Queer Cafe

Fabulous Approach to Promoting LGBTQ Health

“We are grateful that HHS has removed from the books the prior rule’s explicit invitation to discriminate against pregnant people, anyone in need of gender-affirming medical care, and LGBTQ patients in general, regardless of their medical needs,” she continued. “No patient– no matter their religion, sex, race, gender identity, or sexual orientation – should fear being denied the medical care they need based on other people’s religious beliefs.”

Anti-LGBTQ activist Roger Severino formerly led the HHS’s Office of Civil Rights (OCR) under Trump. He used the position to push for religious exemptions to civil rights laws. In his previous role as director of the DeVos Center for Religion and Civil Society for the Heritage Foundation, Severino spoke out against the civil rights protections he was tasked with upholding as HHS head.

While at the Heritage Foundation, he authored a report opposing the OCR’s implementation of a portion of the Affordable Care Act (ACA) known as the 1557 rule, which prohibited discrimination based on race, color, national origin, age, disability, and sex in federally-funded health programs.

Betsy DeVos served as Trump’s head of the Education Department, where she led efforts to repeal protections for LGBTQ students and actively make schools more hostile to them.

[Source: Bil Browning, LGBTQ Nation, January 2024]

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Monkeypox Outbreak in Gay Community

The country's monkeypox outbreak can still be stopped, US health officials say, despite rising case numbers and so far limited vaccine supplies.

Update: The World Health Organization will now refer to "monkeypox" as “mpox.”

The Biden administration's top health official pushed back against criticism about the pace of the response and worries that the US has missed the window to contain the virus, which has been declared a global emergency.

"We believe we have done everything we can at the federal level to work with our state and local partners and communities affected to make sure we can stay ahead of this and end this outbreak," Xavier Becerra, head of the Department of Health and Human Services, explained. But he added that local health officials "must do their part. We don't have the authority to tell them what to do."

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The pushback from federal leaders came as they announced distribution plans for 780,000 shots of the two-dose Jynneos vaccine. The doses will be allocated to states, cities and other localities based on their case numbers and the size of their populations that are considered high-risk for the disease. Health departments in San Francisco, New York, Washington, DC, and elsewhere say they still don't have enough shots to meet demand and have stopped scheduling appointments for second vaccine doses to stretch supplies.

"Clinics around the country are pleading with federal health officials for the information, supplies and staffing they need to successfully bring an end to this outbreak," said David C. Harvey, executive director of the National Coalition of STD Directors, in a statement. The group is pressing for $100 million in emergency funding for local health departments and clinics. The US is now capable of testing 60,000 to 80,000 people per day, though Becerra said daily testing numbers are well below that.

There were more than 4,600 reported monkeypox cases in the US as of July 2022, according to the CDC, and federal officials expect those numbers to rise. More than 99% of reported cases are in men and the vast majority of those are among men who reported sexual contact with other men, though health officials have stressed that anyone can catch the virus.

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The monkeypox virus mainly spreads through skin-on-skin contact, but it can also transmit through touching linens used by someone with the infection. People with monkeypox may experience fever, body aches, chills and fatigue. Many in the outbreak have developed sometimes-painful zit-like bumps.

The US has ordered 5.5 million more vaccine doses for delivery by mid-2023 and has rights to the raw ingredients that could make 11.1 million more doses. US officials said a massive vaccination campaign could still be avoided if communities and individuals take measures to avoid spread.

In San Francisco, Tom Temprano had an appointment to get his second dose next week but was recently notified that it was canceled due to limited supplies. Temprano, who is the political director of San Francisco-based Equality California, said he's frustrated that health authorities have taken so long to respond. "Especially coming out of, still, two-and-a-half years into a pandemic, it's just a very disappointing response for the first larger-scale public health crisis we're facing coming out of that," he said.

He also sees parallels to the slow government response to AIDS in the 1980s. "I've heard from many folks that this feels similar in the lack of real concern and urgency to a disease that is right now disproportionately impacting the LGBTQ community," said Temprano, who is 36.

The CDC estimates about 1.5 million Americans currently meet suggested criteria for vaccination, primarily men who have sex with men.

