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LGBTQ Cultural Competency - Healthcare

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Steven Jagord

on 7 August 2017

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Transcript of LGBTQ Cultural Competency - Healthcare

62
ECG
bpm
Steve Jagord
sjagord@pridecenterwny.org
(716)852-7743 x3853
@stevenjagord
LGBTQ
An Acronym for Lesbian, Gay, Bisexual, Transgender and Queer/Questioning

Often used to describe all sexual and gender minorities

Diversity within each group
Race & Ethnicity
Socioeconomic status
Geographic location
Age


Other variations include: LGBTQIA2
Transgender
A person whose gender identity or gender expression differs from the sex assigned to them at birth
Transgender
Sexual Orientation
Being LGBTQ-Affirmative
LGBT-Tolerant
You are aware that LGBT exist and use your services

LGBT–Sensitive
You are aware of, knowledgeable about, and accepting of LGBT people

LGBT–Affirmative
You actively promote self-acceptance of an LGBT identity and actively seek to create an environment friendly towards LGBT people
Transgender
Pride Center of WNY, Inc.
LGBTQ Cultural Competency
About Us
Pride Center of WNY, Inc.
Established in 2001
501(c)(3) nonprofit
Part of Evergreen Health
Serves the eight counties of WNY
"The Mission of Pride Center of Western New York, Inc. is to work with the community to make Western New York a safe, healthy, and satisfying place for lesbian, gay, bisexual, and transgender people to live, work, and establish their families."
Aging
Healthy lunch for seniors
Silver Pride Project
Arts & Culture
Buffalo Pride Parade & Festival
Gay Men's Book Club
Lending Library
Health
Annual Trans Wellness Conference
HIV Testing
SCOUT
Trans Health Initiative
Pride Works
David Bohnett Cyber Center
LGBTQ Cultural Competency Trainings
Out for Business
Support
Coming Out Support
Trans Art Therapy
TransGeneration
Caregiver Support
Learning Objectives
Define terminology and describe concepts associated with LGBTQ populations
Discuss sex, gender & sexuality
Describe the way in which marginalization and discrimination impact the lives of LGBTQ people, particularly in healthcare
Sex & Gender
Sex and gender are different, yet both words are often used interchangeably - why?
Sex
What you're born with - the genetics that make you, you

Chromosomes - XX (female), XY (male)
Physical characteristics (sex organs, genitalia)
Sex is permanent and cannot be changed
Male-Female
Intersex
Gender
*Multiple concepts are at play when discussing gender
Gender Identity
: the psychological awareness or sense of where one fits on the man-woman binary
Gender Expression
: the way in which one communicates his or her gender identity through appearance and behavior
Gender Role
: that part of behavior that is influenced by society’s expectation of what is gender-appropriate
Man-Woman
Transgender
Transgender
Gender Variant
Gender Non-conforming
Gender Different
*Umbrella terms used to group the many different gender communities
DJ's Story
Transgender
Transsexual:
biological men and women whose gender identity most closely matches the other gender (Is sometimes used more specifically to describe transgender people who have undergone genital surgery)

Genderqueer
: used to describe people whose gender identity does not fit neatly into either male or female categories

Crossdresser
: Individuals with a desire to wear the clothing of another sex but not to change their gender; many are heterosexual men who crossdress for erotic arousal; previously called transvestite

Drag Queen/King
: Individuals, usually in the gay/lesbian community, who crossdress for entertainment purposes and/or to challenge social stereotypes
Sexual Attraction
Who you are attracted to physically, romantically, emotionally, etc. (e.g. heterosexual, bisexual, homosexual)
An internal identity; you only know your own for sure
Develops very early and is not a choice
Also called “orientation”
Sexual Behavior
Who you choose to have sex with
Can be aligned with sexual attraction or not
Sexual Identity
A label you choose to call yourself in order to tell others what you want them to understand about your sexual orientation (e.g. straight, gay, bi, lesbian, dyke, queer, etc.)
Can be reflective of your Sexual Attraction and Sexual Behavior, or not
Culture
Behavior ≠ Identity ≠ Orientation
Why are LGB & T Lumped Together
If lesbian, gay and bisexual are sexual orientations and transgender has to do with gender identity, then why are they grouped together?
All four groups are subject to discrimination based on their gender expression.

