1. Board of Supervisors Health and Hospital Committee 2/12/14 STATUS OF LGBTQ HEALTH: SANTA CLARA COUNTY 2013 © 2013 Santa Clara County Public Health Department The Public Health Department is owned and operated by the County of Santa Clara

2. Overview  Historically, very limited data available on LGBTQ health in Santa Clara County  President Yeager requested comprehensive LGBTQ health assessment in 2013  Goal: understand the health needs of LGBTQ residents to assist with identifying priorities, strategies, and resources to address disparities  Conducted August-December 2013  Guided by co-chairs and Steering Committee  Included 1,175 surveys, 17 discussion groups, and 27 interviews with leaders 2

3. Topics 3 Health and healthcareSocial determinants  General health  Healthcare (includes healthcare discrimination)  Mental health and substance use (includes homelessness)  Sexually transmitted infections  Safer sex and sexual health  Social acceptance and discrimination  Self acceptance  Social services  Safety and violence  LGBTQ families  Community assets and community cohesion

4. HEALTHCARE 4

5. 5 Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey Percentage of LGBTQ survey respondents who needed medical care in the past 12 months but could not get it

6. 6 Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey Percentage of LGTBQ survey respondents who experienced healthcare discrimination in the past 5 years

7. Recommendations 7  Develop LGBTQ competency trainings for all providers and staff in healthcare settings.  Educate LGBTQ healthcare consumers and providers about LGBTQ rights and enforce existing nondiscrimination statutes.  Standardize medical forms to include optional gender identity and sexual orientation questions to prevent unintentional discrimination.  Create an inventory of LGBTQ-competent healthcare providers and conduct outreach around available services.

8. MENTAL HEALTH AND SUBSTANCE USE 8

9. 9 Percentage of LGBTQ survey respondents who felt they might have needed to see a professional in the past 12 months because of concerns with their mental health, emotions, nerves, or use of alcohol or drugs Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey

10. 10 Percentage of LGBTQ survey respondents who had ever shot up or injected any drugs other than those prescribed Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey

11. Recommendations 11  Designate the LGBTQ population as high-risk for mental health issues in order to prioritize services and funding.  Develop LGBTQ-specific mental health and substance use services to reduce barriers and mitigate fears of discrimination.  Provide training to ensure an LGBTQ-competent workforce in mental health and substance use.  Continue targeted outreach and education related to mental health and substance use as well as information on available services.  Reduce economic barriers by providing more affordable mental health services and resources.  Conduct regular tobacco cessation campaigns that target LGBTQ populations.

12. SEXUALLY TRANSMITTED INFECTIONS 12

13. Testing for sexually transmitted infections 13 Among MSM survey respondents:  21% have never been tested for HIV  43% have never been tested for syphilis  38% have never been tested for gonorrhea Among lesbian, bisexual women, and transgender survey respondents:  Between 34% and 40% have never been tested for HIV  Between 45% and 65% have never been tested for chlamydia, gonorrhea, or syphilis (transgender)

14. Recommendations 14  Offer comprehensive HIV and other STI testing and integrate testing in community venues.  Reduce barriers to testing by offering low-cost and anonymous testing.  Promote and subsidize in-home HIV testing kits.  Train medical providers on how to talk to patients about STI risk, testing, and care.  Improve outreach for hard-to-reach groups.  Raise public awareness to reduce stigma about HIV and other STIs.  Mandate school-based sex education inclusive of LGBTQ identities.

15. SOCIAL ACCEPTANCE AND DISCRIMINATION 15

16. 16 Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey Percentage of transgender versus non-transgender survey respondents who were discriminated against due to sexual orientation and/or gender identity in the past 12 months

17. Recommendations 17  Increase the visibility of transgender people through public education campaigns. Engage religious leaders including churches and the Christian community.  Carry out education and training in federal agencies and public social service agencies about transgender issues.  Educate students, teachers, and staff to increase transgender acceptance in schools.  Develop shelters and safe houses for homeless transgender individuals.  Offer legal assistance for transgender individuals, particularly for formally changing one’s gender.  Assist transgender students in attending college by providing scholarships.  Create a transgender community center that would provide a safe space for the community, with services such as legal assistance, information about services, and support services for families.

18. SOCIAL SERVICES 18

19. Housing and homelessness  28% of LGBTQ survey respondents and/or their families needed affordable housing but had a hard time accessing it.  6% of LGBTQ survey respondents and/or their families needed homeless shelters but had a hard time accessing them. 19 Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey

20. Homelessness among LGBTQ youth and young adults  LGBTQ: 29% of the homeless < age 25  Transgender: 4% of homeless < age 25  Underlying causes identified by community members:  LGBTQ youth are sometimes rejected by parents and guardians and kicked out of homes after disclosing sexual orientation and gender identity.  There are limited housing services specifically for homeless LGBTQ youth. 20 Source: Santa Clara County Homeless Census and Survey, 2013

21. Recommendations 21  Leverage existing LGBTQ community resources to provide homeless LGBTQ adults with safe and welcoming services. Use spaces such as the Billy DeFrank LGBT Community Center and Youth Space as “one-stop-shops” for food, clothing, resources, and referrals.  Build partnerships between LGBTQ organizations and homeless shelters to develop capacity to serve homeless LGBTQ individuals and make shelters safe and welcoming.  Dedicate a portion of senior housing to be LGBTQ-specific. Creating an LGBTQ senior living community may reduce isolation and increase social supports for LGBTQ seniors.

22. INTIMATE PARTNER VIOLENCE 22

23. 23 Percentage of LGBTQ survey respondents ever hit, slapped, pushed, kicked, or physically hurt in any way by an intimate partner Source: Santa Clara County Public Health Department, 2013 LGBTQ Adult Survey

24. Recommendations 24  Increase education and outreach within the LGBTQ community to lessen stigma around intimate partner violence.  Develop LGBTQ-specific intimate partner violence services, shelters, and youth crisis services.  Facilitate reporting by training law enforcement agencies and courts about responding to LGBTQ intimate partner violence. Instate victims advocates trained in LGBTQ issues at local police stations.

25. Acknowledgements 25  Co-chairs: Supervisor Ken Yeager, Fred Ferrer & Marty Fenstersheib  Laura Jones & Jim Weston  Public Health Department staff  LGBTQ Health Assessment Steering Committee  LGBTQ community of Santa Clara County

26. 26