Building Support, Celebrating Contributions Are Key to LGBTQ+ Pharmacists

In an interview with Pharmacy Times, Liam Volk, MPharm, president-elect of the Pharmacists’ Defence Association LGBT+ Network, discussed how pharmacists can best support their LGBTQ+ colleagues and patients.

Q: Do you have any data or insights on the LGBTQ+ workforce within pharmacy?

Liam Volk, MPharm: So not much for pharmacy in general, because I think, a couple of reasons. Pharmacists are a bit more of a low-key profession I think as a whole, it's not one that there’s typically lots of information on demographics. I think when I looked at in the UK, the Office of National Statistics said that around 3.1% of the population was in the group of LGB. And about another 0.5% youth were with the term, their gender identity was different to the sex they were registered at birth. So roughly say about 0.5%, in addition to the 3.1% who would identify as non-binary or transgender, or something else. And similarly, there's a Gallup poll in the US, said there was about 7.1% of the population as a whole, that identify as LGBT. I'd say any figures like this, you'd have to take with a pinch of salt, because a lot of people around the world don't answer. There's a lot of people who maybe wouldn't want to answer, a fear, or maybe just wouldn't consider themselves LGBT, even if their actions maybe would suggest something, like particularly groups like MSMs. So men who have sex with men, quite often you'll have much higher levels of activity than would identify as such. So it's pretty hard to actually get figures. But you would expect there's quite a lot, like a sizable amount given how many people in the world are pharmacists and pharmacy techs.

Q: What types of community or support system is there for LGBTQ+ pharmacists, and why is this so important?

Liam Volk, MPharm:

I'm quite lucky, because I am in the UK, we as well as having a position where much of our larger community pharmacy chains, so for us, it'd be Boots or like Lloyds pharmacy, in America it'd be more like your Walgreens and CVS’ I’d imagine would be quite similar. Lots of the larger chains, community pharmacies, will have their own LGBT+ networks, where people can get support there. Similarly, healthcare trusts in the UK and I imagine larger hospital chains in America would be the same as well. In the UK, we also have a number of trade unions, which represent pharmacy. And we have the pharmacy union, which is the PDA union, which also has an LGBT+ network, which I just became president of about a month ago. So that's really useful as well.

I think anything like that really, is really good to have a support network for LGBT+ professionals in general, because I think, in my experience, we have a really good WhatsApp, which is about 50-60 of us all around the UK, in hospital pharmacy, in community pharmacy. And it's always been quite nice, because quite often, you can be quite in a silo as a professional and not really see what other people are going through, particularly if you are like the only LGBT person openly in your area. So it's quite nice that we can have a chat sometimes people have given advice on things work-related, like bullying, discrimination, that sort of stuff, but often, it's quite fun, quite enjoyable, quite lighthearted chatter goes on. I know we've attended parade last year, and we're going to do it again this year for the pharmacy union. We're also, I know a couple of times people have given other members of the group advice on things like LGBT adoption, and LGBT+ parenting, giving them quite good advice and some referrals for that, which is also quite nice, because I think, as well as being a professional support network it’s really good for LGBT people to support each other at a personal level as well, because quite a lot of people don't even have any friends who are in the same boat as them as that goes, as opposed to friends in the same field. So I think we've all found that quite valuable.

Q: How have LGBTQ+ pharmacists changed and contributed to the pharmacy field?

Liam Volk, MPharm: So it's difficult to know, because I think pharmacists as a profession, we are --and team pharmacy techs, and anyone who worked in pharmacy -- very modest, tend to kind of play ourselves down a bit, tend to go in that fit in the background a little bit. I think a lot of that comes from our modesty, a bit of an awkwardness to sort of pick ourselves up a bit, which is why I think it can be harder to find really good examples. But in speaking on a personal level, I have always been very lucky to have some really good LGBT+ pharmacists role models. So when I was a trainee, the leader of the trainee program was a out and proud lesbian woman, and she was there and she was very well accepted within the group and in our company. She was open and everyone was really supportive of her. So I think that was really good, because it kind of, she created a culture where if anyone new was coming in and was LGBT+ you kind of knew that you could be quite open about it and not feel like you had to hide, because she was like a bit of a beacon in a way, sort of “Look at me like, I'm safe to be me in work. And so, you can be as well.” So that was quite good. Similarly, when I moved into hospital pharmacy, my manager there, Mackey, who is our chief pharmacist who has now gone on to be chief of a bigger pharmacy trust in the UK, he, again, out and proud gay man, really kind of flew the flag from a managerial perspective, he was another person, very out and proud, and kind of encouraged others to be the same, which was, I think, being quite lucky in that regard.

On a more less personal level, I have a couple of people actually within our committee, on our LGBT+ committee that I’m on for the UK, we have Soji Ken, who is, actually won an award recently from the Scottish Trade Union Congress for equality for all of his advocacy for LGBT workers in Scotland. And I mean, he's, I think barely 21, 22. He's been working for LGBT advocacy since he was a teenager. And he's originally from Malaysia, where, obviously homosexuality is illegal. So he's a very brave and bold person. We also have one of our members, Josh Welles, who is, again, another gay man, he is the senior clinical lead for this really cool electronic app platform that they've created called Lavender Health, which is kind of an online health platform set up for LGBT+ people. So they can access help on things like PrEP, STD screening, mental health advice, and its treatment provided by either LGBT+ clinicians, or LGBT+ allies, who have had lots of training and experience in that field. So it's very much a sort of specialists sort of fields, where people can kind of feel open, kind of comfortable and be in themselves. And I think that's obviously a very big thing, particularly because there's a lot of studies have shown that lots and lots of LGBT+ people have kind of avoided or kind of postponed medical treatment. I mean, in the US, studies are showing that about a quarter, not a quarter, it's actually about 15% of LGBTQ Americans have said they've postponed or avoided medical treatment, due to either discrimination or the fear of being discriminated by healthcare professionals, that's way higher in transgender people, that's roughly a third. So I think it's really useful to be very open and loud about these sorts of groups.

