Source: Kaos GL, “LGBT’lerin Sağlık Hizmetine Erişiminde Engeller Var” (“There are obstacles to LGBT patients’ access to health care,”) 28 January 2014, http://kaosgl.org/sayfa.php?id=15698

Esin Polat, a student in Kaos GL Association’s “Criticism of Heterosexism and Alternative Policies” course in the Women’s Studies Program of the Ankara University, interviewed Cemal Hüseyin Güvercin M.D. about LGBT (lesbians, gays, bisexuals and trans) people’s experiences in accessing to health care.

Could you give some information about your specialty in public health and medical ethics?

Public Health, known also as community medicine, requires having a vision from a public health standpoint. Namely, it detects the diseases that make people sick, disabled or lead to death and also determines what causes them. It evaluates the loss of workforce based on the perspective of public health, while also promoting care for disadvantaged groups in society and defining them as groups at risk. The main goal of public health is not to find cures but to prevent illness and disease. Additionally, public health works interdisciplinarily in collaboration with other sectors in addition to the health sector. Medical ethics, on the other hand, is the field exploring moral issues in medicine and determining occupational ethics. Both public health and medical ethics are the social aspects of medicine.

What is your opinion about the problems experienced by LGBTs in access to health care?

LGBTs are at high risk of stigmatization in society and because of this sociological reality, they experience significant problems in accessing to health care.

What are these problems?

Generally, there are two main areas: The first one is obstacles to accessing to health care and the second is discrimination while receiving health care services.

Could you expand your points a little bit?

Health insurance is an important factor in accessing to health care. Individuals with health insurance have easy access to health care. Many LGBTs are excluded from the work force due to the sexist approaches in society and have difficulty finding legal work, so they have decreased access to health insurance. Without health insurance, one would not always be able to cover his/her health expenses and pay for medicine, which can be expensive when combined with other issues. Furthermore, since working in a job affects one’s personal health positively, LGBT individuals are affected negatively by unemployment. Those individuals who have difficulty finding a job or remain unemployed are regarded as cheap and illegal workers in the workforce.

Due to the limited or prohibited job opportunities in society, these individuals are often forced to do sex work; so their health risks increase substantially more than a regular person’s. On the one hand, LGBTs are unable to access routine health care services even though they face serious health risks. The threats to those individuals’ health are based on having no protection and the environments in which they are exposed to violence that ranges from being seriously injured, permanently disabled or being a victim of murder. Generally, LGBT people’s rates of morbidity and mortality differ from that of a non-LGBT individual. They are more exposed to violence and they have mental health problems due to this oppression. Therefore, addiction to alcohol and drugs and the intensity of prevalence of mental health diseases, called social diseases, are more common among LGBTs. All these problems affect LGBT people’s general health negatively.

You said that the second problem is discrimination in the health system. Could you also expand on that?

Those individuals who overcome the problems in accessing health care face a risk of discrimination when those health care services are provided.

By health care specialists?

Sexist approaches of health care specialists limit the benefits of the care that LGBT individuals receive. A health care specialist, who is unaware of these issues, has usually not yet internalized human rights and medical ethics and can easily exhibit a discriminative attitude. Not being willing to provide care to patients or hospitalize them, or referring patients to other organizations due to their sexist approach causes disruptions or delays in an individual’s treatment.

How do LGBTs’ requests for health care differ from that of other individuals?

Some LGBTs have specific surgical needs based on their own conditions. For example, we can talk about interventions known also as sex reassignment surgeries by society. The SGK, the health insurance institution, does not cover all surgery expenses and this area is not sufficiently regulated. As a result, these types of surgeries are done by private health care specialists in private medical institutions at high costs. These types of complicated surgeries should be administered by specialized physicians due to the necessity of special treatment and follow-ups after surgery. Acceptability of indication (does this surgery suit this person?), the surgeons’ competence and possible complications should be monitored. Additionally, the violation of LGBT people’s privacy is another important problem. This is also violation of personal rights; so it is essential to stop accessing LGBT people’s health records and to carefully protect this information in data processing.

What are your suggestions for LGBT people’s access to health care?

Educating LGBT people about health risks to which they are exposed to in receiving health care is important for both their own health and public health.

LGBT people have obstacles in accessing to health care, in getting benefits from health rights protected by Constitutional law, and have difficulties receiving services.  What should to be done about this?

The biggest obstacle for patients in exercising their rights to health care is the inaccessibility of health care. If an individual in society is experiencing this as their most significant problem, we can assume that the experiences of LGBTs will be much worse.

Finally, I can conclude this way: The right to health constitutes one’s fundamental right to life and therefore should be equally provided to all people in a fair way with no strings attached. Groups at risk, like LGBT people, should be provided more health care services in the form of positive discrimination and awareness on this subject should be enhanced.