LGBTQ+ Healthcare in Hong Kong | Up for Discussion with Professor Edmond Choi
"LGBTQ+ individuals have significant health needs that we actually have not really looked into or not widely addressed in places like Hong Kong.” In this episode of Up for Discussion, we are excited to welcome Professor Edmond Choi from the University of Hong Kong, a leading expert in mental and sexual health, particularly within the LGBTQ+ community. Join us as Professor Choi shares his journey into LGBTQ+ healthcare research and discusses the unique health challenges faced by this community in Hong Kong.
We will explore critical topics, including:
- The current state of healthcare access for LGBTQ+ individuals in Hong Kong
- The importance of inclusive sexual health education - The impact of societal stigma on mental health and healthcare utilisation
- Strategies for improving health outcomes through better policies and
- Practices Professor Choi emphasises the urgent need for comprehensive healthcare solutions that cater to the diverse needs of LGBTQ+ individuals.
Tune in for an enlightening discussion on how we can advocate for better health resources and support for the LGBTQ+ community, fostering a more inclusive society for all.
Video Transcript
[Blake Chan] (0:16 - 19:05)
Hello, I'm Blake Chan at Community Business and I'll be your podcast host for this episode. Today we are delighted to be up for discussion with Professor Edmond Choi from the University of Hong Kong. Professor Choi is an Associate Professor at HKU's School of Nursing and Director of the Master's Program in Nursing.
A registered nurse and fellow of multiple prestigious organizations, his research focuses on mental and sexual health and he has published over 100 articles in high-impact journals like the Journal of Sex Research. Beyond research, Professor Choi is a celebrated educator, leading innovative programs and receiving the HKU Early Career Teaching Award and Faculty Teaching Medal. His initiatives include developing experiential learning projects in Africa and Asia.
Professor Choi, thank you for joining us on Up for Discussion. Thank you, Blake. First, could you please start by telling us a little bit about yourself and what led you to focus your research on LGBTQ plus health care?
[Edmond Choi]
Yeah, thank you very much for your kind introduction. So I'm Edmond, Associate Professor in Nursing from the University of Hong Kong. So actually, regarding my research journey, it is quite amazing because at the very beginning when I started my research journey, my research focus is totally irrelevant to sexual health or mental health of LGBTQ plus community.
So at the very beginning, I started my research in the area of health services research during my master's degree program. But when I applied for the PhD program, I have to develop another new research area. By that time, during my time as a PhD applicant, the use of dating apps is very, very popular.
That made me think whether I would like to see whether there are some impact of using dating apps on mental health or other health outcomes, including sexual health. So when I started my research in the area of sexual health, dating apps use and other health-related outcomes among LGBTQ plus population, I realized that research on sexual health, particularly in Asia, was quite limited or very under-researched. So consequently, I observed that LGBTQ plus individuals have significant health needs that we actually have not really looked into or not widely addressed in places like Hong Kong.
So that led me to focus my research on LGBTQ plus healthcare nowadays, specifically target the sexual health among gay and bisexual men in Hong Kong.
[Blake Chan]
Can you provide an overview of the current state of healthcare in Hong Kong for LGBTQ plus individuals? Why is it crucial to address these issues now?
[Edmond Choi]
Okay, I think first of all, I would like to talk about PrEP HIV exposure over lessers. So actually, it is a highly effective method for reducing the risk of HIV infection. So it is endorsed by national health guidelines in numerous countries.
For example, in the UK, PrEP is readily available and provides free of charge at the NHS sexual health clinics. So the wide accessibility support by PrEP preventive measure against HIV. But however, in the Asian region, and particularly in Hong Kong, access to PrEP is significantly more restricted and limited.
So in Hong Kong, it is not available through the government funded public health or primary healthcare system, which may create a substantial barriers for those who need it. So consequently, individuals in Hong Kong requiring PrEP, for example, must often resort to purchasing it at private clinics or NGO at a high cost or travel abroad to countries like Thailand. So this situation actually leads to a pronounced inequality because not everyone can afford this costly alternative.
And also, I would like to touch on sex education in Hong Kong. As you may be aware, nowadays there is a very rigorous debate regarding the teaching resources for modules on intimate relationships within the new subject, citizenship, economics, and society, which is compulsory for students for Form 1 to Form 3 in Hong Kong high school. Today I'm not going to discuss this in detail.
But anyway, I would like to say that access or sexuality education is still quite limited in Hong Kong and remains very heteronormative. Some important aspects of sexual health are neglected, such as sexual rights, freedoms, of course, sexual and gender diversity. In conservative sexual health programs, there is often a need to know representation of LGBTQ plus individuals and relationships.
This lack of a representation can lead to feelings of isolation and invisibility among LGBTQ plus students, who may struggle to see themselves reflected in the curriculum. It also promotes ignorance among non-LGBTQ plus students who receive no education or have no insight on the diversity of human sexuality and relationships. Without an inclusive education opportunity, misconceptions and stigmas about LGBTQ plus people persist.
