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LGBT Health

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Phavy Chey

on 1 November 2013

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Transcript of LGBT Health

Missions and Goals of the Capitol Hill Clinic
Lesbian, Gay, Bisexual
and Transgender Health
Insurance Policies and LGBT Health
LGBT Insurance Issues:
Disproportionately uninsured
Many health insurance plans do not cover their partners
-Microsoft and Starbucks’ insurance
plans do
Some aspects of healthcare are not covered by insurance plans
-Ex: Hormone therapy for transgenders, gender reassignment surgery
Local and National Organizations Recommended by Dave Holt, ARNP
Lesbian, Gay, Bisexual and Transgender Health:
Overview of LGBT Health
Systems Map
1. Expand HPV Testing via Anal Pap Smears
Some Facts:
HPV is the most commonly diagnosed STI in males and females
Condoms are not effective in preventing HPV infection
Epidemiologic data suggests a causal relationship of HPV infection with the development of anal cancer similar to that of cervical cancer due to similar composition of the transitional cell walls in the anus and cervix
Anal HPV infections responsible for 90% of all anal cancers
Let’s look at the numbers:

Incidence rate of cervical cancer: 8 cases per 100,000
Incidence rates of anal cancer (general hetero population): 1 case per 100,000
Incidence rates of anal cancer (MSM): 70-144 cases per 100,000
Why is it important to expand HPV Testing and anal Pap smears?

Preventive screening such as anal Pap smears may benefit LGBT by providing opportunities for early intervention
This may reduce the burden of morbidity and mortality due to anal cancer
Can be easily incorporated into primary care practice
2. Increase HPV Awareness
●Establish national recommendations for anal Pap smears
-Some experts recommend anal Paps every 3 years due to slow progression of HPV into cancer
● Educate healthcare providers
-Promote the use of Gardasil® HPV vaccine in males under 26 years of age
-Identify high risk patients acknowledging and using established risk factors
-Recognize signs and symptoms
-How to perform anal Pap smears
-Interpretation of results
-Initiation of treatment interventions, referrals for care
Educate patients
-Yes, there is a Pap for men!
-Information about the actual procedure
-Signs and symptoms
●U.S. Dept. of Health and Human Services website has a tool that searches which plans cover same-sex couples
●36 colleges now include gender reassignment surgery and/or hormone therapy in their student insurance plan
●¼ of Fortune 500 companies cover gender reassignment surgery
○-More of these companies cover hormone therapy
Patient Protection and Affordable Care Act (Obamacare)

How it helps LGBT health:

•Insurers cannot deny coverage to LGBT populations
-Non-discrimination clause
•Ends lifetime dollar limits and restricts annual dollar limits
-LGBT populations suffer chronic disease at higher rates
-Ending dollar restrictions will improve long-term access to care
•Ban on Excluding Pre-Existing Conditions
-Improves access to insurance for HIV/AIDS patients
•Includes LGBT categories into national data collection in order to understand LGBT health
•Covers preventative care coverage such as pap and anal pap smears, STD screening, and depression screenings
•Grants for community-based programs for public health initiatives which targets gay and transgender population as priority populations
Capitol Hill Medical
-The clinic we interviewed
-Caters specifically to the LGBT community and the doctors provide quality care with understanding of the current issues specific to the LGBT community
45th Street Clinic
-Provides health care to youth who are currently homeless or have been homeless in the past year
Pike Market Medical Clinic
-A small clinic that features HIV/AIDS screening and treatment
Gay City Health Project
-Based here in Seattle
-An organization that promotes wellness in the LGBT community and is the leading provider of STD and HIV/AIDS testing in the area
Clinics catering to the local LGBT community are rare
The clinics that offer the most support and are very small
Smaller clinics can be difficult to run and maintain but providers understand the social issues as well as the medical one.
Since there are few clinics on a local level, there has been much more progress fighting for equal access and quality health care for the LGBT community on the national level.
It is important to strengthen the connection between local and national organizations, along with the goals of Healthy People 2020 in order to document, understand, and address the environmental factors that contribute to health disparities and improve the health of the LGBT community.
Health Concerns of LGBT Individuals:
Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs
LGBT people are subject to discrimination, victimization and violence which increases stress and takes a toll on mental health
Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals
LGBT individuals are at higher risk for certain diseases
Tend to visit health care providers less often due to past experiences and mistrust of the medical profession
Often guarded about discussing sexual behavior with health care providers, fearing that will lead to discrimination
LGBT people often have less access to health insurance, as most work place policies do not cover unmarried partners
The CHC opened its doors August of 2008
It is the first and only openly gay clinic in the Seattle area
Staffed by Dave Holt, ARNP and Vy Chu, MD
Together they serve a panel of 2300 patients
The clinic plans to add a female provider to the staff in June of 2013
About the Clinic:
Who Did We Interview?
Key Points from the Interview

