The report should not exceed 5 pages. Please answer ALL questions and follow the structure outlined below.

I.  Organizational details

Project title: / Documentation of discrimination in the field of health
Reporting period: / September 2014 – December 2014
Implementing organization: / FELGTB. Spanish Federation of Lesbian, Gay, Transsexual and Bisexual organizations
Contact information (post, e-mail, phone): / C/ Infantas 40. 4º izda. 28004, Madrid


0034913604605
Contact person: / Jenifer Rebollo
Alberto Martin-Pérez
Date of report submission to ILGA-Europe: / 30th January 2015

Number of people working on the project (staff and volunteers):

5 staff members were involved on the design of the questionnaires and analysis of information and 2 volunteers who provided feedback on the questionnaires

Changes in the project leadership (if different from the application): No changes were made.

II.  Narrative Report

1.  What kind of information did you collect?

We collected information on availability of health services (HIV, transition health services and assisted reproduction) and coverage for LGBT people in different Regions as well as changes over time due to budgetary cuts.

Complementarily we collected information on LGBT population perceptions of accessibility and acceptability of health services and benefits in the three mentioned health areas. We compiled stories of discrimination within the public health system and private health services.

Finally, we collected information on LGBT population’s perceived health, self-reported health status, mental health, prevention practices, use of health services and disclosure of SO/GI to health professionals.

We explored social determinants of health hampering equal access to health services, notably, area of residence, sex, gender identity, sexual orientation, socioeconomic situation, and working status and age. Examples are provided at the report.

Also, comparison with general population might be established to determine health inequalities for LGBTI population and within the population itself.

2.  What methodology did you use to collect the information? If it differs from the methodology initially planned, please provide explanations.

We created a set of 40 indicators to gather information from different Spanish regions. We had planned to conduct interviews with stakeholders in order to better define them. But due to time and budget constraints these interviews did not take place. Instead, a desk review was conducted and a draft questionnaire was discussed with FELGTB member organizations, FELGTB responsibles for health and equality issues and with ILGA-Europe staff. Following ILGA-Europe staff advice we constrained the information gathering to some regions instead of trying to cover all of them as intended. We used the information provided by our member organizations but we sent the questionnaire to different stakeholders in as many regions as possible to contrast information.

At the same time we launched an online survey that provided us with a convenience sample of 685 individuals. The report was built using different filters and analysis provided by www.encuestafacil.com, where the online questionnaire was available for over two months. In order to create our survey we reviewed different questionnaires both targeted to LGBT and general population. The questionnaire was distributed with the support of FELGTB member organizations, as well as mailing lists of health and HIV, transgender and family issues. We promoted our survey at Facebook and Twitter.

3.  Please describe main success / challenges / difficulties of the project. How did you deal with them?

The main success was the unexpected positive response from LGBT people to our questionnaire. We gathered a sample of 685 valid questionnaires, more than double the goal we had set. Other than time constraints, the main challenge was the difficulty to obtain the information from regions. The first challenge was to identify the most adequate stakeholders to contrast the information provided by our organizations. Secondly, it was not easy to gather information from 2008. Finally in many occasions, submitted information was not accurate, which obliged us to search for documental proofs at secondary sources. A challenge (that we consider an opportunity anyway) is the huge amount of valuable information provided by the online survey. Due to the reporting deadline and the delays in launching the survey we haven’t been able to conduct a thorough analysis of social determinants of health and their impact on health, prevention practices and wellbeing. We had, thus, to make a choice and focus on SO/GI, socioeconomic status or working situation mainly although glimpses of other social determinants such as HIV status can be observed in the report. We intend to follow up conducting these types of analysis in the next few weeks and go on reporting to ILGA on the results. However, we believe we have obtained a very valuable data base that will be nurturing our advocacy activities on health issues in the future.

4.  Did you have any partners in this project? If yes, please briefly describe the role of each partner.

Our sole partners were our member organizations who collaborated in the dissemination of the questionnaire. Additionally, some of them helped us identifying regional stakeholders and filled in the indicators set.

III.  Project impact

1.  What product has come out of the project if any (e.g. report, CD ROM, survey)? Please, give a short description.

We have produced a report on the availability and coverage of health services for LGBT people in Spain, specifically around a) health transition services for transgender people, b) HIV prevention, testing, care and support; c) assisted reproductive techniques. The set of indicators can be used overtime to assess changes. Additionally, we produced a survey report on LGBT health including self-reported and perceived health status, mental health, prevention practices, use of health services, disclosure to health professionals, and discriminatory experiences in accessing and using health services.

2.  What are the main outcomes of the project? Give details here on:

a)  How you plan to use this information - for advocacy or other purposes (at local, national and/or European level)?

We are already using the obtained information on exclusion from assisted reproductive techniques in connection to our current advocacy strategy with regional health ministries against such exclusion and inequalities between regions. We plan to produce a specific report with information about mental health and perceived health status of people living with HIV to nurture both NGO and administration strategies of positive prevention. Likewise, information on transgender health and discrimination will help our advocacy efforts in favor of comprehensive regional (and national) laws on transgender people.

Internally we will use the information to develop our future strategies on health promotion and health education with our member organizations. It will be used to support health advocacy work, especially in those regions where we were able to gather more information and/or respondents.