Men who are feminine, women who are “butch” or masculine, and transgender people often find themselves at odds with society for not adhering to conventional norms.
LGBTQ Health
Health disparities that affect the LGBTQ community stem from structural and legal factors, social discrimination, and a lack of culturally-competent health care.

Laws that protect LGBTQ people from discrimination
Health insurance issues
Stigma
Not enough service providers with LGBTQ health expertise
Location/distance
Finances

Health Disparities
Lesbians are more likely to be overweight or obese compared to heterosexual women.
Body image and eating disorders are more prevalent among gay and bisexual rather than heterosexual men.
Lesbians experience high teen pregnancy rates.
Evidence suggests higher rates of breast and cervical cancers among lesbian and bisexual rather than heterosexual women.
LGBTQ youth experience high rates of homelessness.

Substance Abuse
Members of the LGBTQ community are approximately twice as likely to smoke as the general population.
In addition to tobacco use, alcohol and other drug abuse may be more common among LGBTQ than heterosexual men and women.

Mental Health
Several studies have suggested higher rates of depression and suicide ideation among LGBTQ individuals.
LGBTQ youth are 2 to 3x more likely to attempt suicide.
After race and ethnicity, sexual orientation and gender identity are the most common motivations for hate crimes. This often produces an environment of stress and intimidation, even for those not directly impacted.

Domestic Violence
Rates of intimate partner violence are close to on par with heterosexual couples – between one in four and one in three couples experience IPV.
Same-sex IPV has been under-recognized and under-addressed by the medical community.
IPV likely affects transgender individuals more so than those who are straight, gay, lesbian or bisexual.
HIV/STI
Sexually Transmitted Infections – including HIV – are major concerns for some LGBTQ groups including MSM and transgender women.
About
1.2 million
Americans are living with HIV, many of whom which don't know they are infected.
About
40,000
new cases of HIV occur annually in the U.S.
MSM account for two thirds of all new HIV infections in the U.S., yet they make up less than 3 percent of the general population.

HIV/STI
Center of Western New York
Transgender Health
"I am not a high-risk person.
I am a member of a community that is put at high risk."
- Marcela Romero, coordinator of REDLACTRANS and Latin American & Carribbean Transgender Network
Lack of employment opportunities/protections results in sex work/survival sex
Sex workers are often paid more for unsafe sex
Distrust of service providers, postponement of treatment due to fear
HIV/safe sex outreach has historically been focused on cisgender people
STI transmission risks of trans women
Post GCS, vagina is not self-lubricating
Discomfort seeking prostate exams
Lack of info on HIV rates in trans men
Little to no research
Discomfort seeking OB/GYN care
Factors:
#transhealthfail
When does behavior not align with attraction and identity?
People in relationships despite suppressed desires
Drug users that turn to sex work to feed addiction
Circumstantial homosexuality
Stigma/culture
How we ask about behaviors is more important than orientation/identity
Pronouns
MSM
Transgendered?
2015 Nation Center for Transgender Equality Survey
39% experienced serious psychological distress in the month prior to completing the survey, compared with only 5% of the U.S. population.
40% of respondents have attempted suicide in their lifetime — nearly nine times the U.S. general population rate (4.6%).
Respondents encountered high levels of mistreatment when seeking health care. In the year prior to completing the survey:
33% of those who saw a health care provider had at least one negative experience related to being transgender, such as being verbally harassed or refused treatment because of their gender identity.
23% of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated as a transgender person
33% did not go to a health care provider when needed because they could not afford it.
HIV/STI
In 2015:
Gay and bisexual men accounted for 82% (26,375) of HIV diagnoses among males and 67% of all diagnoses.
Black/African American gay and bisexual men accounted for the largest number of HIV diagnoses (10,315), followed by white gay and bisexual men (7,570).
*Source: CDC
HIV/STI
Among all gay and bisexual men, trends have varied by race and over time. From 2005 to 2014:

Among white gay and bisexual men, diagnoses dropped steadily, declining 18% overall.
Among Hispanic/Latino gay and bisexual men, diagnoses rose by 24%.
Although diagnoses among African American gay and bisexual men increased 22%, they have leveled off in the past 5 years, increasing less than 1% since 2010.
Young African American gay and bisexual men (aged 13 to 24) experienced an 87% increase in diagnoses. But since 2010, diagnoses have declined 2%.
*Source: CDC
Sources: Fenway Institute & CDC
Full transcript