LGBT+ communities and cervical screening - key takeaways from our roundtable with Jo's Trust

The APPG on Global LGBT+ Rights was pleased to work with Jo’s Trust to hold a roundtable on cervical screening in LGBT+ communities: Exploring the barriers and identifying opportunities to reduce inequalities, hosted by Alex Davies-Jones MP.

Jo’s Trust has written a summary including the key messages from the roundtable, reproduced in full below:

Key things to take away from our LGBT+ roundtable

Posted on: Thursday, 1st April 2021 by Hannah Wright, Policy and Public Affairs Assistant

Cervical screening is one of the best ways to prevent cervical cancer, but there are a wide range of factors which can make attendance hard.  For LGBT+ communities there can be additional challenges. On Wednesday 24th March we joined together with the All-Party Parliamentary Group for LGBT+ Global Rights for a roundtable entitled, “Roundtable on cervical screening in LGBT+ communities: Exploring the barriers and identifying opportunities to reduce inequalities.”

We facilitated this roundtable in order to discuss the specific experiences of cervical screening in LGBT+ communities, explore the barriers and stigmas that exist, and identify opportunities to improve access and reduce inequalities. 

Our expert speakers included: Jacob Bayliss, the CEO of Switchboard; Dr Alison Berner, Clinical Research Fellow in Medical Oncology and Specialist Registrar in Gender Identity; Alex Davies-Jones MP; Baroness Barker representing the APPG On LGBT+ Global Rights; and Jo’s Cervical Cancer Trust media volunteer Seb.

So what did we cover?

3 stats

1. 40% of lesbian and bisexual women have been told at some point that they don’t need cervical screening. 

[LGBT Foundation: Are you ready for a Screen test] 

Jacob Bayliss, the CEO of Switchboard, discussed the need to ensure everyone with a cervix has accurate information about cervical screening and feels included in the cervical screening programme. Misconceptions and inaccuracies can stem from gaps in understanding about HPV, risk, and transmission. Education for health professionals, in addition to literature which includes the LGBT+ community is essential to this. 

2. 57% of trans men and/or non-binary people surveyed by Dr Alison Berner had never attended a cervical screening, and 7% had been turned away when trying to attend

New UK-based research presented by Dr Alison Berner found that more than half of a sample of trans and/or non-binary people with a cervix have never attended cervical screening. 

Specific barriers to screening for this community include: gender dysphoria from cervical screening and from the associated correspondence, physical pain, technical difficulty with the procedure, stigma and discrimination, gendered information, and providers that fail to encourage screening to all people with a cervix.  

3. Trans men and non-binary people would like the option of HPV self-sampling  

Previous studies have found that the speculum was the most off-putting aspect of cervical screening for this community [Reference: McDowell et al. (2017) LGBT Health]. A potential solution was presented by Dr Alison Berner from her research, “A Survey of Attitudes to Cervical Cancer Screening in Trans Men and Non-binary People in the UK”.  HPV self-sampling could offer an option for many who feel unable to attend cervical screening, with half of participants in her study saying they would prefer this. Dr Berner called for a dedicated HPV self-sampling pilot for this community, to ensure that as and when it is introduced into the cervical screening programme their needs are met.

3 points to consider 

1. One positive healthcare experience can impact wider healthcare 

Jacob shared how positive experiences of healthcare – like cervical screening – can have a knock-on effect and make people more inclined to seek help or access other services.  The positive impact of inclusive conversations and inclusive care can shape people’s health-seeking behaviour for years to come.

2. Self-advocating is important

Seb shared his experience of attending cervical screening as a trans man. He spoke about the need to establish your own boundaries and share your needs with healthcare professionals. However he also shared this can take its toll and can be “exhausting”. Seb asked healthcare professionals to learn how they can better support the trans population, for example asking for accurate pronouns, rather than waiting for patients to do so.

3. The importance of data 

Jacob reminded us all of the importance of gathering accurate data. For services to best serve communities, they need accurate data in order to inform and shape how they work. It is crucial for them to know who they’re talking to and also who they are currently failing to reach.   

3 ways things can change for the better

1. Changes to the cervical screening programme IT system. 

Our own Information Manager, Imogen Pinnell, shared our concerns that the current IT system used by the screening programme is not fit for purpose and presents a barrier to those who are not registered as female with their GP and have a cervix. Invitations to cervical screening are only generated to those registered as female, with no solution in the current central screening IT system to invite trans men or non-binary people with a cervix whose records show them as Male. This leaves responsibility with individuals to understand and feel able to request an appointment, which presents many challenges. 

2. Visibly inclusive services 

A key question raised by Jacob was, “When someone walks through the door of a practice, what message are they being given?” He called for healthcare services to make it clear that they are inclusive and safe spaces. This was reiterated by Baroness Barker, who has previously written about her experience of attending cervical screening as a lesbian woman. Initiatives like the NHS Rainbow Badge, to looking at the imagery and messaging used in resources, can help make a service feel more welcoming and inclusive. Crucially, an inclusive service or resource cannot be created without the group it is being created for involved from the outset. So listening, asking questions, and co-designing resources is essential. 

3. Increased training opportunities for providers 

Alison Berner called for greater education for healthcare professionals at undergraduate and postgraduate level, and for cultural sensitivity training that extends beyond the current Diversity and Equality offering to be given to all staff in healthcare settings, including receptionists. As Seb shared, “everyone’s body deserves care, love, and health.”