On the European level, we are willing to share and discuss with other organizations about our methods, results and tools, and to participate in further European research or advocacy projects in the field of health.

b)  Who is your key target audience who needs to understand the collected information?

Basically the same target audience that we described at the application:

1) At the Ministry of Health, Social Services and Equality: Mr. José Javier Castrodeza (General Director of Public Health), Mr. Agustin Rivero (General Director of National Health System and Farmaceutical Basic Common Portfolio), Mrs. Carmen Plaza (Director of the Women Institute). Mr. Juan Manuel Moreno (State Secretary for Social Services and Equality), Mr. Ignacio Sola Baleycom (Deputy Director for the Equal

Treatment and Non-Discrimination). The Ministry holds the competence to coordinate and guarantee certain minimum coverage of services across regions.

2) Political Parties. They are entitled to initiate parliamentary discussion over these topics to promote legislative and regulations change. They also have the initiative to include our demands into their programs for the elections that will take place in 2015.

3) Regional Ministries of Health, Social Services and Equality: Ministers, General Directors and Vice-directors. They are entitled to organise the health benefits and services in their regions, and to decide which ones are publicly accessible.

4) Participation Institutional Organisms: Namely, COAC and CEONGAS, as well as other networks related to sexual and reproductive health. They provide access to official participatory spaces and it is vital that they assume and support our demands.

5) LGTB community. The information provided by these reports and their participation in the gathering of information will give them tools for this relevant role.

6) General and LGTB mass media professionals: they can create public opinion and bring forward these issues to political agendas.

c)  Provide a short description and concrete steps on how you plan to approach your target audience.

We will translate into Spanish and shape information into small pieces during the next three months in order to make it available for the regional elections campaign in April and May. We will distribute it during formal and informal meetings, mailing, FELGTB formal events, etc. Specifically, we will give a lecture during our Biannual General Assembly in February 2014 to present the results and we will submit at least two abstracts to national conferences based on the information gathered.

We are using our participation in different participation organisms in which we take part (COAC, CEONGAS) to share this information with our colleagues and include concrete proposals resulting from the reports conclusions to be included in strategic plans of different Ministry departments. We will also use the information to illustrate our demands in connection with comprehensive transgender laws and inclusive assisted reproduction.

We will elaborate press notes and articles. Concretely we will try and submit an article to at least one specialized peer reviewed magazine and we will participate in radio debates to raise awareness, highlight and explain the demands, needs and research results. To start with, we will be participating in “Westeria Lane”, one of the most popular radio programs on LGBT issues in February 2015.

Over the year, we will be using the information collected in specific dates (14th of February, 17th of May, 22nd of October, 1st of December), to ensure media attention and highlight specific topics related to these dates.

d)  What impact will this have on legislative / decision-making level (e.g. change in laws/policies, new relations with policy makers etc.), if any.

Ideally, our advocacy work will have as a consequence: a) the end of exclusion of single women an women’s couples from reproductive assisted techniques; b) guarantee of comprehensive quality health care and services for transgender people, either as part of integral laws or simply at the service portfolio level; c) concrete training programs for health care professionals on LGBTI population specificities; d) proper funding and development of HIV and STI prevention and support strategies targeted to LGBT people. Finally, we would like to discuss with the Ministry the need to appoint a responsible (technical/political) at the national and regional levels on LGTB health issues.

3.  What impact (positive/negative) had the project on your organization?

To our knowledge, this is the largest research on LGBT health in Spain so far (covering topics different than HIV), which will position us for continuing building on the topic with scholars. We will discuss the results during our next Assembly, in February and consequently design new interventions, services and strategies to stop discrimination both outside and within the community. It will also empower our demands and advocacy.

4.  What are the lessons you have learned internally? What learning would you share with others undertaking similar projects?

It is important to assess which national data sources you need to compare your results with, in order to shape questions in a similar way. Creating the best possible questionnaire is always time consuming, so allow yourself plenty of time in your planning for that. Also, it is important to keep in mind how defining and shaping questions and possible answers can be discriminatory as well. To this respect we failed to be inclusive with intersexual people, while we announced that our survey was for LGBTI people.

IV.  ILGA-Europe

How satisfied you are with the quality of cooperation with ILGA-Europe? Please, give a maximum of three positive and three negative points / examples, preferably with suggestions on how the latter can be improved.

ILGA-Europe was very supportive throughout the whole process, addressing us to concrete documents or contacts, and advising us to concentrate on some regions instead all of them. We also found them supportive reviewing our questionnaires and providing quick feedback. To suggest only one improvement, we believe it would have been interesting to know which other projects were funded under this call, and see whether it was feasible to establish synergies with them.

PLEASE, INCLUDE A COPY OF THE PRODUCT THAT HAS COME OUT OF THE PROJECT (DOCUMENT, CD ROM etc) WITH THE ACTIVITY REPORT.

V.  Financial report

Please, provide the financial report using the attached excel sheet. In case if deviations from the original budget occurred, please provide explanations. All expenditures need to be accompanied by certified copies of supporting financial documents (bills, invoices, pay slips, bank statements etc.)

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