LGBT Health By Mark, Melissa, Lauren and Susanna

Transgender and Gender Dysphoria Some clarifications… Transgendered - unlike the LGB in LGBTIQ - NOT defining sexual orientation Gender dysphoria and GID vs. Gender non-conformity Transitioning varies widely from individual to individual. SRS = sexual reassignment surgery - includes both top and bottom procedures. Passing/Going Stealth - ability to live one’s life as the target gender without detection of TG status. Intersex - separate set of issues and concerns relating to congenital development and its effects on gender and sexuality, (separate and very interesting advocacy campaigns pertaining to intersex identity) childhood/adolescent SOC vs. adult SOC

GID and Medical Intervention WPATH recently released 7th version of SOC for transgendered patients Adult SOC for PRIOR to medical intervention (hormonal/surgical): – GID diagnosis necessary for medical interventions and to receive medicaid. Very few “qualified” mental healthcare providers - “gatekeepers” Very stringent minimum requirements for diagnosis Amount of surgeries/hormones can be prohibitively expensive -> illegal practices – Real Life Experience Can be mentally distressing/ physically dangerous without anatomical/hormonal intervention

Institutional Obstacles in Transitioning Legally changing name and sex Coming out and the Pronouns Privacy and inappropriate questions Using restrooms

How Physicians Address LGBT Issues Issues for Patients: Already a marginalized population – Adolescents: 69% of LGBT youth ages reported harassment of violence in their schools – 3 to 7 times as likely to commit suicide – Homelessness: 3,800 homeless kids in New York, and 40% off the homeless are LGBTQ youth Mistreatment: Direct discrimination – Horror stories: “You need to pray to stop your ‘problem’” – 45% of GLMA gynecologists observed substandard care given to lesbian women Don’t ask, and patients wont tell – 39% MSM have not disclosed sexual identity to doctor ->Lack of proper healthcare – Excluding LGBT categories in forms; i.e. Single or Married – should add Domestic Partner Addressing the issue: – US DHHS “Healthy People 2010” (national health prevention agenda) finally included reducing LGBT health disparities

Medical Education and Training for LGBT patients Average medical students receive only 4 hours devoted to LGBT health over four years of medical school Lesbian, Gay, Bisexual or Transgender Medical Students feel stigmatized – 65% LGBT physicians have heard derogatory comments about LGBT individuals, 15% have been harassed – Only 10% of medical schools have a LGBT student group (Go Sinai!) – “Gay-friendly specialties”: Pediatrics, Psychiatry, and Family Practice Further resources: Gay and Lesbian Medical Association combats homophobia in medical practice – Resources include a provider list of gay-friendly doctors

The Huffington Post: Are Medical Schools Ignoring LGBT Health? According to the U.S. government's Healthy People program, such needs can include specific adolescent and adult mental health issues, drug and alcohol use, obesity and risk of sexually transmitted infections.The authors of the new study -- which was conducted by Stanford University's LGBT Medical Education Research Group and published in the Journal of the American Medical Association -- did find that 97 percent of the schools surveyed taught students to ask patients if they have sex with men, women or both when asking about sexual history.But fewer schools emphasized the difference between sexual behavior and identity -- just 72 percent indicated they teach students, for example, that some men may have sex with other men but still identify as straight. … Some 33 percent( (of U.S. and Canadian med schools) provided no LGBT- related instruction during students' clinical years, which is when students receive the most hands-on training, and nearly 4 percent of schools reported not covering LGBT health at all.

What does the Affordable Health Care Act say about LGBT health?

Unfortunately, very little! Only one provision (Section 5306, regarding participation by people of “different genders and sexual orientations” in mental and behavioral health education and training programs) explicitly mentions the LGBT community … The logic is that the law as a implicitly addresses disparities, discrimination, and inequity experienced by gay and transgender people as a high-risk population in our society

As identified by the National Coalition for LGBT Health, these are focus areas for advocacy work: “Achieving comprehensive nondiscrimination protections in health insurance exchanges Establishing LGBT-inclusive data collection policies Recognizing and including LGBT families in all health reform activities Supporting community-based health interventions that are LGBT-inclusive” …i.e. We need more data!

Recent Efforts by the U.S. Department of Health and Human Services Equal Employment Opportunity Policy (March 2011) Non-discrimination Policy – (April 2011) In the Hospital The President's Memorandum on Hospital Visitation: Visitation Advance Directives To address the need for more data U.S. LGBT community: Internal LGBT Coordinating Committee – Institute of Medicine Study on LGBT Health Healthy People 2020 Aging Services Anti-Bullying Efforts Improvements in Foster and Adoptive Care Runaway and Homeless Youth Services

More Resources/Info: In New York: Empire State Pride Agenda (equality/justice campaigns) In NYC—The Ali Forney Center (Housing for Homeless LGBT Youth) SAGE: Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders National Coalition for LGBT Health U.S. Dept of Health and Human Services (LGBT Healt) – (Look for a specific section for LGBT youth)