non-existent, and 68% of the students called for more education about lesbian health. One wonders just how much medical curriculae and society's tolerance have evolved when members of our medical profession still hold ignorant views such as those held by our colleague in Bournemouth. We are bound by Good Medical Practice to do no harm and develop our medical knowledge. We must strive to include the specific health needs of lesbians and other minority groups on the educational agenda if Good Medical Practice is to be maintained. Competing interests: None declared |
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Bryan S Connor, medical superintendent with right of private practice Richmond Qld Australia
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Finally there is a shift in Medicine towards looking at everyone as an individual with equal rights of access to quality,and non judgemental,healthcare.Dare I say"do unto others as you'd have done unto yourself"I remember my closeted days in the homophobic NHS in Scotland with great regret.I should have come out then to challenge the bigotted homophobes(my consultants)who made coments like"dirty fags deserve to get AIDS" etc.What a pleasure to escape to Australia where people are treated on merit and not on social background or with whom they choose to share their lives Competing interests: None declared |
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Clare Farquhar, Honorary Researcher King's College London and London South Bank University
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For anyone interested in more than 'anecdotal' evidence (Varney:
Screening and opening the door) on the role of lesbian GUM services, and
the sexual health needs of lesbians, information on a large-scale survey
of lesbian users and non-users of such services can be found at
Competing interests: None declared |
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manan vasenwala md, mrcp (uk), consultant-cardiologist(non-invasive) k.k.heart center, aligarh-202002.india
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it is interesting to see with the changing times, controversy raised by this article.but the furore i think it generated is unprecedented. the truth is lesbianism or homosexualism are deviant sexual behaviors. the affected group have for a long time faced persecution at the hands of moralists and spiritualists. however, these groups have gathered clout and through political pressure able to remove the condition as a disorder from dsm-1v-tr nomenclature. as this group becomes further liberated from the 'biblical injunctions' they have become more assertive of their rights to be as they are.recently a court in usa have said disallowing gay marriages as unconstitutional and have asked for ammendments in the legislature. president bush has been forced to issue a statement opposing this demand.as this particular group are now more forthcoming and less secretive of their sexual preferences, their special medical problems and needs, hitheto unknown, have come to the fore as highlighted in this excellent article by hughes and evans.i think people are beginning to concede that there is a spectrum of sexual behaviour with the majority being heterosexual. the etiology may be genetic or socio-psychological. in india eunuchs also have formed a large organisation and have been allowed political rights and are becoming mayors and so on. what is important is how to handle other fringe groups like zoophilics, pedophilics and necrophilics who may consider themselves as distinct groups thus blurring line between normality and severe deviation? other questions that this article will raise is legalising marriages amongst gays. also can the facilities for in-vitro fertilisation be made available to lesbians? if so what effects this will have on their offsprings. will they become gay too or become distressed of their situation.what will be their special medical needs. this is food for thought! Competing interests: None declared |
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Emma K Robinson, Consultant in Public Health Lambeth PCT, 1 Lower Marsh, London SE1 7NT, Yvonne Young
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We were very interested to read the editorial discussing the health needs of women who have sex with women.(1) We recognise that describing women who have sex with women in any other way is hard as each term has its own political or social connotations. However for ease of reading, for the remainder of this response we will use the term gay women. The National Survey Sexual Attitudes and Lifestyle, undertaken in 1990, addressed a range of questions on homosexual attraction and experience. The survey found that 3.4% of female respondents have had a homosexual experience, whilst 0.6% of women have had at least one homosexual partner in the last five years.(2) These percentages represent a not insignificant number of women in the population, despite the likelihood that these figures will probably be an underestimate, given the sensitive nature of this question. This survey was repeated in 2001 and the anticipated results will be able to provide more up-to-date estimates. Gay women are often assumed to have few health needs and so their specific health issues are rarely addressed by commissioners and front line health care workers.