Sexual Orientation

1  Introduction

This is one in a series of needs assessments regarding protected characteristic groups to support compliance with the public sector Equality Duty (The Equality Act 2010).

The document is intended to raise awareness of the key public health, and health and social care considerations relevant to people with disabilities; and to provide a starting point to inform the development of Equality Impact Needs Assessments (EINAs).

Sexual orientation is a protected characteristic under the Equality Act 2010, recognising that people may be sexually attracted to the opposite sex (heterosexual), their own sex (homosexual), or to both sexes (bisexual)[1].

Within the homosexual community, homosexual men are also referred to as ‘gay’ and homosexual women as ‘lesbian’[2]. Consequently the terms lesbian, gay, and bisexual; and abbreviation LGB, have been adopted in this report.

Given personal sensitivity regarding sexual orientation, limited reliable information is available on the numbers of LGB, and estimates are likely to under-estimate true numbers.

The 2011 census did not have a specific question regarding sexual orientation, but found that 665 people (0.35% of the Borough population) reported being in a same sex Civil Partnership.

Beyond Richmond, surveys found that 1.5% of the national population and 2.5% in London consider themselves LGB[3]; and a government report estimated that between 5% and 7% of the population in England and Wales is LGB[4]. A conservative estimate (5%) equates to 9,500 people in Richmond. However, some local organisations suggest an estimate of 10%, equating to 19,000 people, is more realistic.

LGB people, of course, have the same health and social care needs as their heterosexual counterparts, though also often have particular additional or different needs (e.g. sexual, reproductive, & mental health), including access to services which are accepting and sensitive to their sexuality, preferences, and needs.

An optimal balance needs to be struck between addressing the general and particular health needs among LGB people. It is important to note that the particular needs of gay and bisexual men and lesbian and bisexual women vary substantially.

As explored below, LGB health needs are associated with health related lifestyle/behaviour, differences in disease risks, access to appropriate services, and potential discrimination.

2  Background

2.1.     Lesbian and bisexual women

  • Are twice as likely to have never received a cervical smear test compared to women in general.
  • One in five has deliberately harmed herself in the last year compared to 0.4% in the general population.
  • Half of lesbian and bisexual women have not told their GP about their sexual orientation.
  • 66% have smoked compared to 50% of women in general.
  • 40% drink alcohol three or more times a week compared to 25% of women in general.
  • 80% of lesbians and bisexual women said that their health is good or excellent.

2.2.     Gay and bisexual men

  • 3% have attempted to take their life in the last year compared to 0.4% in the general population.
  • 25% have never been tested for sexually transmitted infections.
  • Two thirds have smoked compared to half of men in general.
  • 25% currently smoke compared to 22 per cent of men in general.
  •  ‘Men who have sex with men’ (MSM) are at substantially higher risk of sexually transmitted diseases (STDs) including HIV/AIDS., London as a whole has the highest rates of HIV/AIDS and many other STDs in the UK. Furthermore, new diagnoses of HIV increased by at least 21% in 2011, in part potentially due to increases in testing, but also in association with reports of changes in drug-use among MSM[5].
  • With dramatic improvements in the treatment of HIV, the number of people living with HIV/AIDS in London (in excess of 32,000) and the average age of those have risen substantially.

2.3.     Lesbian, gay, & bisexual people

  • LGB people suffer disproportionately from some risks of mental health problems. One in six lesbian, gay and bisexual people have experienced a homophobic hate crime or incident over the last three years. One in sixteen regards homophobic harassment or attacks as a big problem in their area[6].
  • 41% aged over 55 years live alone compared to 28% of heterosexual people of the same age.
  • One in six aged over 55 years is not confident that their GP and other health services would be able to understand and meet their needs.
  • Half of lesbians and bisexual women and a third of gay and bisexual men who have accessed healthcare services in the last year have had a negative experience related to their sexual orientation.
  • Three in five are not confident that social care and support services, like paid carers, or housing services would be able to understand and meet their needs.
  • Are more likely to rely on formal support services as they get older, due to living alone & being less likely to have children.

3  Local picture

3.1.     Lesbian and bisexual women

  • Are 5 times more likely to have taken drugs in the last year compared to women in general (35% compared to 7%). In Richmond 48% of lesbians and bisexual women said they had taken drugs in the last year.

3.2.     Gay and bisexual men

  • Half have experienced at least one incident of domestic abuse. In Richmond 55% of gay and bisexual men have experienced domestic abuse since the age of 16 – 45% when in a relationship with a man.
  • 42% drink alcohol on three or more days a week compared to 35 per cent of men in general. In Richmond 46% of gay and bisexual men drink alcohol on three or more days a week.
  • 51% have taken drugs in the last year compared to 12% of men in general. In Richmond 55% of gay and bisexual men have taken drugs in the last year.
  • Richmond has one of the lowest rates of new HIV infections in London.
  • In 2011, fourteen new cases of HIV in MSM from Richmond were diagnosed[7].
  • In Richmond there has been an increase of 37% in the number of residents living with HIV between 2007 and 2011. In 2011 92 MSM Richmond residents were accessing specialist HIV care.

4  Service Provision

A comprehensive range of public health programmes, and health and social care services are designed, planned and delivered to meet the needs of Richmond’s population:

  • Development of needs assessments to research local population health and wellbeing needs.
  • Liaison with a range of local community organisations, including the Richmond Lesbian, Gay, Bisexual and Transgender (LGBT) Forum.
  • Audits, reviews, and evaluations of existing services including consideration of equality and diversity issues.
  • Equality Impact Needs Assessments (EINAs) of new services and changes to existing services.
  • Monitoring of service use by key population characteristics, including some protected characteristic groups.
  • Adoption of equality requirements in service specifications and monitoring processes as part of contracting requirements for services and their providers.
  • Annual reviews of compliance with the Public Sector Equality Duties.
  • Implementation of the NHS Equality Diversity System by local NHS commissioners and providers.
  • The council has undertaken an audit of provisions for protected characteristic groups in public health programmes, and the findings are under consideration.

5  Conclusion

A number of further actions are underway or being considered by Richmond Borough Council, including:

  • Development of detailed Equalities Profiles for the Borough based on the results of the 2011 Census. This will further support general consideration of protected characteristic group equality issues across council responsibilities and beyond.
  • Work to support Richmond CCG in their planned update of their Public Sector Equality Statement and implementation of the NHS Equality Diversity System.
  • Consideration of the extension of routine consistent equality monitoring of all protected characteristic groups, including use by LGB people, across public health programmes, in addition to those groups most frequently routinely covered by standard data collection systems (i.e. age, sex/gender, ethnicity).
  • Review of service specifications for the commissioned services included in public health programmes, to ensure an adequate and consistent approach equality issues relating to the protected characteristic groups.
  • Review of access to data essential to undertake adequate equality monitoring of key public health services, particularly immunisation and screening.

6  References

[1] Equality & Human Rights Commission (EHRC) website accessed 10/03/2014

[2] Stonewall. 2012. Sexual orientation: a guide for the NHS.

[3] 2011 Integrated Household Survey, ONS.

[4] Department of Trade & Industry (2004). Final regulatory impact assessment: Civil partnership.

[5] Kirby,Thornber-Dunwell (2013). New HIV diagnoses in London’s gay men continue to soar. The Lancet, Volume 382, Issue 9889, Page 295

[6] Gay British Crime Survey. 2013.

[7] Public Health England (2013). Review of HIV epidemiology in London.

Document information

Published: July 2014
For review: July 2017 
Topic lead:
 Jane Bailey, Public Health Lead