ABSTRACT
Objective:
In Türkiye, 5th item of Patient Rights Regulation declares that “Health care services must be provided without distinction of patients’ race, language, religion or religious sect, sex, political opinion, philosophical opinion, economic or social state or any other differences”. The aim of this study is to determine the discrimination faced by LGBT, and violation of their rights based on their gender identity or sexual orientation while receiving health care.
Methods:
Our study was conducted as a cross-sectional survey study. LGBT individuals were contacted through the Black Pink Triangle Izmir Association; For Researches On & Against Discrimination Based On Sexual Orientation and Gender Identity. Questions of our survey were compiled from items of Turkish Patient Rights Regulation and questionnaires which were used in “Surveillance Report of Discrimination Based on Sexual Orientation and Gender Identity in Türkiye” study. All data analyses were performed using SPSS software (version 18.0).
Results:
Sixty-three LGBT individuals were included in this study. Forty-four of the participants (69.8%) were homosexual/lesbian or gay, 11 of them were bisexual (17.5%) and eight of them (12.7%) were transgender. 84.1% (53) of the participants had health insurance. We found that transgenders were exposed to discrimination significantly more than bisexuals and homosexuals (p=0.042). Fourteen individuals claimed that they were exposed to discrimination based on their gender identity or sexual orientation: 11 of them were discriminated by physicians (78.56%).
Conclusion:
We found that LGBT individuals face discrimination more than the general population and usually receive health care in inconvenient conditions. We believe that starting from health care providers, public awareness should be raised about discrimination rates, and also a health care policy should be developed and an action policy should be planned about the discrimination of LGBT individuals.
References
1İnsan hakları evrensel bildirgesi. https://www.ihd.org.tr/insan-haklari-evrensel-beyannames/. Erişim tarihi:13.07.2023
2Çotur H. Hasta hakları ve Kocaeli Gölcük Necati Çelik Devlet Hastanesi personeli ile hastaneye müracaat eden hastaların hasta hakları konusundaki bilgilerinin ölçülmesi [yayımlanmış yüksek lisans tezi] Ufuk Üniversitesi Sosyal Bilimler Enstitüsü, İşletme Anabilim Dalı, Sağlık Kurumları İşletmeciliği Bilim Dalı, 2013. https://acikbilim.yok.gov.tr/bitstream/handle/20.500.12812/106051/yokAcikBilim_10022736.pdf?sequence=-1&isAllowed=y
3Özdemir MH, Salaçin S, Ergönen A. The patients’ rights statutes and the physicians’ sensitivities. Türkiye Kilinikleri J Med Ethics. 2000;8(1):32-37. https://www.turkiyeklinikleri.com/article/tr-hasta-haklari-yonetmeligi-ve-hekim-duyarliligi-34884.html
4Hakan Ozdemir M, Ozgür Can I, Ergönen AT, Hilal A, Onder M, Meral D. Midwives and nurses awareness of patients’ rights. Midwifery. 2009;25(6):756-765. https://doi.org/10.1016/j.midw.2008.01.010
5Hasta Hakları Yönetmeliği. Resmi Gazete No: 23420, 1998.
6http://www.csusm.edu/sjs/documents/homophobiaaweaponofsexism condensed. Erişim tarihi: 14.07.2023
7https://www.change.org/p/mehmet-müezzinoğlu-lezbiyen-gey-biseksüel-transseksüel-interseks-bireyler-yalnız-değildir-yanlış-hiç-değildir-bilgilen-önyargını-yık-ve-yeni-bir-sayfa-aç-her-10-insandan-biri-lgbti-bireyi-olarak-doğmakta-varız-varsın Erişim tarihi: 13.07.2023
8https://tr.wikipedia.org/wiki/%C3%9Clkelerine_g%C3%B6re_LGBT_haklar%C4%B1 .Erişim tarihi:13.07.2023
9http://www.coe.int/t/Commissioner/Source/LGBT/LGBTStudy2011_Turkish.pdf Erişim tarihi: 13.07.2023.