When education systems adopt a conservative stance that excludes or misrepresents LGBTQ plus issues, it implicitly or sometimes explicitly teaches that heterosexuality is the norm or more preferable. This can foster an environment where bullying, both verbal or physical, can occur, leading to an unsafe learning environment for our LGBTQ plus students as well. And I think another very significant issue is related to mental health of LGBTQ plus people.
A member of the LGBTQ plus community often face significantly elevated risk of mental health issues due to various stressors, including homophobia, experiences of stigma and discrimination, the emotional toll of coming out and social isolation. So these challenges can lead to higher rates of depression, anxiety, substance abuse, and suicidal ideation as well, compared to the heterosexual and cisgender counterparts. For example, based on some scientific literature review, we find that the preference of major depressive disorder within this community was around 30%, markedly higher than the global preference of the major depressive disorder in the general population.
And also poor mental health can severely disrupt our daily life, making it difficult for individuals to work, maintain relationships, and manage daily tasks. So over time, this can lead to greater social isolation and decreased quality of life, reinforcing the cycle of mental health challenges among LGBTQ plus populations. And also poor mental health among MSM also poses a significant public health concern due to its association with an increased risk of HIV transmission.
Studies have shown that, for example, depression in MSM, men who are obsessed with men, is linked to behavior that elevates HIV transmission risk, such as unprotected sex, substance use, and having multiple sexual partners. Also, depression is associated with a lower likelihood of undergoing HIV testing among MSM. And we also find that, based on the study in Hong Kong, the health service utilization related to mental health services among LGBTQ plus communities remains suboptimal.
For example, a local study in Hong Kong found that among MSM facing mental health challenges, less than one-third recognized the need for professional help, and less than 10% have sought mental health services in the last year. So many LGBTQ individuals don't seek mental health services due to fear of being judged or misunderstood by health professionals, who may not be familiar with or sensitive to their unique need or experience as well. So additionally, there are often lack of mental health professionals who are specifically trained to address the specific health challenges of LGBTQ plus communities.
Moreover, in Chinese culture, you know that there's still a lot of shame tied to both mental health issues and being a member of LGBTQ plus communities, which can prevent people from seeking the health they need. So, talking about mental health, another related issue is ChemSex, what we call sexualized drug use. So CHEMSEX involves the use of certain types of drugs, such as methamphetamines or GPL, commonly used in this CHEMSEX behavior.
So people engage in CHEMSEX for different reasons. For example, they would like to enhance their sexual pleasure, extend the duration of sexual encounter, and lower inhibition. But I would like to tell you that it should be noted that both straight and LGBTQ plus individuals will practice CHEMSEX, because when we talk about CHEMSEX, we always associate it with homosexuality or gay or bisexual men.
But in fact, based on statistics, we found that both straight and LGBTQ plus will practice CHEMSEX. But of course, based on our statistics, we find that gay or bisexual men are more likely to have this practice. As what I just mentioned, individuals may engage in CHEMSEX to experience an increased sense of intimacy and improve sexual performance.
Some use these drugs to enhance experience as a way to cope with psychological stress or personal issues, highlighting a complex interplay between mental health and substance abuse. So, drugs commonly used during CHEMSEX significantly reduce inhibition and impair judgment. This can lead to engaging in risky sexual behavior that individuals may avoid, such as unprotected sex or having multiple sex partners in a single session.
CHEMSEX is often associated with prolonged sexual encounter. Longer duration and greater physical intensity can lead to physical trauma, which is a potential entry point for virus and bacteria. So that's the reason why CHEMSEX sometimes will increase the risk of sexually transmitted infections.
And another issue related to CHEMSEX is also very worrying. It's about the sexual violence or intimate partner violence. Because drugs used during CHEMSEX, such as HBGBL, are known for significantly reduced inhibition and impairing cognitive judgment.
So this can lead individuals to engage in behavior that they would not otherwise consider, for example, like aggressive or non-consensual sexual acts. And certain drugs, for example, like GHB or GBL, can cause users to lose consciousness or enter a semi-conscious state. So in such conditions, individuals may not be able to give or withdraw consent, making them vulnerable to sexual assault.
So, however, intimate partner violence within the LGBTQ community often goes unrecognized or underreported. It is partly due to the zozoto stereotype that either minimizes or overlooks the existence of IPV outside of the heterosexual relationship. And more existing support services and intervention for IPV survivors are designed with heterosexual women.
So these services often do not account for the unique challenges and dynamics in the LGBTQ plus populations.
[Blake Chan]
Professor Choi, what are some common experiences and challenges that LGBTQ plus community encounter when assessing healthcare services?
[Edmond Choi]
Sometimes it may be related to the medical or insurance coverage, because especially policy provided through employment in Hong Kong.