If you have any questions, please do contact Imogen Pinnell (Jo’s Cervical Cancer Trust – Information Manager): imogen.pinnell@jostrust.org.uk 

Click to watch the recording of the webinar >

We have resources for healthcare professionals who carry out cervical screening, to help you support trans men and/or non-binary people with a cervix. Read them here >

The Human Dignity Trust has just launched an innovative new digital tool to support the reform of outdated and discriminatory sexual offence laws around the Commonwealth

Changing Laws, Changing Lives: Assessing sexual offences laws in the Commonwealth, put together by the Human Dignity Trust, reviews sexual offence legislation in all 54 Commonwealth member states using a set of indicators to assess their human rights compliance in four areas of law - sexual assault, child sexual assault, disability and consensual same-sex sexual activity.

Trans Rights Europe & Central Asia Index & Maps 2020

Today Transgender Europe (TGEU) have today released their Trans Rights Europe & Central Asia Index & Maps for 2020.

The Trans Rights Europe & Central Asia Index provides detailed information on the legal situation of all 47 Council of Europe member States and five Central Asian countries. The Index covers a total of 30 indicators in six legal categories: legal gender recognition, asylum, bias-motivated speech and violence, non-discrimination, health, and family.

The Trans Rights Europe & Central Asia Maps focus specifically on two legal gender recognition (LGR) indicators that stigmatise and violate the rights of trans people: forced sterilisation and mandatory mental health diagnosis. Each of the respective maps illustrates which countries demand these problematic LGR requirements.

Collectively, the Trans Rights Europe & Central Asia Index & Maps reflect the current legal situation in countries throughout the region based on consultation from in-country experts as of 10 May 2020. Please note the Index and related maps do not claim to exhaustively portray the complex legal and social contexts that trans people live in. 

A long way to go for LGBTI equality - FRA EU-wide LGBTI survey results released today

“My girlfriend and I were walking down the street in South London, holding hands. A man spat at us, and shouted that we were disgusting.” (United Kingdom, Bisexual Woman, 25)

Today the APPG on Global LGBT+ Rights welcomes the release of the results of the second EU LGBTI Survey conducted by the European Fundamental Rights Agency, but it is unacceptable that LGBTI people across the region continue to face inequalities and more dedicated work is urgently needed to improve their lives.

“Too many LGBTI people continue to live in the shadows, afraid of being ridiculed, discriminated or even attacked. Even though some countries have advanced LGBTI equality, our survey findings show that overall there has been too little real progress, leaving many LGBTI people vulnerable. Their job and healthcare difficulties may worsen due to COVID-19. Policymakers should take note and do more to actively promote full respect for rights of LGBTI people,” says FRA Director Michael O’Flaherty.

In 2012, some 93,000 LGBT people responded to the first LGBT survey which FRA carried out to discover the everyday issues affecting LGBT people. This second survey, conducted in 2019, provides comparable data from almost 140,000 LGBTI people across the EU, the United Kingdom, North Macedonia and Serbia. This time the survey also included Intersex people and young people between 15 and 17 years old.

The survey shows that LGBTI people face continued inequalities in all regions, including in the UK.

Key survey findings include:

• Openness: 6 in 10 avoid holding hands in public with their partners.

• Harassment: 2 in 5 respondents say they were harassed the year before the survey

• Attacks: 1 in 5 trans and intersex people were physically or sexually attacked, double that of other LGBTI groups

• Discrimination: 1 in 5 feel discriminated against at work and over 1 in 3 feel discriminated against when going out to eat, drink or being social.

• Schooling: 1 in 2 LGBTI students say someone among their peers or teachers supported LGBTI people.

• Economic situation: 1 in 3 LGBTI people say they have difficulties to make ends meet. The situation is worse for intersex and trans people (about 1 in 2).

Results from the UK also showed:

• 61% avoid often or always holding hands with their same-sex partner in the UK. For the EU-28, it is 61%.

• 34% in the UK avoid often or always certain locations for fear of being assaulted. For the EU-28, it is 33%.

• 56% are now fairly or very open about being LGBTI in the UK. For the EU-28 it is 47%.

• 21% felt discriminated against at work in the year before the survey in the UK. For the EU-28, it is 21%.

• Discrimination affects many areas of life, such as going to a café, restaurant, and hospital or to a shop. Overall, in the UK in 2019 42% felt discriminated against in at least one area of life in the year before the survey. For the EU-28, it was 42%.

• 1 in 5 trans and intersex people were physically or sexually attacked in the five years

  before the survey, double that of other LGBTI groups.

• 43% in the UK say they were harassed the year before the survey. The EU-28 is 38%.

• 11% in the UK had been attacked in the 5 years before the survey. The EU-28 is 11%.

• 22% went to the police in the UK to report physical or sexual attacks. It is 14% across

  the EU-28.

• 15% reported their discrimination experiences to an equality body or another organisation in the UK. For the EU-28, it is 11%.

• 42% in the UK say that LGBTI prejudice and intolerance has dropped in their country

  in the last five years. It is 40% across the EU-28.

• 36% in the UK say that prejudice and intolerance have risen. This is 36% for the EU-28.

• 48% in the UK believe their national government effectively combats prejudice and intolerance against LGBTI people. For the EU-28, it is 33%.

• Among young people (18-24), less people (41%) hide being LGBT at school. In 2012,

  it was 47%.

• 20% of LGBTI students (15-17 years old) in the UK say were hiding being LGBTI at school. This was 30% in the EU-28.

• 51% of LGBTI students (15-17 years old) in the UK say that in school someone often or always supported, defended or protected their rights as an LGBTI person. This was 48% in the EU-28.

• 68% of LGBTI teenager respondents (15-17 years old) in the UK say their peers or teachers have often or always supported LGBTI people. In the EU-28, this was 60%.

• 46% of LGBTI of teenager respondents (15-17 years old) in the UK say their school education at some point addressed LGBTI issues positively or in a balanced way. In the EU-28, this was 33%.

The full data for the UK can be found collated here.