1. LGBT Health Update Ben-David Barr, MSW Executive Director Rainbow Community Center

2. Terms and Concepts Sexual Orientation –(Attraction, Behavior, Identity) –Terms for Sexual Identity: Gay, Bisexual, Lesbian, Queer Gender Identity Terms for Gender Identity: Male, Female, Transgender, Gender Queer, Gender Fluid

3. Demographics? How many LGBT people? Kinsey Scale (1-6) and 10% estimator. More current studies recommend estimators of 1% – 4% of population (Gates & Ost, Williams Institute). This varies significantly by geographic area. Who gets included in our counts? (Orientation, Behavior, Identity) How do you count a hidden population?

4. Diverse Community There is more to the LGBTQQI Community than gay white men: –Gender: Men, Women, Transgender (MTF, FTM, Gender Fluid), Intersex; –Ethnicity: African American, Asian/Pacific Islander, Latino/Latina; –Faith: Catholic, Mormon, Jewish, Muslim; –Behavior: MSM/Down Low, Bisexual.

5. What is the Commonality Across Diverse Communities? LGBTQ people experience resistance/hostility due to their lack of conformity to gender and sexual norms (G.M. Herek).

6. Discrimination Hurts Shame and Stigma –Isolation –Depression –Suicide –Substance Abuse –Unsafe sexual behaviors

7. Health Disparities The Stress and Vulnerability Model and the Minority Stress Model, attribute health disparities to cumulative exposure to harassment, maltreatment, discrimination, and victimization stemming from a hostile and homophobic culture. Important to stress that mental health and substance use disorders are not intrinsic to sexual orientation, but most likely result from the greater exposure to stressors experienced by sexual minorities, combined with other individual and environmental risk factors.

8. Impact of Homophobia Many people continue to characterize LGBT health disparities such as increased risk of alcoholism, suicide and depression as signs of the innate psychopathology of LGBT people. Only recently has research begun to discuss LGBT health disparities as consequences that result when people endure family rejection, stigma, and discrimination (Young-Breuhal, 1996, Herek, 2007, Ryan, et al 2009). Lesson: Correlation does not prove Causation

9. Health Disparities A growing body of research indicates that LGBT people have higher rates of depression, anxiety, self harm and suicide than their heterosexual contemporaries. A recent meta-analysis combined data from 25 rigorous LGBT mental health studies conducted between 1997 and 2005 (King, Semlyen, et al, 2008, BMC Psychiatry). A two fold excess in suicide attempts in lesbian, gay and bisexual people compared to a mainstream cohort. The risk for depression and anxiety was at least 1.5 times higher in LGBT people. Alcohol and other substance dependence over 12 months was 1.5 times higher. Lesbian and bisexual women were particularly at risk of alcohol and drug dependence. Lifetime prevalence of suicide attempt was especially high in gay and bisexual men.

10. Impact of Hiding on Health Many LGBTQ People do not come out to providers, leading to inappropriate utilization of health and mental health services. LGBTQ groups have higher rates of certain diseases and cancers –Anal Cancer –Breast Cancer –Lung Cancer –Cervical Cancer

11. Political Campaigns Impact LGBTQ Stress and Health Voted Out: Qualitative research that documents the psychological impact of anti-gay legislation on the gay community. Russell found a range of reactions, from depression, anger, and anxiety to a sense of empowerment and a desire to mobilize. –Glenda Russell, (2000). Voted Out: The psychological consequences of anti-gay politics. New York: New York University Press

12. LGBTQ Health Issues Across the Lifespan Youth Transitional Aged Youth (TAY) Coming Out Dating & Relationship Development Parenting Aging Death & Dying

13. Key Health Issues: Workplace Conflicts Work creates structure and meaning –What happens when you hide who you are at work? Transgender Issues and Work

14. Stereotyped Genogram of an LGBT Family

15. LGBT Genogram?

16. Families of Choice Westin conducted an ethnography of mostly Lesbian families who lived in the Bay Area 1991 LGBT people add families of choice as an additional layer to families of origin Families of choice help people cope with intolerance and rejection

17. LGBT Families are Complex LGBT Families may include people who have few legal ties and few genetic ties. Bio Mom Bio Siblings Foster Mom Bio Dad Surrogate Grand parents Social Worker Dad’s BFF

18. LGBT Youth & Stress A recent study on school safety found that 92% of LGBT students hear negative comments such as “faggot”, “dyke” or the negative comment “that is so gay” on a regular basis. The study estimated that LGBT students hear on average 8 negative comments a day with many comments made by teachers and school staff. The 2003 National School Climate Survey by Joseph G. Kosciw. (GLSEN, May 2004)

19. Family Acceptance Project In a recent ground breaking study Ryan and colleagues reported findings that negative family reactions in adolescents are associated with negative health problems in young adulthood (Ryan, et al, 2009, Pediatrics). This study highlights the importance of creating accepting environments for LGBT youth

20. Working with Parents of LGBT People Parents have to come out too –No choice –No reward for the coming out process –Forced to confront their child’s sexuality –Often forced to review their personal values Parents need time to grieve lost expectations Parents need to be reminded that this is not their fault Change usually occurs over a period of years not months. Tolerance precedes Acceptance Complete Repair may not be possible in every family

21. Affirming Practitioners Use gender neutral pronouns (partner vs. wife/husband) when talking with patients. Have space for LGBTQ data on their intake and clinical forms (transgender, spouse, etc). Include LGBT literature in their offices where all of their patients can see them. Display rainbow stickers in their offices or on their name tags. Understand that their patient’s support systems may not look like a traditional family model. Do not assume all their patients are heterosexual. Promote stress reduction for LGBT people. Encourage LGBT patients to find appropriate social support.

22. Contra Costa Resources Rainbow Community Center –http://www.rainbowcc.orghttp://www.rainbowcc.org –(925) 692.0090 211 Pride Initiative County Mental Health Reducing Health Disparities Work Group Area Agency on Aging – LGBT Work Plan Safe Schools Coalition – Ally Action