(3) Gay women report problems with coming out to health care workers. Hostility can result in reluctance to seek help when required and so may cause delayed treatment and poorer prognosis. This highlights the importance of education and training for all health care workers. The majority of data on sexually transmitted infections (STIs) among gay women are obtained from ad hoc surveys. National surveillance data continues to record sexuality for heterosexuals and homosexual men, but not for gay women. Some GUM clinics have begun to introduce such coding locally, but it remains important to implement this nationally. Hughes and Evans noted that HIV transmission has been reported in gay women, and that many of these women also had other risk factors for HIV (e.g. IDU).(1) In addition to this, there are also reports of transmission of HIV between women who have only had oro-genital contact.(4,5) The specific health needs of gay women in relation to conception also merit consideration. Gay women do have children and achieve their pregnancies through a variety of approaches including self-insemination with a known donor and insemination by anonymous donor through assisted conception units. Anecdotally such units are reporting that they are receiving increasing numbers of requests for assistance with conception. This may be as a result of increased advertising of services or due to a genuine rise in gay women deciding to have children. With increasing tolerance of homosexuality in the community, more women may feel able to attempt to have children. A recent survey on lesbian sexual health (803 sexual health clinic attendees and 415 from community settings) found that 26% had been pregnant at some time and 13% were biological mothers.(3) Hughes and Evans described that many of these women have children after the age of 30.(1) This brings with it decreasing fertility and a consequent greater need for assistance with conception. As more gay women have children, there is also an increasing need for primary health care teams to be able to deal with gay mothers and to support them during their pregnancy, delivery and raising of a family. Emma Robinson, Consultant in Public Health, Lambeth PCT Yvonne Young, Consultant in Communicable Disease Control, South West London Health Protection Unit References 1. Hughes C, Evans A. Health needs of women who have sex with women. BMJ 2003;327:939-40. 2. Johnson A, Wadsworth J, Wellings K, Field J. Sexual Attitudes and Lifestyles. Blackwell Scientific Publications. 1994. 3. Farquhar C, Bailey J, Whittaker D. Are Lesbians Sexually Healthy? A report of the ‘Lesbian Sexual Health and Behviour Survey’. South Bank University, 2001. 4. Monzon et al. Female to female transmission of HIV. Lancet 1987;ii:40-41. 5. Perry S et al. Orogenital transmission of HIV. Ann Int Med 1989;iii:951-52. Competing interests: None declared |
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Alastair E Pringle, Health Project Manager Stonewall Scotland, G1 4AL
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I have read with great interest the comments posted following Hughes & Evans article on the health needs of women who have sex with women. I have been working for the past year leading on a partnership between the Scottish Executive Health Department and Stonewall Scotland, a leading charity for lesbian & gay equality, looking at the health needs and service experiences of Scotland’s Lesbian, Gay, Bisexual & Transgender population. In October we launched ‘Towards a Healthier LGBT Scotland’ which draws together the available evidence from Scottish research as well as transferable evidence from other studies. It considers current gaps, activity and initial recommendations for that will be useful for health workers, policy makers and Scotland’s LGBT population Malcolm Chisolm, Minister for Health and Community Care, giving his support to the findings from this project, said; “Developing new patient focus in delivery of health services must recognise diversity of patient needs and preferences. Needs will vary and whatever individual circumstances are - including age, gender, disability, ethnicity, sexual orientation, religion, mental health, economic or other circumstances – everyone needs access to the right health services. While we are committed to developing a ‘LGBT friendly’ health service, we acknowledge that until the root causes of LGBT health inequalities are addressed, we will not be able to tackle the concerning health statistics raised in this report. There is no place for discrimination in the NHS in Scotland. I fully support the findings from this report and look forward to the recommendations being implemented across the NHS.” ‘Towards a Healthier LGBT Scotland’ reports on current levels of discriminatory attitudes towards LGBT across Scotland and provides evidence of how these issues impact directly on the health of LGBT people. Health issues reported include: Health Service Access; Mental Health; Sexual Health; HIV; Addictions; Eating Disorders; Transgender Health; Domestic Violence; Other key social determinants ‘Towards a Healthier LGBT Scotland’ also reports on what NHS Boards and LGBT organisations across Scotland are currently doing to address this issue and provides initial recommendations that fall under 3 key headings: 1) Challenging discriminatory attitudes towards LGBT people in Scotland 2) Improving accessibility and appropriateness of mainstream services 3) Developing and supporting specialist services Central to our work over the next year will be challenging the unacceptable levels of homophobia, discrimination and prejudice that exist across the NHS in Scotland, and from the comments above, are apparent in healthcare workers across the UK and internationally. Copies of this report are available from info@lgbthealthscotland.org.uk. Competing interests: None declared |
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