Good care depends not only on professional knowledge and skills, but also on the personal attitude of the carer and their ability to build an individual and constructive relationship with the person in need of care. An important prerequisite for this is an awareness of the diversity of human existence.
A person's sexual orientation or gender identity is an important part of their identity and influences not only their sexual behaviour or self-image, but also other areas of their life. It is therefore important that care takes these aspects into account and addresses the special needs of lesbians, gays, bisexuals, transgender and intersex people. Similar to people with a migration background, cultural and religious influences should be taken into account in care. Experienced or feared discrimination can lead to LGBTI people withdrawing from facilities or not visiting them at all, which can have serious consequences if medical treatment is necessary.
Our aim is to create a platform that helps lesbians, gays, bisexuals, transgender people, intersex people and people with other gender identities to find the right support services and contacts relating to LGBTIQ+ care simply and free of charge. It serves to network people in need of care, carers, care providers, caring relatives and the family of choice.
Magnus Hirschfeld was the first researcher to scientifically investigate homosexuality. In 1919, he founded the unique Institute for Sexual Science in Berlin. Hirschfeld conducted research, offered sexual counselling and fought against Section 175 of the German Criminal Code, which he regarded as unjust and inhumane. In contrast to his contemporaries, he regarded homosexuality as the effect of a "completely uncaused (...) sexual constitution" and not as an expression of a vicious lifestyle. Hirschfeld did not believe in the bisexuality of human beings, but that there were intermediate stages between the female and male sexes. He was convinced that people could have characteristics of both sexes. As a medical pioneer, he performed the world's first sex reassignment surgery at his institute in 1930 on the Danish woman Lili Elbe, who was born Einar Wegener and was phenotypically male.
In the 1950s, the old gender roles remained in place and non-heterosexual lifestyles were despised; discrimination and rejection continued to be the order of the day. Paragraph 175 of the Criminal Code, which criminalised homosexual acts between men, remained in force in both German states in the form tightened by the National Socialists. While the GDR toned down the paragraph in 1957 and abolished it completely in 1968, it remained in force unchanged in West Germany until 1969. In total, investigations were initiated against around 100,000 men and 50,000 were convicted of same-sex "fornication". Under these conditions, gay men lived in constant fear of discovery, persecution and punishment, while lesbian women hid in "friendships" or so-called "Josefsehen" and renounced sexuality. Transgender and intersex people remained invisible and lived in seclusion, as there were neither meeting places nor support for them.
In the 1980s, the AIDS epidemic broke out and caused social prejudice among many people. Gays and bisexuals were seen as a danger and marginalised, which for many resulted in the loss of work, housing and social relationships. There was a fear of social repression and personal infection as well as mourning for friends who had died of AIDS. Nevertheless, in this existentially threatening situation, a nationwide network of AIDS help centres emerged, supported by a clever state prevention policy. Since then, numerous volunteers have been involved in supporting HIV-positive and AIDS sufferers and providing information to special target groups and the general public. The aim is to replace discrimination and marginalisation with education and prevention.
Section 175 of the German Criminal Code, which was tightened by the National Socialists, was only finally abolished in the Federal Republic of Germany in 1994. Since then, homosexual acts between men have no longer been punishable. In 2002, the German Bundestag apologised to the gays who were persecuted, tortured and imprisoned during the Nazi regime. All sentences from this period were cancelled. In June 2017, the Bundestag passed a law that also cancelled the approximately 64,000 sentences from the post-war period and awarded the victims of justice financial compensation of a lump sum of 3,000 euros per person and 1,500 euros for each year or part thereof spent in prison. However, men who were investigated but not convicted were not compensated. Lesbian women were also not considered, as Section 175 StGB did not apply to them and they were therefore not prosecuted. However, they experienced social marginalisation, homophobic hostility and verbal and physical violence with negative effects on their personal and professional biographies.
The "Act on the Introduction of the Right to Marriage for Persons of the Same Sex", which came into force on 1 October 2017, leads to extensive legal equality between same-sex couples and heterosexual couples. This equality also makes it possible for same-sex couples to adopt children together. Although the law is considered a milestone and ends the state's unequal treatment of same-sex couples, not all hurdles have been removed, especially for female couples who wish to have children. A reform of parentage law is still pending, which means that stepchild adoption is still necessary for both women to be legally equal parents. Even before the introduction of "marriage for all", many same-sex couples were already living together with children. Worldwide studies have shown that children in these so-called "rainbow families" develop just as well as children of heterosexual parents.
