The hall of mirrors: stigma at queer intersections - Q&A with Dr Mark Adley
A Q&A with Mark Adley
Q: What was behind this research?
After years of working in various settings across North East England – including prisons, community drug treatment and homelessness services – I noticed something unsettling: the invisibility of marginalised LGBTQ+ people. This led me to apply for a three-year funded PhD in which I interviewed 72 people – 39 LGBTQ+ individuals dealing with issues like homelessness, substance use, or domestic violence, and 33 professionals who work with them.
Q: What's the biggest misconception about LGBTQ+ experiences?
There's a persistent myth that all LGBTQ+ people are White, middle-class, and doing well financially. There is also the idea that things are universally getting better for LGBTQ+ people. These oversimplified (or ‘essentialist’) views can cause harm by masking the discrimination and disadvantages faced by others. Take ‘coming out’ for example – while it's often celebrated as a universal LGBTQ+ experience, for some people, like queer Muslims I interviewed, being openly ‘out’ could lead to rejection from family, friends, and community, or put them in danger of harm.
Q: How does this misconception affect service delivery?
It creates a frustrating catch-22. Some people resent LGBTQ-specific services because of this assumption that all LGBTQ+ people are wealthy and privileged. There’s also confusion between sexual orientation and gender identity, which gets tangled up in current political debates about trans rights. A number of professionals firmly believed that sexual orientation and gender identity had no bearing on people’s need for treatment or support. Within the workplace, standing up for diversity becomes a stigmatised political stance rather than a celebration of human rights – this contributes to people on the margins, who may need most help, not feeling welcome or understood by services.
Q: Is there discrimination within LGBTQ+ spaces too?
Absolutely. Participants such as Daniel, who was living in a hostel and using methamphetamine told me ‘I don't fit anywhere at all. I don't like the gay community because... they are not that all nice and rainbow as they pretend to be’. Symbols that we assume to be inclusive, like the rainbow flag, don't resonate with everyone. Yasmin, another participant, shared that she doesn't see herself represented in these ‘rainbow’ spaces as a person of colour.
The cover of the pdf from the study
Q: What does LGBTQ+ disadvantage look like in services?
Tony's interview painted a picture of this, as the only openly LGBTQ+ person and the only crystal meth user in his drug treatment service. When he joined a peer support group and mentioned being gay and HIV-positive, other members threatened to walk out, claiming they were afraid of ‘catching something’ from him. The staff did nothing, and their silence in this situation spoke volumes. This approach – not challenging discriminatory behaviour by their ‘main’ client group – added to the marginalisation of those already on the edges of care.
Q: What's the real problem here?
It's bigger than service-level, and it’s unfair to point the finger of blame at hard-working staff. Our current frameworks for multiple disadvantage, adverse childhood experiences and health inequalities focus on what's easily countable, missing the complex social realities of people's lives. These are systemic issues – driven by budget cuts, commissioning requirements, and government policies that don't account for people’s intersecting identities. We can turn towards the Treasury, towards the economic disadvantage of the North East region, and to political ideologies. While governments undoubtedly have to make tough decisions around funding, some groups are easier to overlook than others.
"Benefits", pencil and pen drawing and digital collage by artist Sarah Li (2024)
Q: Why don't we hear more about these issues?
There is mirroring of social privileges within services designed to support those on the margins, leading to the White (apparently heterosexual) male being assumed to be most deserving of support. Research adds to this problem. Using the main homelessness and drug treatment services to collect data assumes that everyone has equitable access to these services. This first paper from the PhD – an Open Access (£0) review of reports found on the web and academic research – highlights some of the barriers to services that marginalised LGBTQ+ people and other minoritised groups can face.
Q: What needs to change?
While economic disadvantage gets a lot of attention – and rightly so – focusing solely on poverty masks other crucial issues like racism, misogyny, and anti-LGBTQ discrimination. People's experiences are shaped by multiple factors – their sexuality, gender identity, race, class, and health status all interact in complex ways.
Bringing people into our services who have been historically ignored has many benefits, both to them and to wider society. However – this might mean shifting how we work and developing a greater understanding of social disadvantages. While LGBTQ+ rights may have progressed on paper, many people from minoritised groups still face significant stigma and barriers to accessing services. Until we acknowledge and address the impact of intersectionality, we risk continuing to fail those who need support the most.
The study’s key findings and recommendations
Findings from the study are available in several formats
PDFs can be downloaded from the project’s website, with videos on YouTube and an Open Access scoping review published in BMC Health Services Research. Mark is involved in ongoing work exploring the experiences of LGBTQ+ people of colour, and collaborations with local organisations in consideration of intersectionality across the North East and Cumbria. To contact Mark or receive project updates via the mailing list click here.
This study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.