LGBT Health Education Blog
Empowering healthier communities is the primary theme of this year's National Health Center Week (August 5-11). As part of our mission to bring more visibility and better quality care to lesbian, gay, bisexual, and transgender (LGBT) people in all communities, we are marking National Health Center Week by introducing our new publication, Improving the Health Care of Lesbian, Gay, Bisexual and Transgender People: Understanding and Eliminating Health Disparities (link). This brief, written by physicians Kevin Ard and Harvey Makadon, can help guide health centers in making organizational and clinical changes to improve the health of LGBT people and, in the process, improve care for all.
Improving the Health Care of LGBT People is a comprehensive overview of major LGBT health issues. It discusses LGBT demographics, terminology, concepts, and disparities. Providers and administrators at health centers will learn about improving access to patient-centered care for their LGBT patients, including collecting data on sexual orientation and gender identity, creating a welcoming environment, and providing interventions that respond to LGBT disparities.
In order to empower healthier LGBT people in our communities, we need to ask patients about sexual orientation and gender identity and support them in all aspects of their identity and health. We hope this brief will help health centers begin or continue those conversations with their patients. Improving the Health Care of LGBT People is written to help close the gap between the hurt of health disparities and the promise of quality accessible care in a truly welcoming patient-centered medical home.
Let us know what you think of the brief, and what you would find helpful in the future, at firstname.lastname@example.org.
The International AIDS Conference continues in Washington, DC, with many of our faculty, colleagues and collaborators participating. The full conference schedule is available at this link: www.aids2012.org. Also, follow Fenway Health’s live tweets from the IAC at @FenwayHealth.
Here is a run down of sessions for the rest of the week featuring researchers from The Fenway Institute, our parent organization.
WEDNESDAY, July 25
- Differences in psychological, social, substance use and HIV sexual risks between urban Black Men who have Sex with Men Only (BMSMO) and Black Men who have Sex with Men and Women (BMSMW) (Ken Mayer)
- When Worlds Collide: Differential Concerns of IRBs Reviewing a "Buy Study" Protocol (Julia Gaggin, Patricia Case)
- An RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India (Steve Safren, Ken Mayer, Matthew Mimiaga
- Knowledge of and attitudes toward PrEP in a New York City sample of MSM. Sean Cahill.
THURSDAY, July 26
- Leadership Institute for Black Gay & Bisexual Men. Biomedical HIV Prevention Research: A Bridge to the End of AIDS. Ben Perkins, Charlie Gregor.
- From promise to Programmes: Treatment as Prevention. Patients in routine HIV clinical care at-risk for potentially transmitting HIV in the "test-and-treat" era of HIV prevention. Ken Mayer, Matthew Mimiaga, Steve Safren.
- Out in the World: Global MSM HIV Epidemics. Non-adherence to HIV testing guidelines and late HIV diagnosis is common among U.S. black men who have sex with men (MSM); Effect of early versus delayed initiation of antiretroviral therapy (ART) on clinical outcomes in the HPTN 052 randomized clinical trial. Ken Mayer.
- Satellite Health Sector Partnerships: Creating Local Clinical Service Networks for MSM in Diverse Global Settings. Rodney VanDerwarker, Ken Mayer.
- HIV-infected Men Who Have Sex with Men (MSM) who report Very High Rates of HIV Sexual Transmission Risk Behavior: Developing a Context for Novel HIV Prevention Interventions. Connal O’Cleirigh, Ken Mayer, Wade Taylor, Steve Safren.
- The Global Picture: Transgender Health and Rights. Ken Mayer.
FRIDAY, July 26
- The cost-effectiveness of treatment as prevention: analysis of the HPTN 052 trial. Ken Mayer.
We are proud to announce the publication of a new brief entitled: Improving the Health Care of Lesbian, Gay, Bisexual and Transgender (LGBT) People: Understanding and Eliminating Health Disparities (link).
The brief offers an overview of major issues relevant to the health and health care of lesbian, gay, bisexual and transgender people. The authors (our faculty members Kevin Ard and Harvey Makadon) discuss LGBT demographics, terminology, and concepts and review LGBT health disparities across the life span. Clinicians and health care organizations will learn steps they can take to improve access to patient-centered care for their LGBT patients, including collecting data on sexual orientation and gender identity, creating a welcoming environment and providing interventions that respond to LGBT disparities.
Be sure to check out this and the many other publications and resources available on our resource pages.
National HIV Testing Day (NHTD) is this week, June 27, 2012. This is the 19th year for NHTD. The CDC estimates that 1.2 million people in the United States are living with HIV and that 1 in 5, or about 240,000 individuals are unaware they are HIV positive. HIV continues to disparately impact gay and bisexual men, and particularly gay and bisexual men of color.
