LGBT Health Education Blog
- 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.
The LGBTQ Policy Journal at the Harvard Kennedy School recently published a study entitled, A Gender Not Listed Here: Genderqueers, Gender Rebels, and OtherWise in the National Transgender Discrimination Survey. The paper (link) evaluates health care and other experiences of people who do not identify as being one or the other gender using data from the National Transgender Discrimination Survey (link). The survey gave respondents the option to write in their self-identified gender rather than choose from predefined male/female/both categories, and 860 of the 6,450 respondents did just that. Compared to respondents who did identify a gender, respondents who chose to self-identify their gender were more likely to be unemployed, suffer physical assaults, and forgo health care due to fear of discrimination. The respondents who self-identified their gender were also more likely than transgender respondents to have attempted suicide (43% vs. 40%); both numbers contrast starkly to the rate of suicide attempts in the general population, which is less than 2%.
This study and the survey data from which it springs only begin to describe the health disparities transgender and gender non-conforming patients face in health care and other aspects of their life. Hopefully these scholars will continue their important work, and inspire others to do the same.
Look for our staff and faculty next week at the National Health Care for the Homeless Council’s National Conference in Kansas City. Further information, including how to register, is here. Providers and advocates from around the country will gather for the conferences many accredited workshops, professional networking, and inspiring plenary sessions.
Our program on Optimizing Care for LGBT People in Health Care for the Homeless Programs will be presented by Education Center Faculty Joanne Keatley, MSW, Ralph Vetters, MD, and Harvey Makadon, MD on Wednesday, May 16th. JoAnne Keatley is Director of the Center of Excellence for Transgender Health at the University of California, San Francisco. Dr. Vetters is Medical Director of the Sidney Borum, Jr. Health Center, which is a program of Fenway Health, our parent organization. Hilary Goldhammer, MS, our Manager of Curriculum Development, will moderate the panel discussion.
Also check out our booth at the conference which will feature giveaways, including a drawing for a copy of The Fenway Guide to LGBT Health, along with a variety of LGBT health information. We would love to discuss how we can be helpful to your health centers.
We are excited to be included in this conference and look forward to additional collaborations with the NHCHC. Check out our calendar, here, for additional NHCHC collaborations in Tennessee and Seattle.
Check out Urbanite Baltimore's noteworthy profile of openly lesbian health care provider Tonia Poteat, PhD, who was recently appointed Senior Technical Advisor for Most At Risk Populations by the Office of the U.S. Global AIDS Coordinator. As a physician assistant at Chase Brexton Health Center (a LGBT-focused health center in Baltimore) Dr. Poteat cared for at-risk transgender patients at Poteat's coming out story was told in the 2007 documentary For The Bible Tells Me So, which profiled Christian families’ struggles to accept lesbian and gay children. Dr. Poteat also did a stint with the CDC and the World Health Organization monitoring and evaluating HIV treatment programs in sub-Saharan Africa. It is inspiring to read about a provider so dedicated to reaching the most vulnerable populations.
Morehouse School of Medicine
Thursday, April 19, 2012
Last week, the White House Office of National AIDS Policy (ONAP) held a one day conference at Morehouse School of Medicine to highlight the issues of HIV/AIDS in the LGBT community. Former Surgeon General David Satcher stated in his speech that there is no greater health disparity than the impact of HIV on gay men.
Also of importance were discussions introduced by the ONAP Director Grant Colfax and CDC's Kevin Fenton on the growth of the epidemic among men who have sex with men (MSM) and transgender women, in particular young black MSM. According to recent statistics from the CDC, MSM accounted for 64% of new cases of HIV in the United States in 2009, and alarmingly there was almost a 50% increase among young black MSM. When considering this, it is important to keep in mind CDC researcher Greg Millett’s meta-analysis of HIV risk factors shows that black MSM do not engage in higher rates of risky behavior but that they do experience lower rates of testing, a higher prevalence of HIV in their community, and barriers to care. Recent evaluation of HIV among transgender women showed HIV rates as high as 27% (Herbst et. al). Regarding our understanding of the epidemic, David Malbranche, MD from Grady Hospital and Emory University presented an eloquent discussion on how we might think of intersectionality and the MSM community, raising interesting new perspectives on how intersectionality, long considered a source of LGBT health disparities, can also be viewed as a reason for resilience. The conference was a particularly good opportunity to develop an agenda; a great deal of work remains to create interventions that will make a difference regarding HIV and LGBT people.
On that note, Sean Cahill, the Director of Health Policy at the Fenway Institute has just written on this topic. His essay follows.
HIV funding and programming targeted at gay and bisexual men in the U.S.: Reasons for hope, and cause for concern
By Sean Cahill
Over the past few years we have witnessed a number of advances in science-based HIV prevention and care policy and LGBT health policy in the U.S.
We have a first-ever National HIV/AIDS Strategy that prioritizes reducing the disparity affecting gay and bisexual men—who were 64% of new infections in 2009, although just 2% of the adult population. We repealed a number of counterproductive policies dating back to the dark days of the 1980s and Senator Jesse Helms, such as ending the HIV entry ban, ending the ban on using federal funds for syringe exchange, and ending funding for abstinence-only-until-marriage education. Unfortunately, the latter two changes were short-lived. And we’ve seen long overdue increases in funding for Ryan White care, the AIDS Drug Assistance Program, HIV prevention through the CDC, and research at NIH, including promising biomedical prevention research.
LGBT seniors who live in New York have reason to celebrate. New York City officials and elder organization SAGE (Services & Advocacy for Gay, Lesbian, Bisexual and Transgender Elders) recently opened the city’s first LGBT senior center (press release), to be called the SAGE Center. The center is the city’s first to provide services that are culturally competent for LGBT elders. In addition to mental health programs, the center will also help clients with meals, fitness classes, health and wellness seminars, cultural offerings, and volunteer opportunities. SAGE’s Executive Director referred to the new center as “a dream for LGBT older people for many years.” Older adults are often presumed heterosexual, creating an environment that is not sensitive to the specific needs of LGBT people in aging services, healthcare and other institutional settings. Senior services and organizations that are culturally competent for LGBT communities help to reduce isolation, a key health barrier older LGBT people face.
The SAGE Center is located at 305 Seventh Avenue 6th Floor in New York, telephone 212-741-2247.
In March, the Veterans Health Administration clarified a portion of its 2011 policy on respectful delivery of health care for transgender veterans. (The National Center for Trans Equality issued an excellent fact sheet about the directive.) The original policy stated that an individual must provide official documentation in order to change their name and gender in VHA medical records. Some VHA staff incorrectly interpreted this to require documentation of sex reassignment surgery. The VHA has now clarified that to change the gender on the patient’s VHA medical records, a veteran must simply provide a physician’s letter certifying that the veteran has changed genders and has had appropriate clinical treatment for gender transition. The physician’s letter need not certify that surgery, or any particular medical procedure, has been completed. Since many transgender individuals do not undergo surgery or other medical treatment, this policy clarification is very important to helping them receive culturally sensitive care. One important way health care staff can create a welcoming environment for transgender patients is by using the individual’s preferred gender, pronoun, and name.
The VHA is among the largest healthcare providers in the U.S., with over 275,000 employees. It provides care to thousands of women and men who have served in the U.S. military.