Q: Having a diverse pharmacy workforce is crucial to provide care for diverse patient populations. Why is this so important for LGBTQ+ patients?

Liam Volk, MPharm: Oh I think it's absolutely very important, because I think if you have a very -- same with everything -- it's very much an intersectional affair, I think you should be, you need people of various sexualities, gender identities, genders, ethnicities, religions, economic backgrounds, etc. because I think you can take a lot more people's opinions on board. If you've got a group of people making big decisions, who are, let's say all white, cisgender, wealthy people, who are straight, it's very likely that they haven't, they may not make a decision that takes into account everyone’s lived experiences or reality. And it's not going to be representative of the population. I think that's really much the case, and a lot of what goes on in politics in the US and the UK is that it's actually not really a representative of what the whole population experiences.

And I can think of an example in the UK, there's lots of issues with lesbian and same-sex female couples in particular, we've had some really quite difficult environment that's been created by policymakers. So in the UK, a lot of like local health boards have required any female same-sex couples to self-fund its artificial insemination cycles before they can access free NHS-funded IVF, whilst straight couples just need to have tried for a certain amount of periods. And obviously this, this artificial insemination costs about one 1500-1600 pounds a cycle; it’s very expensive. It's been known as the “lesbian tax” or so, because it's putting these parents at a massive financial burden before they can even start to access free services, which other people can't. And I think that came through because our big institute, which is obviously in charge of health policy, NICE, they advised that women under 40 were eligible to get IVF if you tried for a family for 12 years, two years sorry, or if you've had 12 or more unsuccessful rounds of IVF, or artificial inseminations. So obviously that's very much, you can see why these health boards have brought that in. But I wonder if there was more representation of same sex couples, or LGBT+ individuals on these committees making these decisions, would the policies have come through that would impact people in such a negative way? I would probably say no.

Q: How can pharmacists (even those who are not LGBTQ+) support their LGBTQ+ patients?

Liam Volk, MPharm: Okay, so there's a couple of good things you can do here, I'd say. First one would be, don't assume that a patient is cisgender and a heterosexual. You don't know people's experience, you know, people's existence. I would say, don't assume, because it can be quite invalidating. I mean, I've been in situations when I myself have got healthcare, and they've asked me questions like, “Have you got a girlfriend?” then I'm like, oh, no, I don't. And they go, “Okay, so you're single,” tick. And then, it's just it's very invalidating, it's very much a case of you feel quite invisible, and you kind of feel like you can't really express yourself freely in that situation, which is never really a good place to be in, if you’re having a consultation with a health care professional. So I think that's a huge one. I would say, particularly as well, with elderly patients. I think particularly, as we are reaching a part now where people are living longer, and I think visibility, increased visibility has gone on for enough time now that there's a lot of LGBT+ elderly people that are entering the population. So a lot of people of a certain age who are more -- obviously, elderly LGBT people are more likely to live alone, more likely not to have children, they're more likely to not have anyone who can depend on them. So I think that is another issue as well, I think that needs to be addressed. And so, big thing would be to be open and honest with patients. And it's also, just be mindful of pronouns of your patients, if they are, particularly if they're undergoing -- if you know they are transgender or non-binary, it's always good to say, “Oh, my pronouns, are he/him,” whatever they are, like, “Oh, my pronouns, are he/him, can I ask you what yours are?” And I find, if you are dealing with patients, particularly those who you know have issues -- are dealing with gender dysphoria, or are non-binary or trans, I think that they really appreciate that you kind of make an effort and will take that on board. And I think if you're expressing that you're supportive of them, I think it's a really good way to kind of build a really good rapport with them. And they tend to be a lot more engaged and open and honest with you, which I think is always handy.

I'd say to show that allyship, as well. Make sure if it is possible, I know at some places you can wear pronoun badges or like, there’s like a little pride progress flag badge that you can have to show that you are an ally, so to speak, so people know that they can speak to you about these matters. I’d also say that something that we have tried on our LGBT+ network as the pharmacists union is to amend the curriculum of universities, because lots of studies in the UK and abroad have shown that the university curriculum for pharmacy education is not very diverse or inclusive, outside of like cisgender, heterosexual normality. So it's very much minimizing the different healthcare experiences of LGBT people. It's not really included things like PrEP, and it's not really including things like safe sex, as well as stuff like that, which is problematic, I’d say. I think a lot of it comes from a place that is well meaning. It's very much a case of people quite often don't want to offend, like lots of university people do not feel there’s the time in the curriculum, and I know that the university has issues with funding, so they may not have the staffing either. But I think it's definitely something that we need to have more of a broad curriculum, because there's kind of this impression, I would say, that I would never need to know like, this is speaking from quotes that I've read, I would never need to know my patients gender identity or sexuality because it's not relevant to their healthcare, which, appreciate the statement, that's lovely. And I think it's good they’ve realized that it doesn't really matter in general, but it actually is relevant to health care and it is relevant for interacting with these people as patients. So I think it is good to get that out there as well.