10Türkiye Cumhuriyeti Anayasası, Kanun Numarası: 2709, Kabul Tarihi: 18.10.1982, Yayımlandığı R. Gazete Tarih: 09.10.1982 Sayı: 17863, Yayımlandığı Düstur: Tertip: 5 Cilt: 22. https://www.mevzuat.gov.tr/mevzuatmetin/5.5.2709.pdf
11İş Kanunu, Kanun Numarası: 4857, Kabul Tarihi: 22.05.2003, Yayımlandığı R. Gazete Tarih: 10.06.2003 Sayı: 25134, Yayımlandığı Düstur: Tertip: 5 Cilt: 42. https://www.mevzuat.gov.tr/mevzuatmetin/1.5.4857.pdf
12Türk Ceza Kanunu, Kanun Numarası: 5237, Kabul Tarihi: 26.09.2004, Yayımlandığı R. Gazete Tarih: 12.10.2004 Sayı: 25611, Yayımlandığı Düstur: Tertip: 5 Cilt: 43. https://www.mkilavuz.av.tr/?p=mevzuat&id=138
13İstanbul Bilgi Üniversitesi İnsan Hakları Hukuku Uygulama ve Araştırma Merkezi. Türkiye’de cinsel yönelim veya cinsiyet kimliği temelinde ayrımcılığın izlenmesi raporu 1 Ocak-30 Haziran 2010, İstanbul Bilgi Üniversitesi. 2011.
14Türk Medeni Kanunu, Kanun Numarası: 4721, Kabul Tarihi: 22.11.2001, Yayımlandığı R. Gazete Tarih: 08.12.2001 Sayı: 24607, Yayımlandığı Düstur: Tertip: 5 Cilt: 41. https://www.mevzuat.gov.tr/mevzuatmetin/1.5.4721.pdf
15The Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-I) 1952. https://www.springernature.com/gp/researchers/sdg-programme/sdg3/mental-health- Erişim tarihi 21.07.2023
16The Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II) 1968. (https://shapse.com/articles/dsm.pdf)
17Karataş S, Buzlu S. Difficulty of getting health care of transgender people having. Lectio Scientific Journal of Health and Natural Sciences. 2018;2(2):70-81. https://dergipark.org.tr/tr/download/article-file/635389
18Homosexuality and Sexual Orientation Disturbance: Proposed Change in DSM-II, 6th Printing, page 44. Amerikan Psikiyatri Birliği. Position statement (Retired), 1973.
19Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması El Kitabı, beşinci baskı (DSM-V-TR). (çeviri ed. E Köroğlu) Ankara, Boylam Psikiyatri Enstitüsü, 2018.
20The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), 1980.
21The Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revision (DSM-III-R), 1987.
22The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1994.
23The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-R), 2000.
24Yoksulluk ve Sosyal Dışlanma. Türkiye Psikiyatri Derneği. https://psikiyatri.org.tr/uploadFiles/publicationsFile/file/1972011171129-A9RA284_yeni.pdf , Erişim tarihi: 11.05.2023
25van Heeringen C, Vincke J. Suicidal acts and ideation in homosexual and bisexual young people: a study of prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2000;35(11):494-499. https://doi.org/10.1007/s001270050270
26Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry. 1999;56:876-880. http://doi.org/10.1001/archpsyc.56.10.876
27Aaron DJ, Markovic N, Danielson ME, Honnold JA, Janosky JE, Schmidt NJ. Behavioral risk factors for disease and preventive health practices among lesbians. Am J Public Health. 2001;91:972-975. https://doi.org/10.2105/ajph.91.6.972
28Cochran SD, Mays VM, Bowen D, Gage S, Bybee D, Roberts SJ, et al. Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. Am J Public Health. 2001;91(4):591-597. https://doi.org/10.2105/ajph.91.4.591
29Rankow E, Tessaro I. Cervical cancer risk and papanicolaou screening in a sample of lesbian and bisexual women. J Fam Pract. 1998;47(2):139-143. https://pubmed.ncbi.nlm.nih.gov/9722802/
30Wadsworth E, McCann K. Attitudes towards and use of general practitioner services among homosexual men with HIV infection or AIDS. Br J Gen Pract. 1992;42:107-110. https://pubmed.ncbi.nlm.nih.gov/1493026/
31Harrison AE, Silenzio VM. Comprehensive care of lesbian and gay patients and families. Prim Care. 1996;23:31-47. http://doi.org/10.1016/s0095-4543(05)70259-1
32White JC, Dull VT. Health risk factors and health - seeking behavior in lesbians. J Womens Health. 1998;6(1):103-112. https://doi.org/10.1089/jwh.1997.6.103
33McNair R, Anderson S, Mitchell A. Addressing health inequalities in Victorian Lesbian, Gay, Bisexual and Transgender Communities. Heath Promot J Austr. 2001;11(1):32-38. https://www.researchgate.net/publication/279463931_Addressing_health_inequalities_in_Victorian_lesbian_gay_bisexual_and_transgender_communities
34Korkmaz M, Aydın Avcı İ. Halk Sağlığı Hemşirelerinin LGBT Bireylerin Sağlıklı Yaşam Sürdürmelerindeki Rolü. SETSCI Conference Indexing System. 2018;3:460-466. https://www.researchgate.net/publication/348817700_Halk_Sagligi_Hemsirelerinin_Lgbt_Bireylerin_Saglikli_Yasam_Surdurmelerindeki_Rolu
35Martin-Pérez A, González E, Marrero N, Rebollo J. LGBT people and discrimination in the area of health in Spain. FELGTB 2015.
