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Durham E-Theses Durham E-Theses Normalized Absence, Pathologised Presence Understanding the Health Inequalities of LGBT People in Greece GIANNOU, DIMITRA How to cite: GIANNOU, DIMITRA (2017) Normalized Absence, Pathologised Presence Understanding the Health Inequalities of LGBT People in Greece , Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/11989/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 “Normalized Absence, Pathologised Presence” Understanding the Health Inequalities of LGBT People in Greece Dimitra Giannou School of Applied Social Sciences February 2017 Thesis submitted to Durham University for the degree of Doctor of Philosophy TABLE OF CONTENTS TABLE OF CONTENTS ......................................................................................................1 LIST OF TABLES..................................................................................................................4 STATEMENT OF COPYRIGHT .......................................................................................5 ACKNOWLEDGMENTS .....................................................................................................6 ABSTRACT .............................................................................................................................8 CHAPTER 1 ...........................................................................................................................9 INTRODUCTION ..................................................................................................................9 1.1 The rationale and the research questions of the study .................................9 1.2 The health system and the right to equal treatment in Greece ..................... 14 1.3 Exploring LGBT health inequalities at a time of austerity in Greece ........... 17 1.4 The LGBT movement in Greece ............................................................................. 20 1.5 Exploring the international debate on LGBT health inequalities ................... 22 1.6 Chapter Breakdown .................................................................................................... 27 CHAPTER 2 ......................................................................................................................... 29 RESEARCH METHODOLOGY ...................................................................................... 29 Introduction .............................................................................................................................. 29 2.1 Intersectionality as the theoretical context of the study ...................................... 29 2.2 Qualitative research studies and ethnography ...................................................... 34 2.3 Sampling and Data Collection .................................................................................... 36 2.3.1 The participants ....................................................................................................... 41 2.3.2 Fieldwork and research sites ............................................................................... 44 2.3.3 Reflections on group interviews .......................................................................... 47 2.3.4 Reflections on semi-structured interviews ....................................................... 48 2.3.5 Narrating the place of ―I‖ within my research and the insider/outsider question ................................................................................................................................ 50 2.4 Data Analysis ................................................................................................................... 56 2.5 Ethical Considerations .................................................................................................. 58 Conclusions ............................................................................................................................. 60 CHAPTER 3 ......................................................................................................................... 62 THE CONSTRUCTION OF LGBT INVISIBILITY IN HEALTH CARE ................. 62 Introduction ........................................................................................................................... 62 3.1 The heterosexual assumption as a form of discrimination in health care ..... 63 1 3.2 Assuming information on sexual orientation as being irrelevant to health care ............................................................................................................................................ 69 3.3 Same treatment in unsafe environments ................................................................ 74 3.4 The individualization of stigma and its role in the invisibility of LGBT people ..................................................................................................................................................... 84 3.5 The invisibilizing effect of depersonalized health care services ....................... 94 3.6 ―I would confuse her if I came out as pansexual‖: The erasure of bisexual and non-binary identities in health care .......................................................................... 98 3.7 Ensuring safety for disclosure in health care settings ....................................... 105 3.7.1 An intersectional analysis of the role of confidentiality to disclosure decisions ............................................................................................................................. 113 3.8 The impact of invisibility on LGBT same-sex couples and carers in hospital settings .................................................................................................................................... 120 Conclusions ........................................................................................................................... 128 CHAPTER 4 ....................................................................................................................... 130 THE PATHOLOGISATION OF LGBT BODIES AND ACCESS IN HEALTH CARE ................................................................................................................................................ 130 Introduction ......................................................................................................................... 130 4.1 The pathologisation of non –penetrative sex and its impact on lesbians‘ access in health care ....................................................................................................... 131 4.2 The pathologisation of anal sex and its impact on gay men‘s access in health care ....................................................................................................................................... 139 4.2.1 VIP patients or contaminating bodies? The health care of people who live with HIV ................................................................................................................................... 144 4.3 The pathologisation of trans bodies and its impact on trans persons‘ access in health care .......................................................................................................................... 152 4.3.1 Transition related medical care in Greece ........................................................ 152 4.3.2 The primary and secondary health care of trans persons ............................ 158 4.4 Countering pathologisation and the supportive role of the LGBT community ................................................................................................................................................ 166 4.4.1 ―They thought I was an alien‖: Making a place for intersex persons within the LGBT community .......................................................................................................... 170 4.4.2 ―There is no collectivity, there is no group, there is nothing‖: Experiences of multiple oppression and exclusion: social class and age ................................... 176 Conclusions ........................................................................................................................ 184 CHAPTER 5 ....................................................................................................................... 186 2 INVISIBILITY AND PATHOLOGISATION IN MENTAL HEALTH CARE ......... 186 Introduction ......................................................................................................................... 186 5.1 LGB participants‘ perceptions of the impact of homophobia on their mental health .................................................................................................................................... 187 5.2 Trans participants‘ perceptions of the
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