[Source: Associated Press, July 2022]

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Biden Bans Discrimination Against LGBTQ People in Healthcare

"No one should ever be denied access to health care because of their sexual orientation or gender identity."
-President Joe Biden

The US will protect gay and transgender people against sex discrimination in healthcare, the Biden administration announced in May 2021, reversing a Trump-era policy that sought to narrow the scope of legal rights in sensitive situations involving medical care.

The action by the Department of Health and Human Services (HHS) affirms that federal laws forbidding sex discrimination in healthcare also protect gay and transgender people.

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The Trump administration had defined “sex” to mean gender assigned at birth, thereby excluding transgender people from the law’s umbrella of protection.

“Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences,“ the HHS secretary, Xavier Becerra, said in a statement. “Everyone – including LGBTQ people – should be able to access healthcare, free from discrimination or interference, period.”

Becerra said the Biden administration policy will bring HHS into line with a landmark supreme court decision last year in a workplace discrimination case, which established that federal laws against sex discrimination on the job also protect gay and transgender people.

Despite that ruling, the Trump administration proceeded to try to narrow the legal protections against healthcare discrimination, issuing rules that narrowly defined “sex” as biological gender. A federal judge had blocked those rules from taking effect, although Trump administration officials argued that as a legal matter healthcare discrimination was a separate issue from the employment case the supreme court decided.

The action means that the HHS Office for Civil Rights will again investigate complaints of sex discrimination on the basis of sexual orientation and gender identity. Hospitals, clinics and other medical providers can face government sanctions for violations of the law.

The Biden administration action essentially restores policy established during the Obama years. The Affordable Care Act included a prohibition on sex discrimination in healthcare and the Obama administration had interpreted that to apply to gay and transgender people as well. It relied on a broad understanding of sex shaped by a person’s inner sense of being male, female, neither or a combination.

[Source: Associated Press, May 2021]

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Biden Revives LGBTQ Protections Against Healthcare Discrimination

"So now it's clear. There is no ambiguity. You cannot discriminate against people based on sexual orientation or gender identity."

-Health & Human Services Secretary Xavier Becerra

Gay and transgender people will be protected against sex discrimination in healthcare, the US health secretary said in May 2021, as President Joe Biden’s administration reversed a policy put in place under his predecessor Donald Trump.

Health and Human Services Secretary Xavier Becerra said the action restores protections under a provision of the Affordable Care Act, also known as Obamacare, against sexual discrimination in healthcare. It was the latest in a series of steps the Democratic president has taken to bolster LGBTQ rights.

"It simply says what everyone already should know: You should not discriminate against people," Becerra told CNN. "That includes those based on sexual orientation or gender identity and when it comes to healthcare - we want to make sure that's the case."

The new policy represents a reversal of a reversal. HHS under Trump in June 2020 issued a rule that lifted some anti-discrimination protections under the Affordable Care Act, a law signed by former President Barack Obama in 2010.

In 2016, Obama's administration introduced rules that made clear that LGBTQ people would be protected under the federal healthcare discrimination provision. The Trump-era rule reversed those provisions of the law that extended civil rights protections in healthcare to cover areas including gender identity and abortion.

"So now it's clear, there's no ambiguity: You cannot discriminate against people based on sexual orientation or gender identity," Becerra added.

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HHS said in a statement that its Office for Civil Rights made the decision in light of a June 2020 US Supreme Court ruling and subsequent court decisions. The Supreme Court last year delivered a watershed victory for LGBTQ rights and a defeat for Trump's administration, ruling that a longstanding federal law barring workplace discrimination protects gay and transgender employees.

"The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation," Becerra said in the statement.

House of Representatives Speaker Nancy Pelosi, a Democrat, praised the administration's step and called Trump's LGBTQ action in the middle of the coronavirus pandemic "an act of senseless and staggering cruelty."

The issue of transgender rights has become a flashpoint in the US culture wars, with Republicans at the state level pursuing measures targeting transgender people. Such bills have been introduced in about 28 states so far this year, according to the Southern Poverty Law Center advocacy group.

