New Zealand Rehabilitation Association, Inc.

Since I came out as a gay man at 19 years old, I've been a user of home-based support, needs assessments, wheelchair assessments, physiotherapists as well as other health professionals and services, even rehabilitation at times.

Every service provider, in my experience, has assumed I am heterosexual. Unless I actually say, ‘I'm a gay man', people assume I'm straight. That assumption operates at all levels of the organisation - from management, to administration, to individual staff.

Once I contacted a homecare provider and said I'd prefer a guy to help me shave (it's not that women can't shave me, but men have a slightly different technique because they shave themselves). I didn't ask for a gay man because it didn't matter to me - men shave the same whether they are gay or straight). The guy they sent turned up about three times. I don't make a big thing of being queer, but I don't pretend to be straight. I think he cottoned on, felt uncomfortable and just didn't come back, but it was never verbalised.

When managers interview me about what services I need, there is never any question about lifestyle or sexual preference. I've never dealt with a provider who has shown they've considered the possibility that I might be gay. There's never been any transparency about it.

I assume providers train their staff to be accepting of people. I don't see it as my role to say, ‘By the way, I'm a fag, so anyone you send to me has to be okay with that.'

Luckily for me - and others - I'm pretty good at managing the situation. I let my sexual orientation come to the fore as the relationship develops. By the time I've built a relationship with someone who doesn't know I'm gay, when they find out its obvious or irrelevant. But it's my good management rather than the provider's. I don't think that's good enough, because if I wasn't good at managing it, it could have been disasterous many, many times.

Since the late 1990s, I've had individualised funding - so I manage my own personal support. When I recruit people I always say I'm a gay man and part of the requirement for the job is that they're comfortable with that lifestyle. As an employer I have the responsibility to canvas that but, as a client, I don't think it's my responsibility.

There are two reasons to make this issue a priority in organisational policy development. Firstly, because providers put themselves at huge risk, especially as employers, when they don't have sound policy to protect their staff and clients against, at best, misunderstanding and, at worst, discrimination, harassment, even abuse, due to lack of awareness of sexuality issues.

But there's a second, more important reason I think. Most people think that sexuality is just one part of life and that, because it deals with intimacy and feelings and private behaviour, it's probably best left alone in the disability support arena. That's true, but it's only one truth. It's also true that sexuality - as an experience and expression - encompasses every human aspect. People express and experience sexuality socially, physically, emotionally, creatively, intellectually and spiritually. So when you look at it from that point of view, leaving out sexuality means you miss the whole person.

Any rehabilitation professional interested in holistic practice should, therefore, be interested in sexuality. So how do you begin? By developing policy that involves the whole organisation using best practice principles. This involves consulting with staff, service users and experts.
Policies should include the whole range of intimacy and sexuality issues, not just sexual orientation. They need to include everything from intimate support such as bathing, to support with intimate relationships, to access to sex surrogacy. It should include sexual preference and identity as well as gender preference and identity. For example, same-gender attraction and behaviour is not the same as identifying as gay or lesbian. Any policy or training has to recognise same-gender sex as distinct from sexual identity.

Policies should also be living documents, regularly reviewed. They may change, depending on the group of people, staff and clients, who owns it at a certain time.

But a policy is no use without training and implementation. If you go, ‘Here's the policy,' and slap it down on the table at the staff meeting, it won't work. You need to get buy in from staff and ensure people are comfortable with it and trained to implement it.

At the broadest and most detailed level, responsiveness to sexuality is an organisational culture issue. If your organisation is not committed to this as a matter of principle, it won't work. It's much more than telling staff what to do. How the organisation does its business needs to be saturated with comfort with and respect for sexual diversity. Primarily it's about the quality of relationships between management and workers; management and clients or residents; staff and clients.

And it's no good speaking only with staff about policy development. It's important to involve service users in developing awareness and comfort in thinking openly about sexuality in a safe way. There's nothing more alarming than to have a support person or rehab assistant who has never before said anything about sexuality suddenly say, ‘Hey, I heard you're gay and single so, if you want me to get you some porn, just let me know!' That's as disempowering, for someone who's not ready for it, as the opposite stance from a provider - ‘That kind of sexual expression would never happen here!'

Consultation enables staff and clients to think about where the right to a harassment-free workplace ends and where the right to an open, holistic service begins. Being open to help someone lead a gay life needs to be seen by staff as part of job fullfillment, not harassment. It also needs to be seen by clients as an opportunity, not a threat. That's the pivotal issue - it's a blurry, complex area. It's not going to be the same for every carer or every service user or resident.

It's worth mentioning the issue of how, as a client, you get privacy in a relationship when your caregivers treat your home and your bedroom as their workplace. I have to manage my needs for support in the same way I'd manage living with children, flatmates or in any other shared living situation. I have the same responsibility not to wander around naked every morning as I would if I was living with flatmates.

I have to negotiate privacy with my partner and support person. I might give my support person the morning off and have my partner cater for support needs, for example, so we can have a romantic lie in.

The thing to remember is this: the support relationship, in any form, is inherently uncomfortable. You are only there because somebody needs you in order to do things they would, under usual circumstances, do themselves.

So, at its most fundamental level, managing an organisation's response to sexuality issues is about teaching people to be comfortable with discomfort. If staff think it will be easy, their expectations won't be met. They'll be negotiating and, sometimes even overstepping, their clients' boundaries (as well as having their boundaries tested) and will have to deal with the feeling either shouldn't or don't want to be there.

But that doesn't mean it's wrong - it's just a bit uncomfortable for a while. Good policy and training can ensure the skills and attributes staff need to move on from a temporarily uncomfortable moment and continue to support and celebrate the entirety of people's lives, including sexuality.

[Check out Philip on stage in Auckland from 2-9 May or in Wellington from 20-23 May - Ed.]