Begin Removing Barriers

BARRIERS TO CULTURALLY COMPETENT CARE

REMOVING BARRIERS: ELIMINATING HETEROSEXISM

Heterosexism is the institutionalized assumption that everyone is heterosexual and that heterosexuality is inherently superior and preferable to other sexual orientations. Heterosexism has both external, environmental manifestations as well as internally felt experiences of shame due to a non-heterosexual identity. Because it is so pervasive in our society, the manifestations of heterosexist assumptions are inevitable. In the clinical setting, it refers to a provider’s assumption that the patient is heterosexual without questioning otherwise. Another example of organizational heterosexism is the experience of lesbians who are in long-term, spousal relationships but are handed intake forms that limit marital status to “Single, Married, Widowed, Divorced.”

The health care system is often heterosexist. For example, forms often do not allow patients to indicate a same-sex relationship. A culturally competent provider should:

  • Use intake forms that include space to indicate a same-sex relationship.
  • Be aware of areas of personal privilege.
  • Ask questions using gender-neutral, inclusive language without making assumptions about the client.

Alternative ways to ask questions include:

  • Are you involved in a significant relationship at this time?
  • Is your partner a man or a woman?
  • Have you had sex with men, women, or both?

A culturally competent provider may ask whether or not sexual orientation should be recorded in the patient’s medical forms, and will explain how privacy and confidentiality are maintained.

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REMOVING BARRIERS: PERSONAL CONCERNS

Lesbians often delay health-seeking behaviors until they are symptomatic or until symptoms are at their worst. These delays are often the result of past experience with heterosexual assumptions from health care providers and the negative impact that accompanied those assumptions.

In addition to the barriers faced by all women, lesbians and WPW can also be affected by:

Lack of Knowledge

  • Lack of valid and generalizable research about the medical needs of lesbians and WPW
  • Myth of lesbian invulnerability to sexually transmitted infections (STIs), HIV, and cervical cancer held by some clinicians and WPW
  • Lesbians may less frequently require contraception or pregnancy care and may therefore have fewer opportunities to access preventive care services routinely
  • Perceptions of lesbian/bisexual sexual orientation or “butch” gender identity as unhealthy

Confidentiality/Privacy Fears

  • Fear that breaches of confidentiality will result in loss of child custody, a job, housing, social supports
  • Fear of military discharge

Anticipated, Perceived, or Actual Discrimination

  • Attempts to change one’s sexual orientation
  • Hostility toward the patient or her partner
  • Neglect
  • Denial of care
  • Undue roughness in the physical examination
  • Unnecessary voyeuristic questions
  • Sexual assault

Institutional Barriers

  • Exclusion of partner(s) and family of choice from health care settings and decision making
  • Lack of insurance coverage under a partner’s policy
  • Exclusion, or perceived exclusion, from health promotion campaigns

 

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