Learning to love safely

Gay people with learning difficulties have few
outlets through which to explore their sexuality and little support
from their carers, leaving many isolated or even in danger. Natalie
Valios searches for some solutions.

Being gay in a largely heterosexual
environment brings with it a few problems. Add learning
difficulties to that, and people find themselves facing a double
whammy of discrimination and a whole new range of unforeseen
obstacles.

Most people see the world through heterosexual
glasses, says Paul Cambridge, senior lecturer in learning
disability at the Tizard Centre, University of Kent at Canterbury.
“Homosexuality, whether between men or women, is tolerated but
still not valued.”

Having a sex life is a problem for many people
with learning difficulties. In many settings, carers and staff
actively discourage any form of sexual activity between clients –
and some would react with horror and disgust if they discovered the
existence of same-sex relationships.

But even when the right to a sex life is
respected and acknowledged, most people with learning difficulties
– whether they live in a residential home, at home with their
families or in supported living accommodation with carers – are
steeped in heterosexuality. Services, in particular, are often
biased because most managers are heterosexual and male, says
Cambridge.

But if we accept that same-sex relationships
do occur, how should carers and staff handle it, and what should be
done to ensure clients’ safety?

Generally, men with learning difficulties who
have sex with men do not identify themselves as gay. There are
various reasons for this: many are struggling to overcome the label
“learning difficulty” and to think beyond that is difficult; and
alternatives to the heterosexual role are not easy to come by.

Cambridge says: “There is less reason for men
with learning difficulties to identify as gay than other men. If
they have never been given the option to come up with a different
identity then they are hardly likely to realise it.”

Some do not understand what being gay means,
while other men with learning difficulties have sex with both men
and women, so they would not define themselves as gay, says David
Thompson, manager of the Growing Older with Learning Disabilities
scheme at the Foundation for People with Learning Disabilities.

There is evidence to suggest that men with
learning difficulties are more likely to find sexual partners who
are male rather than female – simply because the opportunities
present themselves more readily. The fear of a woman with learning
difficulties becoming pregnant often results in stricter rules
around contact between opposite sexes, whereas it is common for men
to share bedrooms and toilets.

Only a few men with learning difficulties who
have sex with men are in a position to think about whether they are
gay.

“First, you have to know what being gay
means,” says Thompson. “Then there is huge pressure not to come out
because you are probably living in services with about 30 carers,
so it would be like coming out to 30 parents. And where do you go
with that? As a person with learning difficulties you are going to
be unwelcome in gay venues, and you will still be seen as an
undesirable sexual partner by many men because of your learning
difficulties.”

One of the biggest hurdles for gay men with
learning difficulties is the lack of gay role models. Residential
homes do not have a culture of discussing sexuality openly and tend
to be particularly reticent on same-sex relationships.

Although gay staff may come out to other
members of staff, they are cautious about coming out to clients.
They may feel anxious that allegations may be made against them and
sensitive to the possibility that they will be accused of imposing
their sexuality on a client or “leading them astray”.

This leaves people with learning difficulties
few outlets through which to explore their sexuality and can give
them the impression that all staff are heterosexual.

In the absence of sexuality policies, staff do
not know how far they can go in discussions, and often feel unsafe
talking about same-sex relationships, says Christopher Bennett,
chartered clinical psychologist for a tertiary assessment and
treatment service for people with learning difficulties at the
Hertfordshire Partnership NHS Trust.

Generally, the subject of same-sex
relationships is raised only when it has been identified as a
problem, for instance when a client has been seen hanging around
public toilets or has approached another man in the home. Staff are
then confronted with the issue but in a negative context.

Clients are left feeling isolated and
reluctant to talk about having sex with men. Also, the support
networks on which gay men rely to support them – such as contact
with the gay community, gay role models and family and friends who
accept them as they are – are often not in place for those with
learning difficulties.

“They pick up the message that it isn’t good,”
says Thompson. “It doesn’t stop them doing it, but it stops them
talking about it. That makes them more vulnerable to abuse and HIV
infection.”

This is a particularly important issue for men
with learning difficulties. Getting sex is not the problem, says
Bryan Mellan, manager of Consent, which takes referrals of people
with learning difficulties around relationship and sexuality
issues. Most of the men he has worked with have had sexual
encounters through cottaging in public toilets or cruising. Mellan
is concerned about sexual health risks for men with learning
difficulties because no one knows whether the sort of sex they are
having is penetrative and unprotected.

Because of these risks, Mellan says clients
need facts and the skills and assertiveness to negotiate with the
other person about a sexual encounter. Crucially, they must also be
made aware of the legal and personal consequences of cottaging and
cruising.

Thompson says: “It’s relatively
straightforward to give people the basic information. What’s
difficult is getting people to do that in their sexual
relationships.

“Men who go to public toilets are at greater
risk. They have little control over what takes place when they have
sex with men without learning difficulties. When anal sex takes
place, it is generally the men with learning difficulties who are
penetrated. Even if it hurts they are not able to assert themselves
and tell the man, so what hope is there of them saying he has to
use a condom?”

Bennett agrees that there is a discrepancy
between what people know about safe sex and what they do. “It
worries me that we assume that because people know how to use
condoms they are using them. But what if they aren’t readily
available?”

Mellan would like to see more work with staff
and carers on their values and their attitudes. Although some
people are openly homophobic, he believes it is more likely that
many are ignorant. Consent is often called in to support groups on
relationships and sexuality. Mellan says: “We ask them to think
about how they present issues. Do they always have a heterosexual
bias, for example, do they assume that the men want
girlfriends?”

There are several options for staff who want
to look at the issue of sexuality and people with learning
difficulties. Advocacy services specialising in working with gay
men with learning difficulties could be used as a befriending
service; gay outreach workers could be brought in; or if gay staff
were given the right support themselves, they could become
identified support workers.

Men with learning difficulties will continue
to have sex with men, regardless of whether they are supported.
But, by being supported, they are put at far less risk of abuse and
HIV infection.