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HEALTHCARE

LGBTQ Youth Need to Be Counted

Surgeon General Says LGBTQ Youth Should be a Priority

Info: AIDS/HIV

LGBTQ Healthcare Publications: National LGBTQ Health Education Center

Advancing Healthcare for the LGBTQ Community

High Rates of Depression Among Rural LGBTQ Population
Info: Alcohol/Drug Abuse

Foundation for Better Understanding: The Health of LGBTQ People

 

LGBTQ Health Report

 

The Division of Gender, Sexuality & Health, at the New York State Psychiatric Institute and the Columbia University Department of Psychiatry, wrote this report regarding LGBTQ health issues.

Background

Over the past decade, and especially in the past few years, there have been sweeping changes in US society, law, and public policy, including the following:

--In 2003, the Supreme Court invalidated all remaining anti-sodomy laws in its ruling in Lawrence v. Texas.

--In 2004, individual states began adopting same-sex marriage.

--In 2010, the “It Gets Better” online campaign was launched, a signal of growing societal support for LGBTQ youths, parents, and families. It now has over 50,000 videos and 50 million views on YouTube.

--In 2011, the federal government repealed the “Don’t Ask, Don’t Tell" policy in the military and articulated LGBTQ rights as a foreign policy goal.

 



--In 2011, the Institute of Medicine (IOM) released a report on the health of LGBTQ people. Federal agencies such as CDC, SAMHSA, and others have also highlighted the issue.

--In 2012, marriage equality was endorsed by President Obama, the Democratic Party’s platform, and a plurality of poll respondents.

--In 2013, President Barack Obama, in his second inaugural address, articulated equality for a LGBTQ people as a priority area of his administration.

--In 2013, the Supreme Court allowed the restoration of marriage equality in California and struck down the provision of the Defense of Marriage Act (DOMA) that prohibited the federal government from recognizing married same-sex couples.

--In 2014, a range of challenges to state same-sex marriage bans are being pursued and the federal government continues to proactively implement the Supreme Court's partial overturning of DOMA.

 

--In 2015, the US Supreme Court legalizes same-sex marriage nationwide.
 


 

Troubling Statistics

Despite these advances, the health and mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals has emerged as a major concern across the nation. Numerous examples of stigmatization, discrimination and health inequities have been documented, including the following:

--Increased rate of suicide attempts and of homelessness among LGBTQ youth (Estimates indicate that as many as 40% of homeless youth are LGBTQ).

--Decreased utilization by lesbians of preventive services for cancer and increased risk factors and elevated rates of cancer (Estimated relative risk of invasive breast cancer among lesbians is 1.74).

--Higher risk of HIV and STDs among gay men, especially in communities of color (From 2006-2009, gay men accounted for 56-61% of all new HIV infections; MSM 13–29 represented more than 27% of all new HIV infections; among MSM 13-29, HIV among black MSM was up 48%).

--High prevalence among transgender individuals of HIV/STDs, victimization, mental health issues, and suicidal ideation (41% of trans respondents reported suicide attempt vs. 1.6% of the general population; 23% were impacted by at least three major life-disrupting events due to bias.)

--Barriers to health faced by elderly LGBTQ individuals because of isolation, and lack of social services and culturally competent providers (Older LGBTQ people are 2 times as likely to live alone; 1/3 plan to hide LGBTQ status if in long-term care).

Higher rates of mental health morbidities and tobacco, alcohol, other drug use (Alcohol abuse and smoking are more than 2 times greater among LGBTQ people).

--A significant proportion of people with serious mental illness (SMI) in the US are LGBTQ (Estimates suggest that about 720,000, or about 4% of people with SMI, are LGBTQ).

At the same time, new areas of concern are also emerging across the lifespan, such as:

--children "coming out" at ever-younger ages.
--schools trying to tackle the problem of bullying.
--early medical interventions becoming available for transgender youth.
--new family dynamics emerging among same-sex couples who are legally married and/or who are raising children.
--the first large cohort of openly LGBTQ people becoming senior citizens.

 

These are no longer merely potential or emerging issues with regard to mental and physical health. Rather, they are immediate and pressing needs demanding focused efforts in research, clinical practice, education, and public policy. Yet far too few LGBTQ individuals, particularly from within poor and marginalized communities have access to the quality services they need. Through the LGBTQ Health Initiative, we aim to address these and many other related issues.
 

HHS: LGBTQ Health and Wellbeing

Info: Aging/Elder Care

2016 Was a Banner Year for AIDS/HIV Research

Info: Safe Sex

LGBTQ Health Link

US Health & Human Services Reports: LGBTQ Health and Wellbeing

Info: Reparative Therapy

Foundation for Better Understanding: The Health of LGBTQ People

Huff Post: LGBTQ Wellness

 

LGBTQ Access to Care and Coverage

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity.

While sexual and gender minorities have many of the same health concerns as the general population, they experience certain health challenges at higher rates, and also face several unique health challenges. In particular, research suggests that some subgroups of the LGBTQ community have more chronic conditions as well as higher prevalence and earlier onset of disabilities than heterosexuals. Other major health concerns include HIV/AIDS, mental illness, substance use, and sexual and physical violence. In addition to the higher rates of illness and health challenges, some LGBTQ individuals are more likely to experience challenges obtaining care. Barriers include gaps in coverage, cost-related hurdles, and poor treatment from health care providers.