"With healthcare for transgender youth under attack by state legislatures, this move to protect LGBTQ people from discrimination in healthcare is critical," the American Civil Liberties Union said. "It's unfortunate that such an obvious step had to be taken; the AMA welcomes this common-sense understanding of the law," added American Medical Association President Susan Bailey.

Biden, who took office in January 2021, has sought to overturn other Trump policies limiting the rights of LGBTQ Americans. Biden has reversed his Republican predecessor’s ban on transgender people serving in the US military, issued an executive order that extends existing federal nondiscrimination protections to LGBTQ people and issued a presidential memorandum aimed at expanding protection of the rights of LGBTQ people worldwide.

[Source: Doina Chiacu, Reuters, May 2021]

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Folx Health

Five Things to Know for Optimizing LGBTQ Health

1. LGBTQ healthcare needs and concerns aren’t monolithic. Just as straight people don’t all share the same health experiences, neither do LGBTQ individuals. The healthcare system needs to consider all the various and individual factors that make up health, wellness, and experience in ways that aren’t identity-defining or diagnosis-limiting.

For example, transgender people may face barriers to specific health care needs like hormone therapy that cisgender people do not. And HIV positive gay and bisexual men are more than the sum total of their viral loads. There are just as many specific health needs of LGBTQ+ people as there are LGBTQ people, which is about 10 million American adults according to recent surveys.

2. Youth homelessness, substance use disorders, and suicide disproportionately affect LGBTQ individuals. LGBTQ youth experience more homelessness with far greater risks to their health, such as substance use and suicidality, than their cisgender, heterosexual peers. Black and Hispanic youth in particular are overrepresented among unstably housed LGBTQ youth, with racial discrimination further compounding the effects of sexual orientation-based discrimination.

Stigma and lack of mental health provider training also serve as barriers to consistent, high-quality medical care and supportive services for this vulnerable population.

3. Ongoing medical education can help healthcare providers reach LGBTQ and other underserved populations. Despite great strides in LGBTQ visibility and rights over the last decade, healthcare access remains an arena where LGBTQ people continue to face biases and other barriers to health. Continuing medical education that trains providers about the specific healthcare needs of LGBTQ communities can improve the ways providers integrate culturally competent and accessible care.

The same goes for the training of office staff. From the front desk to the billing department, the more that staff are trained about the specific needs of their patients, the more welcoming and effective these access points become.

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4. Social support and mental health are vital. Mental and behavioral health matters as much as clinical and physical health, and LGBTQ individuals are more likely to experience bullying and discrimination based on sexual orientation, gender identity, and gender expression. LGBTQ community organizations, mental health services, and advocacy efforts that spearhead acceptance and affirmation go a long way towards normalizing LGBTQ people’s health needs. Achieving health equity is a synchronous endeavor that requires care for the whole person.

5. LGBTQ health outcomes align with public policy. Historically, LGBTQ individuals have had few legal protections from discrimination when seeking healthcare. The Equality Act, passed by the House of Representatives in February 2021, would uniformly apply an anti-discrimination law to services and programs receiving federal funding in all states. If signed into law, healthcare providers would be required to provide the same standard of care to all patients regardless of sexual orientation or gender identity.

The Equality Act faces a challenge in a senate that is split by party lines, and it’s unclear whether it has the support to cross the President’s desk. If you want to get involved, contact your senator’s offices and let them know you support LGBTQ health.

[Source: Brian Hujdich, Executive Director, National Coalition for LGBTQ Health, June 2021]

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Seemingly Harmless Habits That May Increase Your Risk Of Dementia

Your Risk Of Dementia...
These common behaviors could be affecting your brain health....

Dementia is the loss of memory, language, problem-solving and other abilities that require thinking. It is often caused by Alzheimer’s disease, and mainly affects those 65 and older. Unfortunately, dementia can be severe enough that it interferes with daily life, and those who have dementia often require additional care.

“Dementia is a group of conditions characterized by impairment of at least two brain functions, such as judgment and memory loss,” explained Blair Steel, a psychologist at Carrara Treatment, Wellness & Spa. “Symptoms of dementia include forgetfulness, limited social skills and impairment in thinking that interferes with daily functioning.”

