It was under the prism of the health of LGBTI+ people (lesbians, gays, bisexuals, transgender, intersex) that Marseille addressed World Day against Homophobia, Transphobia and Biphobia of May 17. A conference that echoes To the report of the Defender of Rights (DDD) entitled “Preventing discrimination in care courses: an issue of equality”, published on May 6 and completed by a second text, on the Transgender, on June 17.
“In the Provence-Alpes-Côte d’Azur region, after a constant drop in men with sex with men (HSH) between 2012 and 2021, the incidence of HIV no longer decreases in the past two years, or even starts a recovery”, Observes the researcher Annie Velter (public health France) by presenting the latest results of the Eras survey among the HSH (1). If the use of PREP continues to increase (from 5 to 27.5 % between 2017 and 2023), “At the same time, there is a significant decrease in the use of condoms. The level of protection thus remains high (73 %) but does not increase, which is a national trend ”specifies Annie Velter. “” The current situation leads us to launch a national survey in order to assess the appropriation of combined prevention (screening, post-exhibition treatment, prep, treatment as prevention [Tasp]Editor’s note) », she continues.
Increased mental health risks
As Michel Bourelly, President of Vers Marseille without AIDS recalled, LGBT people are exposed to increased risks in mental health. “This vulnerability is not intrinsic to their identity but to the discrimination, violence and marginalization that they undergo”, he explains.
“Among the 16 % of the population who declare that they have suffered, over the past five years, discriminatory treatments (18 % of women and 14 % of men), the prevalence of depressive syndromes is doubled compared to the rest of the population, Declares the Directorate of Research, Studies, Evaluation and Statistics (DREES) in light of the Epicov survey published on June 4. Likewise, people who define themselves homosexual or bisexual are almost twice as frequently suffering from depressed syndrome as those defining as heterosexual (16 % against 9 %). »»
“The prejudices and ignorance of the specific health needs of these populations by health professionals are still too frequent and lead to strategies of avoidance of care, non-selve or medical wandering”, explains the sociologist Gabriel Girard, inserm researcher at the Sesstim, who conducted an investigation in Marseille and in the Bouches-du-Rhône between March 14 and April 30, 2024 at 535 LGBTI+ people (online and paper questionnaire).
In this survey, while 70 % of respondents declare themselves “In good health”this is only 40 % of transgender people. On the psychic level, the situation is alarming: only 36 % of respondents declared a good mental health, this figure falling 11 % among transgender people.
If 70 % of respondents have consulted a general practitioner in the last 12 months and 26 % another specialist, “This link to health and care professionals can be” complex “, even” violent “,” reports the researcher, deploring “Prejudices”, “intolerance” and “hyper-intrusive questions”. More than a quarter (27 %) claim to have suffered discrimination in the medical environment in the past two years, a figure reaching up to 57 % in transgender people.
For inclusive policies
“LGBT people bear witness to the lack of knowledge of health professionals As for the prevention examinations to be carried out (…), the risks of sexually transmitted infections, pain during relationships or precautions to be taken when taking treatment ”, For its part, the DDD. Che lack of knowledge their harm to sexual health, but also for the screening of so-called “sexo-specific” cancers. Almost 33 % of transgender men would avoid gynecological care. Several reasons, lists the DDD: “The difficulty in living a gynecological examination does not correspond to its chosen gender, a lack of training and knowledge of the transidentity by these practitioners as well as transphobic remarks and attitudes”.
Faced with the specific and not covered needs of LGBT people, it is the responsibility of institutions to promote fair health for all, ” ranging from the training of health professionals to the adoption of inclusive policies, in connection with associations ”, According to Michel Bourelly. “Significant progress has been made in recent decades in the field of rights and social recognition of sexual and gender minorities in France, but we are not immune to declines, as the international context demonstrates”, warns the researcher Gabriel Girard.