As you may know, the legal recognition of same-sex marriage is very limited in Hong Kong. So often, resulting in employer-provided health insurance policy may not be able to cover same-sex partner. So, you know, this lack of coverage can create significant barrier to assessing necessary health services for LGBTQ individuals and their family members.
And also discrimination is also a very concerning area, because based on our study or based on our personal experience, so some LGBTQ plus clients may display discrimination when assessing healthcare services, as not all providers may be sufficiently sensitive or informed about the specific healthcare needs of the LGBTQ plus community. You know that inappropriate or insensitive language can make patients or clients feel uncomfortable and unwelcome. Also, the fulfilling heteronormative assumption in healthcare setting can lead to incorrect presumption about patient sexuality and sexual orientation.
And then this lack of awareness and insensitivity can hinder provision of equitable and compassionate care for our client as well. So you mentioned that insurance is a very tough and tricky topic, and a lot of employers provide insurance for their employees. How can employers better support their LGBTQ plus employees?
So I think it is important to see whether they can have more benefit coverage for LGBTQ plus employees' partner. For example, because nowadays I know that some insurance companies will accept beneficiaries or the coverage for their LGBTQ plus partner as well. So I think when the employer would like to provide such benefits or insurance coverage for their employees, they should consider whether they can find an insurance company that can be more LGBTQ friendly, so that the LGBTQ employees' family can also be covered.
[Blake Chan]
Thank you. How do you feel about the future of LGBTQ plus healthcare?
[Edmond Choi]
I think it's very important to have a more inclusive health policy, because I think it's very important to develop and implement an inclusive healthcare policy that explicitly cater the needs of LGBTQ plus individuals.
So for example, I think non-discriminatory policy is very important and should be put emphasis in all healthcare settings. It's crucial to develop and implement this kind of policy in order to respect our LGBTQ plus community with dignity, because of their sexual orientation and gender identity. And importantly, I think training for healthcare providers is also very important.
For example, like continuous educating healthcare providers, like nurses, medical doctors, about LGBTQ plus specific health issues to enhance their competency in providing care to this group. And to be honest, as a nurse educator in Hong Kong, I do think that we do not provide adequate training for our future nurses about the LGBTQ plus community and how we should provide individualized care to our clients with different gender and sexual orientation as well. And removing barriers and ensuring that every individual has access to healthcare services they need without facing prejudice or bias.
So I think it's also very important. That was obvious because I'm a researcher. I think that the government or the funding body should put more resources or provide more funding opportunity for research in the area of LGBTQ plus community, because we need more evidence, local data in order to inform our healthcare to make a better health system for everyone.
[Blake Chan]
Is there any resources that the LGBTQ plus community can make use of because of this lack of healthcare from the government side?
[Edmond Choi]
I know that there are different NGO or different private clinics. So they are very good that they provide specific care or more individualized care for our LGBTQ plus community.
But of course, because it is outside of the public health or government fund, the primary care system, so you have to pay. So as I mentioned before, not everyone can afford the medical expenses in private sector. So it's also the issue why I think it's very important to make our government funded healthcare system to be more inclusive.
So that everyone in Hong Kong can deserve a better healthcare, even within the government healthcare system.
[Blake Chan]
Do you think we should mention by name what some of these resources are?
[Edmond Choi]
So for example, I know that like AIDS Concerns or even the LGBTQ Medical Society, in fact, I think they did a lot of work, advocacy work, public education and provide a lot of resources for our LGBTQ plus community.
There are a lot more, in fact, but these two I'm more familiar with.
[Blake Chan]
Thank you, Professor Choi. Finally, a question that we like to ask all our guests.
What do you think is the biggest way we can make a ripple of change throughout society?
[Edmond Choi]
It's a very good question. I know it is a little bit cliche, but I still believe that it's very important to have legal protection and recognition of LGBTQ plus status in Hong Kong, because it not only affirms the dignity and the equality of LGBTQ plus individuals, but also set a fundamental or foundational standard for our society.
Because legal recognition can lead to a greater awareness and social acceptance. So we are very crucial for reducing stigma and discrimination. And it can also empower the LGBTQ plus community by ensuring access to rights and services that many take for granted, like marriage, adoption and social welfare as well.
So I think it is very important. And by embedding this protection into law, Hong Kong can in fact send a strong message to everyone over the world that it values all citizens equally. It is particularly important when Hong Kong wants to be a leading global society.
So I think this kind of more inclusive and diversity background can attract more talent or expect to come to Hong Kong.
[Blake Chan]
I completely agree, Professor Choi. Thank you so much for your time and thank you for coming up for discussion.
Before we go, I'd like to shout out again some resources that Professor Choi has mentioned, including AIDS Concern as well as the Hong Kong LGBT Medical Society. Thank you everyone for listening in and we'll see you next time.