So what causes dementia? Your age, family history, race and ethnicity, heart health and history of a traumatic brain injury are all factors that increase your risk of developing the condition. But another big category is lifestyle habits. So while you can’t control your genetics, there are a few seemingly harmless behaviors you may be doing that can increase your risk.

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Not moving your body enough or sitting for too long...

Exercising ― aerobic exercise, especially ― can help reduce cognitive impairment and dementia risk. Long-term, regular exercise can affect your brain and your overall health in a positive way, especially if you’re nearing 60. Getting your body moving daily is something you can do to decrease your risk of dementia.

Steel said “being inactive does a number on the brain.” Just like other muscles, a good thing to remember is, “If you don’t use it, you lose it.”

Not socializing enough...

Social health plays a role in the development of dementia; an active and socially integrated lifestyle can protect against the disease. Stimulating the brain with social interaction is important for everyone, especially as they age. Though, in the age of social media, socializing has become a broader term.

“We spend a lot of hours on social media, however this likely does not stimulate the brain’s experience of connection as much as socializing in person,” Steel explained.

Poor social health can overstimulate the body’s stress response through increased levels of the stress hormone cortisol, raise blood pressure and decrease blood flow to vital organs amongst other health issues.

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Getting inadequate sleep...

Sleep disturbances and dementia are two common and significant health problems in older adults. (Let’s face it, sleep tends to be put on the back burner.) Whether due to family obligations, work or staying up late on your phone or watching TV, there’s always something in the way of adequate sleep.

Unfortunately, sleep patterns in earlier life may contribute to later problems. If you’re having trouble sleeping, or not sleeping at all, sleep deprivation could increase your dementia risk.

“Avoid screens and light after a certain hour and try to not reach for your phone if your sleep is interrupted,” Steel suggested. Try unplugging at least 30 minutes before bed.

Being chronically stressed...

According to the Alzheimer’s Society, stress is linked to dementia because when you’re stressed and cortisol is released, it can create problems with your memory. The negative effects of stress, particularly chronic stress, on the brain can lead to cognitive decline due to prolonged elevations of cortisol — which plays an important role in how your body responds to stress.

Working to reduce your stress through healthy habits can be key to mitigating this risk. Exercise, creative activities or hobbies, spending time with loved ones, meditation, watching a good show or reading a good book can all help you relax.

Additionally, “try to be flexible with your reactions and avoid the ‘my way or the highway’ mentality, which can be common in older adults,” Steel said.

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Consuming excessive amounts of alcohol...

The Alzheimer’s Society also says there’s a specific type of alcohol-related dementia that is considered alcohol-related brain damage (ARBD). This is due to the damage of the brain caused by drinking too much alcohol on a regular basis, usually over many years.

Those with this type of dementia may have issues like cooking a meal, remembering things, thinking things through, and even struggle with more complex tasks like managing finances.

Eating an unbalanced diet...

Research shows a diet high in ultra-processed foods can increase dementia risk in adults. While no one’s diet is perfect, ensuring that the majority of the time you are sticking with well-balanced, healthy meals can be extremely beneficial.

Try eating leafy greens, berries, whole grains, beans, nuts, fish, and healthy fats like olive oil while limiting red meat, sweets, cheese, butter, and fast and fried food. These are healthy options that optimize your brain health.

You can lower your risk of dementia by altering the habits mentioned above, but you should also speak to a doctor if you’re struggling with your cognition.

“If you or a loved one is experiencing signs of dementia, it is important to speak to a doctor and get an assessment,” Steel said. Your primary care physician will be able to assess you, and if needed, refer you to a specialist.

[Source: Sydney Wingfield, Huff Post, Jan 2024]

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Coronavirus: LGBTQ Population at Higher Risk

The LGBTQ population may be at increased risk for COVID-19, the disease caused by the new coronavirus. To get the word out, over 100 national and local organizations have signed an open letter initiated by a coalition of six organizations. According to the letter, three main factors increase the vulnerability of the LGBTQ community to COVID-19:

--The LGBTQ population uses tobacco at rates that are 50% higher than the general population. This is relevant because COVID-19 is a respiratory disease that is harmful to smokers.

