Lesbian, gay and bisexual (LGB) people: introduction

We do not understand the health needs of lesbian, gay and bisexual (LGB) people living in Scotland well.  The main obstacle to better health information about LGB people is that they are not identifiable in routine health surveys or in most population based research studies.

This lack of information is not restricted to health topics. Reliable information on the size of the LGB population is absent. Although same sex co-habitation is now included in the census, questions about sexual orientation are not.

When the UK government was introducing the Civil Partnership Act 2004 an impact assessment was carried out to estimate how many people might apply for a civil partnership. The government used a variety of information sources in their Final Regulatory Impact Assessment: Civil Partnership Act 2004(119 Kb) to estimate that approximately 5-7% of the UK population might be LGB. This estimate should be used with caution. It relied on information collected in other countries that may be quite different to Scotland. Also, it is not clear how the different studies included defined sexual orientation.

The National Survey of Sexual Attitudes and Lifestyles (Natsal) provides an estimate of the number of adults aged 16-44 years in Britain who have ever had same sex partners.  The most recent survey (Johnson et al., 2001) reported that 5.4% of men and 4.9% of women reported ever having had a same sex partner. The survey did not collect information about self-identified sexual orientation so cannot be used directly to estimate the numbers of LGB people in Scotland.

Defining the LGB population

"An ethnic group or ethnicity is a population of human beings whose members identify with each other, usually on the basis of a presumed common genealogy or ancestry." (Smith, 1987).

Sexual orientation is a self-defined identity. Classification is based on commonly accepted terms that allow appropriate use for research or policy. While an individual's self-identification with an ethnic group is based on assumed common cultural or ancestral connections, in the case of the lesbian, gay and bisexual population it is based on assumed common experience, although this experience will vary in its details from individual to individual. Components of this common experience include 'coming out' and experiences of discrimination.

'Coming out' includes both the process by which someone who is lesbian, gay or bisexual comes to accept their non-heterosexual sexual orientation and the continuing disclosure of that sexual orientation. Due to the general assumption that all people will be heterosexual, people who are lesbian, gay or bisexual must correct and challenge this assumption when it is encountered.

Discrimination, in the forms of heterosexism and homophobia, can lead to a fear of disclosure of non-heterosexual sexual orientation, even at times when it may be pertinent. This fear of disclosure means that lesbian, gay and bisexual people variously practice concealment of their sexual orientation in different settings.

The experience of heterosexual people is significantly different. They do not need to explain or define their sexual orientation to others, as it coincides with social expectations. They do not experience heterosexism negatively or homophobia unless perceived to be lesbian, gay or bisexual.

Identity and behaviour

The process of coming out experienced by self-identified lesbian, gay and bisexual people is a mental and social process, not one of sexual behaviour. For example, someone can recognise and accept that they are predominantly or exclusively gay without ever having engaged in any sexual activity. Similarly, the majority of people who are heterosexual accept that they are so without having to engage in sexual activity, and typically do not question the assumption that they are heterosexual.

Sexual behaviour and sexual attraction are not necessarily congruous with self identified sexual orientation. Sexual behaviour varies between individuals in self-identified sexual orientation groups and particular sexual acts are not exclusive to any particular group.

Impact on data collection

Clearly both sexual orientation and sexual behaviour are sensitive pieces of data, and collection needs to be done with care and forethought. Recording self-identified sexual orientation is of importance both in terms of individual and population health. Sexual behaviour should be recorded separately when necessary as it may not correlate with self-identified sexual orientation. The main value of recording sexual behaviour data is for sexual health care, though they may also be relevant to general health.