[Source: Kaiser Family Foundation, 2015]
 

National LGBTQ Cancer Network

Info: Alcohol/Drug Abuse

LGBTQ and Public Health
NIH: Launches Call for Input on LGBTQ Health

CDC: LGBTQ Health

Info: AIDS/HIV

Gay & Lesbian Health Association
 

 

LGBTQ Medical Issues

LGBTQ individuals are as diverse as the general population in terms of race, ethnicity, age, religion, education, income, and family history. A number of health concerns are unique to or shared by the LGBTQ community, however, including an increased risk of certain cancers, infectious and sexually transmitted diseases (STDs), and mental health disorders; issues relating to nutrition and weight, tobacco use, and substance abuse; and discrimination by health care and insurance providers.

The definitions of different sexual identities have shifted over the years, as have the perceptions and stereo-types of the general population. Because of the wide range of behaviors and identities that exist in the LGBTQ community, it is difficult to develop an inclusive definition. It is generally accepted, however, that gay men and lesbians are sexually attracted to or participate in sexual behaviors with individuals of the same gender, while bisexual men and women are sexually attracted to or participate in sexual behaviors with individuals of both genders. Transgender individuals live part- or full-time in a gender role opposite to their genetic sex.

It is estimated that approximately 2.8% of men and 1.4% of women identify as being gay, lesbian, or bisexual while 9.1% of men and 4.3% of women have participated in sexual behavior with someone of the same gender at least once. The true extent of the transgender community has not been well researched in the United States; one study from the Netherlands in 1993 found that one in 11,900 males and one in 30,400 females are transgender.
 

Info: Safe Sex

Reporting on Health: LGBTQ Health Issues
Healthline: Gay and Lesbian Health

Info: Aging/Elder Care

 

LGBTQ Health Issues and Sexual Concerns

There are a number of issues that arise when trying to define sexual orientation. Many gay men and lesbians have participated in or continue to participate in sexual activities with members of the opposite sex but choose not to identify as heterosexuals or bisexuals. Others have never participated in sexual activities at all yet still identify as gay, lesbian, or bisexual. Some men and women identifying as bisexuals are in long-term, monogamous relationships with individuals of the same or opposite sex. Male-to-female (MTF) or female-to-male (FTM) transgender individuals may or may not identify themselves as gay or lesbian.

 

The implications of these identity issues are far-reaching. Misdiagnoses or improper medical recommendations might come from health care providers who have mistakenly assumed sexual behaviors or risks from the patient's stated identity. For example, a provider might incorrectly assume that a lesbian patient has never had sexual intercourse with a male and therefore would not have contracted STDs not normally transmitted by sexual activities between women. It has been difficult to closely estimate the numbers of LGBTQ individuals in the United States because of varying definitions. Likewise, the statistics in medical or social studies and surveys on LGBTQ issues might vary widely depending on what definitions were provided for the respondents. Because of this, many researchers have opted for the more inclusive terms of "men who have sex with men" (MSM) and "women who have sex with women" (WSW) to categorize gay, lesbian, and bisexual respondents.
 

Info: Reparative Therapy

 

LGBTQ Health and Coming Out

Many LGBTQ individuals have difficulty revealing their sexual identity ("coming out") to their health care providers. They may fear discrimination from providers or believe that their confidentiality might be breached. In some cases health care workers have been poorly trained to address the needs of LGBTQ individuals or have difficulty communicating with their LGBTQ patient (one study indicated that 40% of physicians are uncomfortable providing care for gay or lesbian patients). In addition, many questions posed in questionnaires or examinations are heterosexually biased (asking a lesbian which birth control methods she uses or a gay man if he is married, single, or divorced).

Other reasons why LGBTQ individuals are often hesitant to share their sexual identity are more logistical. Many insurance companies deny benefits to long-term partners on the basis that they are not married. LGBTQ patients may have inadequate access to health care, either because they live in a remote rural area or in the crowded inner city. Some same-sex partners encounter discrimination in hospitals and clinics when they are denied the rights usually given to spouses of a patient such as visiting, making medical decisions, and participating in consultations with physicians.
 

Understanding & Eliminating Health Disparities in the LGBTQ Community

Kaiser Family Foundation: LGBTQ Health & Access to Care & Coverage

APA: LGBTQ Health Disparities

US Office of Disease Prevention & Health Promotion: LGBTQ Health Update

Foundation for Better Understanding: The Health of LGBTQ People

 

LGBTQ Medical Notes: Risk Factors

Some of the health concerns and risk factors that are relevant to LBGTQ individuals may be shared by the general population, while others are more specific to the LGBTQ community, and still others are specific to different subgroups of LGBTQ individuals. These health concerns may be grouped into the following areas of concern:

Sexual behavior issues: STDs such as human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), hepatitis A virus (HAV), hepatitis B virus (HBV), bacterial vaginosis, gonorrhea, chlamydia, and genital warts (human papillomavirus or HPV); anal, ovarian, and cervical cancer.

Cultural issues: body image, nutrition, weight, and eating disorders; drug and alcohol abuse; tobacco use; parenting and family planning.

Discrimination issues: inadequate medical care; harassment at work, school, or home; difficulty in obtaining housing, insurance coverage, or child custody; violence.

Sexual identity issues: conflicts with family, friends, and work mates; psychological issues such as anxiety, depression, and suicide; economic hardship.

 


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