--The LGBTQ population has higher rates of cancer and HIV, both of which can compromise a person’s immune system and make someone more vulnerable to COVID-19.

--The LGBTQ population still faces discrimination, including in health care settings. This makes many people hesitate to seek care.
The letter also notes that because LGBTQ seniors may fear harassment or discrimination, they are less likely than straight elders to be involved in health and wellness programs for seniors. Over 3 million LGBTQ older people are living in the United States and they are especially vulnerable to COVID-19, which has a higher mortality rate among older people in general.

The initial signers include the National LGBTQ Cancer Network, GLMA Health Professionals Advancing LGBTQ Equality, Whitman-Walker Health, SAGE, New York Transgender Advocacy Group and National Queer Asian Pacific Islander Alliance.

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Trump's Military Ban Ignores Science to Inflict Harm

In enacting the ban on transgender troops, President Trump stated, "The US government will not accept or allow transgender individuals to serve in any capacity in the US military."

Dr. Juno Obedin-Maliver is an Assistant Professor of Obstetrics and Gynecology at Stanford University School of Medicine. Along with Dr. Mitchell Lunn, Dr. Obedin-Maliver is the Co-Director of The PRIDE Study, the first large-scale, long-term national health study of people who identify in the United States. He says there is no rationale for the president's cruelty, except being cruel. Here are his further comments, as reported in Advocate Magazine:

Astounded. Alarmed. That’s how I’m feeling right now (as a doctor, as a researcher, and as a queer person) while our government threatens to erase the existence and experiences of transgender and gender expansive people.

Trump's transgender military ban has become reality: openly transgender people cannot join the military — and many who are already within its ranks can face discharge if they receive a gender dysphoria diagnosis while serving. According to guidelines from The Pentagon, trans service members will be required to serve according to “the standards associated with their biological sex” and cannot “serve in their preferred gender.”

This is not a fringe issue. This is a deliberate move to define personhood in a very particular way — a straight, white, male cisgender-dominated, Republican, wealthy, colonial way. But news flash: Sex is not binary. Gender is not binary. And sex and gender don’t always match. In short, some men have vaginas. Some women have penises. And some people have both.

Today I worked on three projects: one about challenges to abortion and contraception for trans masculine and gender expansive people, one about family-building and fertility preservation for transgender people, and another about contraception and abortion for sexual minority women, especially lesbian and bisexual women. What all of these projects have in common is that they arise from the understanding that health care is worse when we don’t acknowledge all of who people are, and the totality of their experiences.

That includes acknowledging the existence of more than two genders and recognizing that people’s gender can be potentially different from their sex assigned at birth. When our laws define sex as either male or female, and gender as either woman or man, real people receive worse care, avoid care, or are harmed in the process of getting health care. Legislating the fallacy of binary sex won’t make things better for anyone.

In fact, there is tons of evidence that shows denying the existence of transgender people and their health care needs and resiliencies leads to worse health care. On the other hand, when we call people by their affirmed names, use their self-identified pronouns, and provide services needed to transgender people, health outcomes improve. Challenges to fully participate in civic life will also become easier—whether it’s getting a job, obtaining a driver’s license, having health insurance, or going to school. Our country and military benefits by more diversity, not less.

Denying the reality of who people are including that someone’s gender and sex assigned at birth are different, makes life unsafe. It exposes people to violence and vitriol. When this country is unsafe for anyone — specifically immigrants, people of color, and transgender people (and especially folks who live in all of these domains at the same time) — it is unsafe for us all. We are all hurt by narrowed definitions of humanity that only seek to limit the possibilities of life. We are all diminished when some among us are rendered invisible, cloaking the true diversity of nature and humanity.

We must all fight now because our lives depend on it. Even if you are not LGBTQ or trans specifically, we must stand strong and be heard. Now.

