The development of a Gay Health initiative from the work of Gay HIV Strategies emphasises the importance of addressing the general health inequalities faced by the LGB population in Ireland. It recognises that the health and well-being of lesbian, gay and bisexual people is compromised by social discrimination, heterosexism and the lack of cultural competence in many health settings.

Research has identified the existence of both higher levels of ill-health among LGB people and the existence of heterosexism and homophobia. While it can be relatively easy to establish a causative link between homophobia and the effect on someone’s health as an individual, it is perhaps more difficult to achieve this at a population level. However it seems reasonable to suggest that heterosexism and homophobia are among a range of factors contributing negatively to the health of the LGB population.

A clear example of the effect of negative social attitudes in primary care is the number of LGB people who do not reveal their sexual orientation to their GP due to embarrassment or fear of a negative response which can affect the quality of care and their relationship with the GP.

Individual practitioners may feel that their practice is open to all and that they have no problems with the sexual orientation of the person consulting them. But in the absence of measures to make it clear that LGB people are welcome, the risk of assuming everyone is heterosexual is real and exacerbates the challenge of coming out for the LGB person.

Addressing the impact of heterosexism and homophobia on LGB health requires interventions that deal with the outcomes and the structural inequalities that promote it.

Gay Health Strategies and colleagues in GLEN will work to ensure that actions to meet the health needs of the LGB population address four strategic areas, which are:

• Public Profile
• Policies and Procedures
• Professional development
• Programme development

GHS and the Director of Mental Health Strategies are members of the recently convened HSE LGBT sub-committee.