An open dialogue between provider and patient is important for a complete health assessment
The Healthy People 2020 website stressed the importance of "increas[ing] the provision of culturally competent care" for LGBT patients
-Dave Holt reiterated this point, particularly in respect to conversations about sex
-Most healthcare providers don't ask their patients about their sex practices at all, let alone gay sex
The Capitol Hill clinic tries to foster an environment in which their patients "can be open and honest without fear of judgment or rejection."
"To treat me, you have to know who I am."
Group 1: Phavy Chey, Susan Glenn, Annie McHugh, Nhi Tam Nguyen, Leah Trangen, Becky Ostrem
Capitol Hill
Medical Clinic

Dave Holt, ARNP
Board Certified
American Academy of Nurse Practitioners
HIV Specialist
American Academy of HIV Medicine

"I believe that GLBT patients deserve health care providers with whom they can be open and honest without fear of judgment or rejection."
--Dave Holt
American Academy of HIV Medicine
-Supports HIV practitioners and specialist
-Encourage quality and access to care for those with HIV by teaching, communicating with, and advocating for the HIV medical community

Gay and Lesbian Medical Association (GLMA)
-Oldest and largest LGBT association
-At first GLMA focused on HIV/AIDS related issues but now they have expanded to a wide breadth of LGBT medical facets
-Main focus is public policy advocacy for the LGBT community

Center for Excellence for Transgender Health (CoE)
-Based in San Francisco with many connecting institutions to promote quality access of care to the transgender and gender variant community
-CoE has access to some of the best training and prevention research centers located at UCSF

•45th Street Clinic. Retrieved February 25, 2013, from http://www.neighborcare.org/clinics/45th-street-homeless-youth-clinic

•American Academy of HIV Medicine. Retrieved February 25, 2013 from http://www.aahivm.org/

•Baker, K. (2012, March 26). Top 10 Things Health Reform Does for Gay and Transgender Americans. Retrieved February 21, 2013, from http://www.americanprogress.org/issues/lgbt/news/2012/03/26/11246/top-10-things-health-reform-does-for-gay-and-transgender-americans/.

•Capitol Hill Medical. Retrieved February 22, 2013 from http://www.capitolhillmedical.com/

•Center for Transgender Health. Retrieved February 25, 2013 from http://transhealth.ucsf.edu/

•Cichocki, M. (April 22, 2011). The Dangers of Anal Cancer: The Silent Killer in Men with HIV. In About.com AIDS/HIV. Retrieved February 16, 2013, from http://aids.about.com/od/otherconditions/a/analca.htm

•Cichocki, M. (December 14, 2008). Anal Papilloma Screening: Will Anal Paps Prove Beneficial in Men?. In About.com AIDS/HIV. Retrieved February 16, 2013, from http://aids.about.com/cs/conditions/a/analpaps.htm

•Gay City Health Project. Retrieved February 25, 2013 from https://www.gaycity.org/

•GLMA. Retrieved February 25, 2013 from http://www.glma.org/

•H.R. 3590--111th Congress: Patient Protection and Affordable Care Act. (2009). In www.GovTrack.us. Retrieved February 22, 2013, from http://www.govtrack.us/congress/bills/111/hr3590

•Holt, Dave. "Interview with Dave Holt." Personal interview. 8 Feb. 2013.

•Lindsey, K, and C. DeCristofaro, and J. James. (2009). Anal Pap smears: Should we be doing them?. Journal of the American Academy of Nurse Practitioners, 21 (8), 437-43.

•New York City Health and Hospitals Corporation, (2011, May 25). To Treat Me, You have to Know Who I am. Retrieved February 20, 2013 from

•Perez-Pena, Richard. (2013, Feb. 12). College Health Plans Respond as Transgender Students Gain Visibility. The New York Times. Retrieved from http://www.nytimes.com/2013/02/13/education/12sexchange.html?_r=1

•Pike Market Clinic. Retrieved February 25, 2013, from http://www.neighborcare.org/clinics/pike-market-medical-clinic

•The Affordable Care Act Helps LGBT Americans. Retrieved from http://www.whitehouse.gov/sites/default/files/docs/the_aca_helps_lgbt_americans.pdf

•U.S. Department of Health and Human Services. Healthy People 2020. LGBT Health. Retrieved February 22, 2013 from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=25

•United States. Center for Disease Control. (2012). HPV and Men- Fact Sheet. Retrieved February 16, 2013 from http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm
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