This fight must be waged beyond the ballot box. Speak out. Write op-eds. Talk to friends and families. Tell people about the lives of trans folks and how this ban flies in the face of science and what is supported in medicine. Do what you can in your jobs and in your free time. Support trans-run programs, projects, and businesses with time, money, and visibility. Hold people accountable to being trans-inclusive and supportive. Teach your kids not to assume gender or ascribe gendered activities to people. And while you’re at it, teach yourself to do the same: it can be tough to unlearn that life is more than either/or, but it’s not hard to understand if you simply respect, listen, and love people as who they are.

For the nearly 1.5 million trans people in the US, I will keep fighting every day to make sure your lives are recognized, respected, and that we make medicine and health care a better place for you all and all of us in the process. I hope you’ll join me.

[Source: Juno Obedin-Maliver, MD, Advocate Magazine, April 2019]

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Unique Healthcare Vulnerabilities for LGBTQ People

In 2010, more than half of LGBTQ people reported being discriminated against by a health care providers and more than 25 percent of transgender respondents reported being refused medical care outright. Since then, LGBTQ people have gained protections from health care discrimination—most notably, regulations stemming from the Affordable Care Act have prohibited federally funded hospitals, providers, and insurers from discriminating against LGBTQ patients. Despite progress, LGBTQ people, and transgender people in particular, remain vulnerable to healthcare discrimination: In 2015, one-third of transgender people who saw a health care provider reported “at least one negative experience related to being transgender.” These negative experiences included being refused treatment or even being physically assaulted. Transgender people of color and people with disabilities reported particularly high rates of discrimination from health care providers.

Unsurprisingly, people in these vulnerable groups are especially likely to avoid doctor’s offices, postponing both preventative and needed medical care:

--23.5 percent of transgender respondents avoided doctors’ offices in the past year, versus 4.4 percent of cisgender LGBQ respondents
--13.7 percent of disabled LGBTQ respondents avoided doctors’ offices in the past year, versus 4.2 percent of nondisabled LGBTQ respondents
--10.3 percent of LGBTQ people of color avoided doctors’ offices in the past year, versus 4.2 percent of white LGBTQ respondents

These findings are consistent with research that has also identified patterns of health care discrimination against people of color and disabled people. For example, one survey of health care practices in five major cities found that more than one in five practices were inaccessible to patients who used wheelchairs.

[Source: Sejal Singh and Laura E. Durso, May 2017]

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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.

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--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.

CDC: Gay and Bisexual Men's Health

Heteronormativity in Health Care is Harmful for LGBTQ Patients

Seemingly Harmless Habits That May Increase Your Risk Of Dementia

Graph: GLAAD Tolerance Survey

Center for American Progress: Widespread LGBTQ Discrimination

USA Today: Review of LGBTQ Equality Over the Past Decade

Battles the LGBTQ Community is Still Fighting

Human Rights Watch: Anti-LGBTQ Laws Around the World

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.

Folx Health

HHS: LGBTQ Health and Wellbeing

Creating LGBTQ Friendly Communities in Healthcare and Education

Info: Aging/Elder Care

2016 Was a Banner Year for AIDS/HIV Research

Pediatrician Group Endorses Affirming Care for Trans Youth

Info: Safe Sex

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]

LGBTQ and Public Health
Info: LGBTQ Mental Health

Info: Alcohol/Drug Abuse

CDC: Gay and Bisexual Men's Health

NIH: Launches Call for Input on LGBTQ Health

SAMHSA: Top Health Issues for LGBTQ Populations
Info: AIDS/HIV

CDC: LGBTQ Health

Gay & Lesbian Health Association
Stanford Medicine: The Pride Study

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: Reparative Therapy

Doing the Right Thing for Transgender Health

PrEP Directory Goes Live

LGBTQ Health Professional Journal

Info: Ageing/Elder Care

Heteronormativity in Health Care is Harmful for LGBTQ Patients

LGBTQ People and Mental Health Issues

Most LGBTQ people have had mental health issues because of their jobs. Mental health issues in the workplace are a common occurrence for LGBTQ people, according to a poll conducted by YouGov on the behalf of Business in the Community and Mercer.

72% percent of LGBTQ employees have experienced mental health issues as a result of their workplace.