The U.S. Centers for Disease Control and Prevention (CDC) recommends routine HIV screening as part of primary care adolescents and adults, and repeat screening at least annually for those at high risk. High risk behaviors include injecting drug use, unprotected sex with men who have sex with men, sex work and diagnosis and/or treatment with hepatitis, tuberculosis or STIs, and unprotected sex with anyone who falls into one of the above categories, or with some someone whose history is unknown.
Health centers across the country are getting folks in their communities tested, offering free walk-in testing events that coincide with cookouts, free haircuts, and consciousness-raising walks. The CDC’s listing of events is here: link.
Check out our website resources pages for links to many additional HIV testing and treatment resources (link). Also, our colleagues at the National Association of Community Health Centers have developed numerous tools and guidelines for incorporating HIV screening into primary care. Their tools have been tested and evaluated by health centers (link).
LGBT youth make up a disproportionate share of homeless youth in the US.The National Association for the Education of Homeless Children and Youth has published a toolkit (link) for service providers who work with homeless youth. While not specific to LGBT youth, the sections related to helping youth access Medicaid and other benefits, and how and when youth can consent to treatment will be of interest to health care providers and organizations. Our resources page also links to the toolkit, along with numerous other helpful links; check it out here.
The Centers for Disease Control and Prevention (CDC) recently updated their fact sheet on HIV among gay, bisexual and other men who have sex with men (MSM). The news, unfortunately, is not good. In the US, HIV continues to affect gay and bisexual men more severely than any other group. Among MSM, Black/African American men bear the most disproportionate burden of HIV and young men of color continue to represent increasing proportions of new infections. The fact sheet is available on our resource page (link).
National LGBT Health Education Center faculty member Sean Cahill has collaborated with Jason Cianciotto to write a new book, LGBT Youth in America's Schools. The book reviews of social science research with analyses of school practices and laws that affect lesbian, gay bisexual and transgender students.
The book is a useful guide for service providers who interact with school-age clients. It also provides useful information for creating and improving policies in agencies and programs that care for youth. One reviewer called the text, "the first systematic, research-based review that brings together a huge literature on the status of LGBT youth..." It is available from University of Michigan Press (link).
- After a long struggle, a New Jersey transgender woman finally received reimbursement from her health insurance company for her mammogram. The insurance company relied on language in their plan that excluded from coverage costs related to the woman’s change in gender status. The Transgender Legal Defense and Education Fund intervened and ultimately convinced the company that the exclusion should not apply to the mammogram, a procedure that had nothing to do with changing sex characteristics. Such an overbroad interpretation could have led to denial of many claims for medically necessary care, such as treatment for breast cancer. This is just one of many examples of how trans women and men are denied access to care based on their transgender status. The TLDEF’s press release is here: link.
- A study (link) in the most recent issue of the Journal of Homosexuality finds that people whose parents react negatively to their coming out are at higher risk for depression and substance abuse. The authors looked at data from a Massachusetts population-based survey and also found that lesbian and bisexual women who had not come out to their parents experienced worse health outcomes than those who did.
- The New York Times reports (link) that Robert Spitzer, MD recanted his 2001 study on reparative therapy (therapy directed at making gay and lesbian people straight). The study is often used to advocate for the validity of reparative therapy. The American Psychiatric Association and the American Psychological Association formally oppose this form of therapy, which can lead to increased depression, anxiety, and suicidal ideation.
- California may become the first state to ban reparative therapy, reports the San Francisco Chronicle (link). If passed, the legislation will become prohibit sexual orientation change therapy on minors, and require adults to provide written consent for the therapy.
- San Francisco State University’s Family Acceptance Project released multilingual versions of a booklet, entitled Supportive Families, Healthy Children. It educates parents about how to support LGBT children (link). The U.S. government-supported Suicide Prevention Resource Center (link) recognized the booklets as a suicide prevention “best practice”. The booklet is available in Spanish, Chinese, and English.
- The Agency for Healthcare Research and Quality (AHRQ) recently published its 2011 National Healthcare Disparities Report (link), which for the first time recognizes and tracks LGBT health disparities. The report’s LGBT-specific sections focus primarily on transgender disparities. AHRQ is a federal agency charged with improving quality, safety, efficiency, and effectiveness of American health care.
[This post was originally published on the Fenway Health Fenway Focus blog, here. Fenway Health is one of the National LGBT Health Education Center's parent organizations.]
Looking at other Women’s Health Week resources, I found the same general health advice: eat healthy, exercise, seek routine preventive care, avoid unhealthy behaviors, and foster good mental health. Yes, these are all vital to maintaining health, but hasn’t almost everyone heard this advice at least 100 times? And shouldn’t people of all genders aim to practice these healthy behaviors? Of all the extremely important women’s health issues, this is what we focus on during a week dedicated to women’s health?
Many lesbian, bisexual and transgender women feel uncomfortable talking about their sexual orientation or gender identity, preventing them from getting the care they deserve.
I was ready to give up on this post when I was inspired by some simple words from my mother. She was a single mom who returned to college when my sisters and I were in elementary school. Despite having three daughters to raise alone, she managed to excel in school and eventually complete a graduate degree.
