Raising awareness and informing the gay community and political and health system authorities is crucial for gay health, as is training and sensitizing health care providers around the specific vulnerabilities of gay men. Indeed, health care providers are largely unaware of the specific needs of gay men and the measures necessary to offer respectful, appropriate care. It is still widely-believed that AIDS and STIs are the only health problems facing gay men. Given the breadth of this undertaking which is even larger if we include the entire LGBT population, it is worth asking who is best placed to spearhead efforts to promote and develop gay health. LGBT organizations, AIDS organizations or figures involved in public health organizations?
The Health Directorate of the Canton of Geneva has supported Dialogai financially for AIDS prevention since 1987. The Directorate was consulted and has supported the roll-out of the gay health project since it was launched in 2000. It approved of the project from the very beginning and offered both financial and moral support to intervention projects such as Checkpoint and Blues-Out. That being said, the Directorate has so far refrained from putting Dialogai in charge of promoting overall health among gay men and continues funding the association under legislation aimed primarily at HIV and STI prevention. Nevertheless, in the current procurement contract, the Directorate asks Dialogai to promote general health and in particular, the mental health of gay and bisexual men.
The Federal Public Health Office financially supported the preliminary scientific part of the 2002 survey, the presentation of the survey outcomes to those involved in AIDS prevention in multiple cities and the development of a pilot project “Checkpoint” with a view to use the same model in other Swiss cities. The gay health project research findings were also presented on multiple occasions to Swiss researchers and those working in AIDS prevention. More recently, the project’s findings on suicide were incorporated into the Swiss Suicide Prevention Plan.
Health Care Providers
The fact that gay men visit health care providers frequently and yet are still in generally poor health points to the likelihood of inadequate care. On one hand, health care providers are not yet trained around the health vulnerabilities of LGBT people. On the other hand, they are rarely trained to communicate with their patients about sexuality, sexual orientation and gender identity. The main question is whether LGBT health issues should be part of the basic training or continuing education for health care providers, especially doctors. This question has not yet been answered. LGBT associations and health experts are currently cooperating to develop training modules in French-speaking Switzerland.
The Geneva Cantonal Association of Physicians (AMGe) was informed about this initiative from the beginning and was part of the project experts’ group. For the Checkpoint project, a cooperation contract was signed with the Community Medicine Department of the Geneva University Hospital (HUG). With the development of the Checkpoint Medical Center, more doctors from multiple specialties are working with or receive continuing education on the gay community and get first-hand knowledge of gay health on the ground. In the future, Checkpoint might be recognized as an internship placement spot for medical students.
Dialogai is in a unique position in Switzerland. It is the only gay organization to carry out professional HIV prevention and has acquired skill in community work and health education which allowed it to develop the gay health project. That being said, even Dialogai has found it challenging to develop a comprehensive health promotion project for gay men. Any organization tackling such an ambitious action-research project must be prepared to put the utmost behind it in terms of interest, resources and activity over many years.
The initiative, research findings and intervention projects were presented on numerous occasions to Swiss LGBT organizations such as Pink Cross, Medigay, the French-speaking LGBT organizations’ meeting and the Geneva LGBT Association Federation. With the support of the Federal Public Health Office (OFSP), two national days were organized in Lausanne and Zurich in 2003 to present the gay health project and the first findings to French and German-speaking gay organizations. This was done to encourage them to take the promotion of overall health on board. In 2006, the project was also presented to the ILGA international conference in Geneva.
Our work piqued the interest of certain LGBT associations and institutions and stimulated new research such as Profa and Santé PluriELLE on the health of women who love women and the 2011 PREOS health working group report. Some projected actions were carried out in tandem with other LGBT associations such as Lestime, a lesbian association based in Geneva, for the Blues-out project.
This being said, it should be noted that so far the main Swiss LGBT organizations have shown little interest in getting involved in the health arena so as to respond to their communities’ needs. Some of them believe that the gay health project surveys painted too grim a portrait of gay men in society and could damage the public image of the community.
AIDS associations and their umbrella organization, the Swiss AIDS Federation also showed an interest in gay health, most notably regarding Checkpoint which was launched in 2005 by Dialogai. This project was meant as a direct response to the desire to address sexual health, albeit primarily from the standpoint of HIV and STI treatment. Checkpoints were opened by AIDS associations in Zurich, Basel and Bern in the following years. The Zurich Checkpoint also offered mental health services. Generally, most AIDS organizations are still focused primarily on HIV and STI prevention and do not yet seem ready to carry out overall health promotion activities.