The survey also showed that a little more than a quarter of LGBTQ employees are not open about their sexual orientation in the workplace, and 28% of LGBTQ upper management and owners have been encouraged to hide their sexual orientation.

What’s more, people of color who were also LGBTQ were twice as likely to face negativity from customers and clients than their white LGBTQ counterparts.

Customers or colleagues have physically attacked 7% of LGBTQ workers, with that number rising to 13% among blue-collar workers. That also includes 15% of people of color, 20% of non-binary identified people, and 30% of seniors.

Additionally, 9% felt that being seen as LGBTQ prevented them from getting a job or a promotion, with 6% saying that it as a significant factor losing a job in the past year.

According to the report, good employee mental health is crucial to running a successful, sustainable organization. These numbers point to failures in handling employee mental health, particularly for LGBTQ and other minority populations in the workplace.

The report, titled “Seizing the Moment,” is Business in the Community’s 2018 report on mental health at work.

[Source: Gwendolyn Smith, LGBTQ Nation, October 2018]

On the Job: LGBTQ People and Mental Health Issues

NAMI: How Mental Health Conditions Affect LGBTQ Community

Family Doctor: LGBTQ Mental Health Issues

LGBTQ Healthcare: To Treat Me, You Have to Know Who I Am

Ethical Guidelines for Professionals Working With LGBTQ Clients

Info: LGBTQ Mental Health

Mental Help: Mental Health in the LGBTQ Community

Counseling Today: Promoting LGBTQ Wellness

Creating LGBTQ Friendly Communities in Healthcare and Education

Puberty Blockers

Puberty blockers (puberty inhibitors, puberty suppressors, hormone suppressors) are a group of medications used to inhibit puberty. They were originally used to treat children with precocious puberty or other such early onset of puberty. Puberty blockers are commonly used for the transgender community. In this community, puberty blockers are used to provide transgender youth with time to further explore their identity, while halting the development of their predisposed sex characteristics caused by the onset of puberty.

The medication that is used in order to stop puberty comes in two forms: injections or an implant.

Puberty blockers prevent the development of biological secondary sex characteristics. They slow the growth of sexual organs and production of hormones. Other effects include the suppression of male features of facial hair, deep voices, and Adam's apples for children and adolescents and the halting of female features of breast development and menstruation.

Transgender youth are a specific target population of puberty blockers. Gonadotropin-releasing hormone (GnRH) agonists (leuprorelin, histrelin) to halt puberty, can be used for transgender youth before the development of natal secondary sex characteristics.

Puberty blockers serve the transgender community by giving future trans men and trans women more time to solidify their gender identity, without developing secondary sex characteristics. If a child later decides not to transition to another gender, the effects of puberty blockers can be reversed by stopping the medication. Another function of puberty blockers is that it gives the future transgender individual a smoother transition into their desired gender identity as an adult.

Wikipedia: Puberty Blockers

Health Topic: Blocking Puberty in Transgender Youth

Video: Struggles of Transgender Youth

AMA: Suppression of Puberty in transgender Children

Info: Transgender

Puberty Blockers and Hormones for Trans Kids

Video: Trans Youth Share Struggles and Hopes

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

HRC Healthcare Equality Index

Gay & Lesbian Medical Association

Info: AIDS/HIV

CDC: Gay and Bisexual Men's Health

How Medical Schools Are Failing the LGBTQ Community

SAMHSA: Top Health Issues for LGBTQ Populations

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

Ethical Guidelines for Professionals Working With LGBTQ Clients

Foundation for Better Understanding: The Health of LGBTQ People

Info: LGBTQ Mental Health

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.

NBC News: Hospitals Make Tremendous Strides Toward LGBTQ Inclusive Care

Trump's Military Ban Ignores Science to Inflict Harm

LGBTQ Healthcare: To Treat Me, You Have to Know Who I Am

Surgeon General Says LGBTQ Youth Should be a Priority

Seemingly Harmless Habits That May Increase Your Risk Of Dementia

World Health Organization: Transgender Not a Disorder

LGBTQ Wellness: Take Pride in Your Health

Info: Living With AIDS/HIV