My mom is a fighter, and she fought for her health and the health of her children. She disagreed with healthcare providers if she was unsatisfied with their diagnosis or treatment plan. We lived in poverty, went through periods of being uninsured, and had limited access to competent healthcare providers. Yet, my mom always advocated for the best possible care. And, believe me, we got it.
I spoke to my mom a few days ago and we discussed some health problems she has been experiencing. She said to me, “Christina, why don’t doctors listen to their patients? I know my body better than anyone.” As we talked about her plans for seeking further care she told me that, “it always helps to be assertive."
Check out the rest of the post at the Fenway Focus blog.
[We are posting today as part of the International Day Against Homophobia and Transphobia or "IDAHO" blogathon. IDAHO is an opportunity to pay tribute to the progress that has been made for LGBT rights and draw attention to persisting inequities still affecting LGBT people how this impacts LGBT youth in particular.Check out the IDAHO blogathon here.]
As issues facing LGBT youth are coming to the forefront of public attention and catching the eye of public health officials, cities are beginning to respond to the issues in concrete ways. Recently, several new programs have been announced in Chicago.
LGBT youth in Chicago and across the country shoulder an especially heavy burden, as demonstrated by many recent studies documenting serious health disparities. Gay activists celebrate the fact that LGBT people are “coming out” at younger and younger ages. This must mean that society is becoming more accepting of gay and lesbian people, right? But what does it actually mean to come out as a gay or lesbian or transgender young person?
Many young people are not finding the reaction they’re hoping for from their friends and families. At school, 13.9% of GLB-identified students skipped school in the past month because they felt unsafe en route to or at school (compared to 2.2% of other students), and 17.3% were injured or threatened with a weapon at school in the past year (compared to 6.4% of other students) (link). And at home, at the time of disclosure to family members, 50% of gay teens experienced a negative reaction from their parents, and 25% are met with a parental demand to leave their home (link). While only 3-5% of the U.S. population identify as LGBT, they make up 40% of the entire homeless youth population (link). These conditions lead to startling health impacts such as soaring STD, HIV, and suicide rates (LGB students are four times more likely to commit suicide: 24.7%, compared to 5.6% of their straight counterparts) (link). Other health risks include higher risk of the development of substance abuse, risky sexual behaviors, racism, eating disorders, obesity, and lack of access to care (Fenway Guide, link).
The good news: Chicago has joined other major cities in rolling out new programs last month to specifically address these issues. In early April, the Chicago Department of Public Health announced its LGBT Community Action Plan (link), which supplements the City’s current public health agenda and addresses LGBT-specific health disparities. Specific to youth, the plan addresses school bullying with a focus on how it disproportionally impacts LGBT students, and parent education about creating a supportive home environment for children with alternative sexual orientation or gender expression. The plan also provides many productive changes related to health care, including improving data collection of sexual orientation/gender identity and providing clinical education for health providers.
Another success is the creation of the Midwest’s first homeless shelter targeting LGBT youth, which opened its doors in March (link). El Rescate (Spanish for “the rescue”) is geared towards LGBT and HIV positive youth aged 18-24 to provide shelter, link residents with peer mentors, and connect youth with training and employment experience. Surprisingly, El Rescate is located in Chicago’s Humboldt Park, a traditionally Puerto Rican neighborhood, which organizers chose over the “boystown” gay neighborhood in hopes to create an integrated, city-wide support system for LGBT youth. Staff members will act to alleviate the disproportionate percentage of the homeless population that is LGBT youth and the discrimination by homeless services against LGBT youth that are far too common.
A new research program is a resource for young transgender women in Chicago. The Lifeskills project, whose sister site is housed at The Fenway Institute in Boston (the parent organization of the National LGBT Health Education Center), engages Chicago trans women in a year-long intervention study. Participants develop key life skills to help decrease high-risk behaviors, thereby curbing widespread rates of HIV in this vulnerable community. More information about participating in this study in Chicago or Boston can be found at www.projectlifeskills.org
Finally, one Chicago clinician has stepped forward as a national leader in providing the highest quality of care to LGBT Youth and HIV, Robert Garofalo, MD. The Chicago Phoenix highlighted a recent speech of Dr. Garofalo at the University of Illinois Chicago School of Medicine in late March about the health of LGBT youth as part of the school’s LGBTQA Health Week (link). Dr. Garofalo is an associate professor of Pediatrics and Preventative Medicine at Northwestern University Feinberg School of Medicine, and is a faculty and advisory board member of the National LGBT Health Education Center. He spoke about how the Institute of Medicine’s recent groundbreaking report on The Health of LGBT People is a tipping point to shift the focus of LGBT youth research from deficit-based studies (like HIV and suicide rates) to studies focused on well being. Dr. Garofalo also applauded the IOM’s recommendation of collecting consistent, nationwide data on government forms regarding sexual orientation and gender identity. This data can be used to create effective and lasting programs to help end many of these health disparities.