Many people who are LGBTQ2+ experience discrimination and stigma. Policies and governance are slowly changing, but many big policy changes have only begun in the last few decades. As a result, many people experience an intersectionality of discrimination that affects their health and wellness. Some still have to fight to have their basic rights met. Before we examine some of the challenges that LGBTQ2+ face in relation to health outcomes, it’s helpful to define some terms.

Here Are Some Terms Defined:

Assigned sex refers to the biological characteristics used to classify people into the categories of male, female, or intersex. It refers to the physical elements of our bodies, including features like genetics, hormones and internal and external sexual anatomy, and is often assigned at birth. Being intersex means that someone has natural variations in their physical sex development, which is different from being trans (related to gender identity).

Gender expression is the way someone expresses their gender to the outside world. This shows up in behaviour, clothing style, hairstyle and sometimes through pronouns and name, etc.

Gender identity is a person’s internal and individual sense of being a woman, a man, both, neither, or something entirely different (as described below). A person’s gender identity may also be affected by social, emotional, cultural, spiritual elements of their life. Examples of gender identities include:

• transgender or trans: when someone’s gender identity differs from their assigned sex at birth
• non-binary: when someone’s gender identity exists beyond, between, or outside of “man or woman.” Some people may use terms like gender non-conforming, genderfluid, genderqueer, agender, bigender, pangender, and many other terms
  *Remember, there is no one way to “look trans” or “look non-binary” – trans and non-binary people can express their gender in a wide variety of ways, and may or may not seek gender-affirming medical or surgical care.*
• cisgender or cis is when someone’s gender identity aligns with their assigned sex; not trans. Cis people also express their gender in a wide variety of ways.

Sexual orientation refers to who someone is attracted to sexually, romantically, and/or emotionally. Examples of sexual orientations are: queer, asexual, bisexual, pansexual, lesbian, gay, and heterosexual/straight, among others.

Two-Spirit: Pre-contact, many Indigenous communities acknowledged more than two genders. Through the residential school system and other colonial practices and institutions (e.g. medicine, language, law, economics, religion, government, etc.) there was an attempted erasure of these genders and of the language that described them, and an enforcement of a Western European patriarchal gender binary. Today, Two-Spirit is a term used by some Indigenous people and communities that can encompass cultural, spiritual, sexual, and gender identities. Often, being Two-Spirit is connected to specific roles and responsibilities within a community. While some Indigenous people who hold diverse sexual and gender identities consider themselves Two-Spirit, others may have terms in their own traditional languages, or identify themselves as LGBTQ+ and Indigenous, Indigiqueer, or use multiple terms.

Remember too that some people choose not to label themselves at all, and it is important that we respect that

Pronouns

We want to be respectful of each individual’s identity, and part of that means asking them for their pronouns (example, she/her, they/them, he/him, etc.). Using pronouns we aren’t used to using will require much intentionality and practice, but just like learning a new language, when you put in the time and energy, it will become second nature and will begin to flow more naturally for you.

When you mess up someone’s pronoun, simply correct yourself and move on. If you make a big deal of the mix-up by over-apologizing, it centers you. When you center yourself in situations like these, you could be unintentionally asking for emotional support from the person to whom you are speaking.

LGBTQ2+, Social Determinants & Health Outcomes

Many healthcare processes and policies can be inherently discriminatory to LGBTQ2+ folks – even if unintentionally. For example, many medical forms don’t include space for a full range of gender identity questions or sexual orientation questions, which impacts not just the level of care a person may receive but also the types of services made available to them.

Healthcare providers are also commonly not trained in gender affirming care or the specific health issues faced by LGBTQ2+ people, and this can be more of an issue in remote or rural communities. The majority of providers are also often unaware of issues faced by LGBTQ2+ populations beyond health issues; for example, someone who is trans may be unable to obtain identity documents that list their correct gender and name (and instead only list sex assigned at birth and legal name). Over and over, this places the burden on the service user rather than the care provider as they have to explain their gender identity, sexual orientation, name differences, pronouns and more.

“41% of LGBQ people and 75% of transgender people report needing to educate their health care providers on LGBTQ-specific health needs.” ~McAfee, 2019

What Does This Mean for Us as Peer Support Workers?

We can offer our emotional support, encouragement and empathy, and we can challenge discrimination against LGBTQ2+ folks whenever we encounter it. Our peer support work offers a vital way to reduce the common feelings of isolation and rejection amongst LGBTQ2+ service users and support them on their journey.

We can also share our lived experiences and what has helped or hasn’t helped us in similar circumstances. We can use their pronouns and apologize when we get it wrong. And we can acknowledge the many barriers in place that may be affecting them.