36Marin C. Documentation of discrimination in the field of LGBT heath in Romania, general overview, legal framework, findings and recommendations. ACCEPT Association 2014.
37Hidasi B. Documentation of discrimination in the field of health of trans people in Hungary. Transvanilla Transgender Association; 2014. https://books.google.com.tr/books/about/Documentation_of_Discrimination_in_the_F.html?id=3r7SvQEACAAJ&redir_esc=y
38Grzejszczak R. Transgender and healthcare in Poland. 2014.
39Showdon S. The medical school curriculum and LGBT health concerns. Virtual Mentor. 2010;12(8):638-643. http://doi.org/10.1001/virtualmentor.2010.12.8.medu1-1008
40Poteat T, German D, Kerrigan D. Managing uncertainty: a grounded theory of stigma in transgender health care encounters. Soc Sci Med. 2013;84:22-29. https://doi.org/10.1016/j.socscimed.2013.02.019
41Aypar G, Tanyaş B. İstanbul’da yaşayan transların dışlanma ve ayrımcılık deneyimleri üzerine nitel bir çalışma. Sosyal Bilimler Dergisi. 2017;2(1):71-90. http://openaccess.altinbas.edu.tr/xmlui/handle/20.500.12939/1915
42Dakić T. New Perspectives on Transgender Health in the Forthcoming 11th Revision of the International Statistical Classification of Diseases and Related Health Problems: An Overview of Gender Incongruence - Depathologization, Considerations and Recommendations for Practitioners. Psychiatr Danub. 2020;32(2):145-150. https://doi.org/10.24869/psyd.2020.145
43Lombardi E. Transgender Health: A Review and Guidance for Future Research-Proceedings from the Summer Institute at the Center for Research on Health and Sexual Orientation, University of Pittsburgh. Int J Transgend. 2010;12(4):211-229. https://doi.org/10.1080/15532739.2010.544232
44https://kaosgldernegi.org/images/library/2011lgbt-haklari-insan-haklaridir-saglik.pdf Erişim tarihi: 13.07.2023. http://doi.org/
45Ozdemir MH, Ergönen AT, Sönmez E, Can IO, Salacin S. The approach taken by the physicians working at educational hospitals in Izmir towards patient rights. Patient Educ Couns. 2006;61(1):87-91. http://doi.org/10.1016/j.pec.2005.02.013
46Kurtcebe ZÖ. Bir üniversite hastanesine başvuran hasta ve yakınları ile araştırma görevlilerinin hasta hakları konusundaki bilgi, tutum ve yararlanma durumlarının değerlendirilmesi, (yayımlanmış tıpta uzmanlık tezi). Gazi Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı, 2009. https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=qHVoli_5Sq3eXTUjjHKZ-w&no=cblNFjZCAEei7_N7Ju98Bw
47Yılmaz H. Osmangazi Üniversitesi Eğitim Uygulama Araştırma Hastanesi’nde yatan erişkin hastaların hasta haklarından yararlanma durumları ve hemşirelerin hasta haklarına ilişkin görüşleri, (yayımlanmış yüksek lisans tezi). Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü, Hemşirelik Esasları Anabilim Dalı, 2002. https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=5fWF_0fXm986nsDKfORXkg&no=y6mwxQu0EANSTwNzcYY3Sw
48Çabuk FD. Tıp öğrencileri ve hekimlerin eşcinsellik hakkındaki tutumları ve gey ve lezbiyenlerin sağlık hizmeti deneyimleri, (yayımlanmış tıpta uzmanlık tezi). Gazi Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, 2010.