The Self-Determination Act, which came into force in Germany on 1 January 2024, is a significant step forward for the rights of trans*, inter* and non-binary people. It simplifies the legal recognition of gender identity and is a decisive step against discrimination. Before this law, changing the gender entry in the civil status register was a laborious process that often required two psychiatric assessments and was traumatising for many of those affected. Now the SBGG makes it possible to change the gender entry by means of a simple declaration at the registry office, without the need for medical reports or operations. This law strengthens self-determination and promotes social acceptance of gender diversity. Nevertheless, challenges remain: Trans*, inter* and non-binary people continue to experience discrimination and marginalisation, which shows that more needs to be done to combat transphobia and achieve true inclusion.
Did you know that 97% of residential care facilities cannot provide quality standards in dealing with same-sex living environments? This fact is worrying and emphasises the need for change. Unfortunately, many LGBTIQ people hide their sexuality and identity for fear of discrimination and marginalisation, while inter* people are often afraid of discrimination because of their physicality. It is our responsibility to create an environment where all people are safe and accepted, regardless of their sexuality or identity.
A positive example of this is the "Lebensort Vielfalt" in Berlin.
In order for carers to be able to act successfully, it is very important for them to examine their own ideas about life, values and norms, their own gender and sexual identity and their own cultural background. This self-reflection enables carers to differentiate their perspective from that of the person being cared for and to develop an empathetic understanding of their thoughts, feelings and actions. This enables carers to respond sensitively to the situation of the person in need of care and to act in the patient's best interests.
Biographical work is an important method for carers to understand the reality of the lives of people in need of care. This involves looking at the person's personal history in order to draw conclusions about customs, traditions and cultures in the respective environment and their influence on health and illness. In this way, those in need of care can be better understood and care measures can be tailored to their individual needs. Symbols, books or pictures in the patient's room can also provide clues to the realities of the patient's life. When observing behaviour, it should be noted that lesbian, gay, bisexual, transgender and intersex people may display gender-flexible behaviour that could be misunderstood by carers as "affected" or "effeminate". It is important to develop an understanding of these behaviours in order to adequately treat expressions of pain and respond to the individual needs of those in need of care.
Transgender and intersex people often find it difficult to find easily accessible information about their life situation. There is a lack of support services during the transition process (passing) for transgender people or during the self-discovery of their own intersexuality. There are too few references to specialised clinics and too little information on how to deal with psychological and physical changes. Carers must incorporate the knowledge of transgender and intersex people into their care. Care problems should be discussed together in order to find good solutions. It is important to find out about the lifelong hormone therapy that many transgender people undergo. In addition, there will be more transgender people in the future who have not undergone gender reassignment surgery after their name and civil status change. It is therefore important to use the correct pronouns (she/her, her/hers) and to accept them in their gender, especially when it comes to intimate care. This also applies to intersex people, who can have both male and female external sexual characteristics.
In hospitals and care facilities, relatives of lesbian, gay, bisexual and transgender people (LGBTIQ) are often not recognised, as the attention of care staff is primarily focused on traditional family relationships. However, LGBTIQ people are often part of alternative queer communities that form a kind of surrogate family. It is important to understand that these communities have a similar supportive nature to the traditional family. Many LGBTIQ people have close relationships with their 'family of choice', which is a natural part of their lives. For example, if carers see a lesbian woman's partner as a good friend or neighbour, they are deprived of important information about the person they are caring for. However, if she is recognised and acknowledged as a life partner, carers can gain valuable information about the needs of the person being cared for.
When providing support during difficult phases of life, it is particularly important to understand the actual life situation of the person in need of care. If, for example, the partner of a lesbian woman or the partner of a gay man is not recognised at the bedside, it can be difficult to provide appropriate support. It is the role of nursing to enable those in need of care to express their pain and grief at the loss of a loved one and to find ways to deal with it. Dying, death and grief have a special significance for older LGBTIQ people due to the AIDS crisis in the 1980s. At that time, many had to witness how many gay friends and acquaintances, including younger ones, died within a very short space of time. When providing end-of-life care for LGBTIQ people, it is very important to take into account the traumatic experiences during the AIDS crisis and to connect the fears and worries of those in need of care and their relatives during the dying process with these experiences in order to enable them to say goodbye and die with dignity.
Care measures, hospital stays and examinations can trigger stress and re-traumatisation in LGBTIQ people due to previous traumatic experiences. Even being touched can lead to negative emotional reactions. To counteract such feelings of dependency or powerlessness, it is important to use touch consciously and sensitively.
An open and tolerant attitude towards the diversity of people can be demonstrated in various areas, such as hospitals or care facilities for the elderly. One possibility is to display the rainbow flag in the entrance area, which stands for acceptance and respect for all people, regardless of their lifestyle, origin, religion or sexual orientation. This sends out a signal in favour of an open and peaceful corporate culture. The legal basis for this is provided by the General Equal Treatment Act (AGG), which prohibits discrimination based on various characteristics such as sexual or gender identity and protects people from this.
