“We do not go to the doctor because we are afraid. Because we might be looked at differently. Because we might be asked something inappropriate. Because we might have to explain again who we are. Because in Cyprus everyone knows someone.” For many LGBTI+ people, seeking medical care does not begin with which doctor is available, but with which doctor is 'safe' for them.
This reality is reflected in the findings of the European programme SAFE‑R, Safeguarding LGBTIQ+ People’s Right to Health, which were presented last week. Based on these findings, those who avoid or postpone medical care include trans people who face administrative barriers or seek gender‑affirming care abroad, as well as lesbian and bisexual women who encounter inappropriate or heteronormative questions in gynaecological settings.
The SAFE‑R findings point to a two‑speed reality for patients. On the one hand, there is formal access to healthcare, services, professionals, GHS and patient rights. On the other hand, there is lived access, shaped by fear of scrutiny, incorrect questions, exposure, inaccurate recording and the need to find not just an available doctor, but one who is also 'safe.'
Filtered Care
One of the key findings of SAFE‑R is that access to healthcare is not always equal and often depends on personal networks. According to the report, many LGBTI+ people rely on recommendations from trusted individuals to identify healthcare professionals who are considered safe, discreet and inclusive.
This practice is linked to previous negative experiences or fear of discrimination. It does not concern only cases of outright refusal of care. The research records microaggressions, stereotypes and assumptions based on heteronormative and cis‑normative premises. As a result, seeking care becomes a process of precaution and self‑protection.
It emerges that many individuals avoid or delay seeking medical and mental‑health services due to past negative experiences, fear of judgement or the absence of healthcare professionals who provide inclusive care. In order to avoid uncomfortable situations and feel safe, they turn to informal networks and community recommendations.
Willing but Untrained
At the same time, the research records that the majority of healthcare professionals expressed willingness to provide care with respect, while confirming a lack of formal training and continuing education. The gap appears mainly in issues relating to trans, non‑binary and intersex people, for whom professionals reported limited exposure during their academic or professional training.
This lack has practical consequences in day‑to‑day care. In mental health, for example, support is described by the report as unequal in terms of quality and sensitivity. While many LGBTI+ people benefit from psychological support, others encounter professionals who are unfamiliar with LGBTI+ issues, resulting in discomfort, misunderstandings or a loss of the possibility for effective care.
In gynaecological settings, lesbian and bisexual women report experiences linked to inappropriate questions or assumptions about their sexual lives. The study places these incidents within a broader pattern of discrimination that does not necessarily manifest through overt rejection, but through everyday practices that make the patient feel invisible or exposed.
Systems That Exclude
Particular reference is made to the administrative systems of healthcare, which, according to the findings, do not reflect gender diversity. Software and procedures are structured on the basis of binary gender norms, creating practical barriers for trans people, such as blocked referrals, incorrect classification and document mismatches. Trans and non‑binary people are identified by the research as the group facing the most complex barriers to accessing care.
Problems include fragmented services, administrative difficulties and limited knowledge on the part of healthcare providers. In rural areas, barriers are compounded by the lack of trained professionals and heightened concerns about privacy and stigma. Although gender‑affirming procedures are, in principle, foreseen in the public healthcare system, access remains difficult. The report refers to advance payments and complex reimbursement procedures that create additional challenges for trans patients.
Invisible in the Data
“At an institutional level, LGBTI+ health is absent from planning. The National LGBTI+ Strategy, approved by the Council of Ministers in October 2024, is not sufficient without a separate health pillar. There are no clinical protocols, particularly for trans health. Epidemiological data are not even collected. When a population is statistically invisible, it becomes politically invisible.”
This was stated by ACCEPT secretary Stefanos Evangelidis while presenting the research findings. He added that “at a social level, stigma remains the greatest inhibiting factor. When someone avoids the doctor for years, problems do not disappear, they grow. Diagnoses that should have been made early are made late. Conditions that should be treated preventively become chronic.”
At a practical level, Mr Evangelidis referred to forms that assume heteronormative identities, a GHS system that struggles to correctly register trans patients, as well as a near‑total lack of services for LGBTI+ migrants and asylum seekers. He also referred to the 2022 law on legal gender recognition, noting that it was an important step, but maintains the requirement that the applicant be unmarried, excludes non‑binary identities and is not fully based on the principle of self‑determination.
Immediate Interventions
ACCEPT proposes five interventions which, according to the organisation, can begin within 2026. The first is the integration of a separate health pillar into the National LGBTI+ Strategy currently under preparation, in alignment with the EU LGBTI+ Equality Strategy 2026 to 2030. The second intervention is the creation of clinical protocols for trans health through the Health Insurance Organisation, based on international standards such as WPATH and WHO, so that trans people do not have to leave the country for specialised care.
The third is mandatory continuous education on LGBTI+ issues through the Cyprus Medical Association and the Cyprus Nurses and Midwives Association. The fourth proposal concerns the creation of a contact point within the GHS for discrimination complaints, with a clear investigation and redress procedure. The fifth concerns reform of the law on legal gender recognition, so that it is fully based on self‑determination, covers non‑binary identities and removes the requirement that the applicant be unmarried.