1. Literacy and happiness

2. Men hate each other because they fear each other, and they fear each other because they don't know each other, and they don't know each other because they are often separated from each other. - Martin Luther King -

5. Who is this person in the front of the room?

6. Basic Concepts: Sex (assigned at birth): The designation assigned to a baby at birth based on the appearance of their genitals Sexual Orientation: A person’s sexual or romantic attraction to another person Gender Identity: A person’s innate sense of themselves Gender Expression: How a person chooses to outwardly act, dress, speak, move, etc. (or not) based on their gender identity

7. Question: But, you can only be either male or female, right?

8. The Gender Binary: The concept based upon societal “norms” that one can be either a man or a woman, only. He! She!

9. Where do I fit? Sexual Orientation: Straight, Gay, Bi, Pansexual, Asexual, Something Else! Gender Expression: Masculine, Feminine, Androgynous, Something Else! Gender Identity: Masculine, Feminine, Neither, Both, Something Else! Birth Sex: Male, Female, DSD MALE FEMALE BOTH NEITHER

10. Forms of biases

11. Homophobia is an intense, irrational fear of homosexuality, and homosexual behavior.

12. Homophobia in medical practice is a reality. In 1998 a survey of nursing students showed: – 8-12% “despised” lesbian, gay, and bisexual people – 5-12% found LGB people “disgusting” – 40-43% thought LGB people should keep their sexuality to themselves HAVE THINGS CHANGED………

13. Homophobia More than 25% of the medical students agreed with the statement 'homosexuality is a psychological disorder that requires therapy'. More than 15% would avoid any physical contact with homosexuals to minimize the chance of contracting diseases, especially AIDS. Comparison between the medical students and non-medical students showed that the attitudes of the medical students were significantly more homophobic. Journal of Homosexuality 2009

14. LGBTI Barriers to Health Care

15. Think! How many barriers to care for LGBTI individuals can you think of?

16. Provider Bias 25% of 2 nd year medical students in a survey done in 1999 thought homosexuality was “immoral and dangerous to the institution of the family” 15% in 2006 Journal of Homosexuality 37(1):53-63, 1999,2006

17. 2012 University Of Nevada responses to lecture… “therapy is all that is necessary for people that believe they are homosexuals” “ Why do we cover these issues…there are more important medical issues to learn…” “Best lecture I’ve ever heard” “ I wish I knew more…”

18. Providers’ Lack of Education Over half of all medical schools offer no training on LGBTI health issues with the remainder providing an average of 2.5 hours of education regarding LGBTI issues in the 4 year program. http://books.nap.edu/books/0309060931/html/index.html p. 43. http://books.nap.edu/books/0309060931/html/index.html Family Medicine 1998, 30 (4) 283-287.

19. Inappropriate Behavior By Providers Respondents to a survey by the Gay and Lesbian Medical Association (1994) reported having seen doctors perform “rough” or “violent” digital rectal exams on patients the doctor knew to be gay. http://www.glma.org/policy/hp2010/index.html p. 128 http://www.glma.org/policy/hp2010/index.html

20. Biases in Health Care -Forms/Interviews Do the forms in your medical clinics have boxes that only offer the choices single/ married/ widowed/ divorced? When a female patient says that she is sexually active, is the next question automatically “What are you using for birth control?” Are the only choices on your forms under gender male or female?

21. Youth Barriers LGBTI high school students have been threatened with a weapon at a rate four times that of heterosexual high school students. While 10% of heterosexual teens reported attempted suicide, 40% of LGBTI teens reported suicide attempts. http://www.siecus.org/pubs/fact/fact0013.html

22. LGBT Students and Safety at School Three-quarters (74%) of youth felt unsafe at school because of at least one personal characteristic.

23. Legal Barriers Denial of spousal benefits to unmarried partners Blood relatives may override health care decisions of same-sex partner unless couple has health proxy/ durable power of attorney Hospitals may limit visitation to blood relatives or spouses LGBTI people may be wary to seek health care where sodomy laws still apply. (14 states, Puerto Rico, the military) http://www.sodomylaws.org/usa/usa.htm

24. Think! How can you improve your awareness of an individual as a medical provider?

25. Why Ask About Sexual Health and Behavior? Learning about the sexual health and behavior of patients is an important part of what we do every day.

26. Sexual History is Prevention Open safe doors for self disclosure If you ask you care If you don’t ask –you don’t care Be accepting of yourself….. This may be difficult Accepting yourself helps you accept others

27. The Sexual History Is Prevention Taking a sexual history is personal.. Taking a history of sexual health allows us to find and discuss STDs and high risk behaviors before they occur Taking a sexual history also gives us the opportunity to talk with patients about ways they can stay healthy. Taking a sexual history can create a safe environment for questions

28. How Can We Learn about Patients’ Sexual Health and Behavior? Providers, or other members of the clinical care team, should ask all adolescent and adult patients about their sexual health and behavior as part of the routine history. The sexual history for adults generally begins with these type screening questions, with follow-up as appropriate: – 1. Have you been sexually active in the last year? – 2. Have you had sex with women, men, or both? – 3. How many people have you had sex with in the past six months? – 4. Are you comfortable with your sexuality – 5. Anything you wish to talk about…

30. of a kind heart... Attentive 9 elements Authentic Compassionate Courageous Enthusiastic Charitable Grateful Inspirational Patient

31. of a kind heart... Attentive 9 elements an attentive heart is one that recognizes the needs of others.

32. of a kind heart... 9 elements Authentic an authentic heart is one that is genuine and acts from truth.

33. of a kind heart... 9 elements Compassionate a compassionate heart is one that is sensitive towards all living things.

34. of a kind heart... 9 elements Courageous a courageous heart is one that acts from love rather than fear.

35. of a kind heart... 9 elements Enthusiastic an enthusiastic heart is one that displays limitless energy and passion.

36. of a kind heart... 9 elements a charitable heart is one that gives yet expects nothing in return. Charitable

37. of a kind heart... 9 elements Grateful a grateful heart is one that is content and filled with appreciation

38. of a kind heart... an inspirational heart is one that encourages and motivates others. Inspirational 9 elements

39. Patient a patient heart is one that waits and responds at the proper moment. 9 elements of a kind heart...

40. Looking at Your Beliefs

41. Think! Do your beliefs about sexuality and gender identity negatively affect the people in your life? Do you feel that you are sensitive to the needs of the LGBTQ community?

42. Think! What can you do to improve life for LGBTQ individuals in your community?

43. Be the change you want to see in the world. Mahatma Gandhi