LBGT Healthcare Disparities

LGBT Leadership Symposium Hosted by AMSA & GLMA, and primarily attended by medical students Goals of the Symposium: Help students to advocate for more accurate LGBT health inclusion into curricula Help students to brainstorm ideas for cultivating vibrant and supportive networks of LGBT students on their own campus

Are LGBT people even in my community? o Yes... LGBT people live in every part of our society — rural and urban, north and south o Recent research indicates that about 4% of the population “self- identify” as LGBT o The 2008 US Census Bureau estimated that there are nearly 565,000 same-sex couples in the US o Couples in the U.S. have with at least one partner who is disabled: same-sex (28%) and opposite-sex (29%) o One out of three female same-sex couples and one out of five male same-sex couples are raising children The Williams Institute, UCLA School of Law

What is the root of LGBT healthcare disparities? Stigma & stress RT societal/familial rejection Inequality and discrimination Internalized homophobia Lack of focused resources on LGBT-specific health problems “Bar culture” o 38% HIV rates among bar-going MSM in Baltimore City o ¾ were unaware of their status CDC, 2011

Alienation from the health care system due to: Denied, Delayed, Substandard & Avoided Care Low rates of health insurance secondary to lack of domestic partner benefits No legal protection federally No legal protection in most states Lack of survivor benefits & sick leave Underinsurance Same-sex partner coverage rare & taxed Transgender care explicitly excluded from coverage

Lesbian-Specific Disparities Obesity o Lesbians have 2x the rate of obesity as compared to the straight community Breast/gynecological cancer Suspected higher hypertension rates Suspected higher Diabetes & CV disease rates Tobacco/Alcohol/Substance Abuse o 2x higher rates of tobacco in LGBT community use as compared to straight community Anxiety/Depression Psychiatric Disorders Violence and Trauma (hate crimes, DV, sexual assault) The Fenway Institute, 20110; Gay and Lesbian Medical Association, 2011

Disparities Prominent in the Gay Community HIV/STI’s Depression/Anxiety Eating/body image disorders Hepatitis Violence and Trauma (hate crimes, DV, sexual assault) Prostate/Testicular/Colon Cancer Anal HPV Tobacco/Alcohol/Substance Abuse Gay and Lesbian Medical Association, 2011

Transgender-Specific Disparities Depression/Anxiety Psychiatric Disorders Suicide Substance Abuse Limited Healthcare Access Adverse Effects of Hormone Therapy Cancer RT Hormone Therapy Gay and Lesbian Medical Association, 2011

Discriminatory and Abusive Health Care Experiences 56% of LGB patients & 70% of transgender patients reported at least one of these health care experiences, based on LGBT status: Being blamed for their health condition Refusal to touch or excessive precautions Harsh or abusive language Physical roughness or abuse When Health Care Isn’t Caring (Lambda Legal), 2010

New JCAHO Standards Included beginning January 2011: “The hospital provides care, treatment, and services free from discrimination related to age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.” Standard RI , EP 11

New Federal Standards on Hospital Visitation Rights As of January 2011, medical facilities participating in Medicaid and Medicare programs must: Inform each patient of his or her right to receive visitors whom he or she designates, including a domestic partner; Do not restrict or limit visitation rights based on sexual orientation and gender identity, among other factors and; Ensure that all visitors have full and equal visitation rights, consistent with a patient’s wishes. Code of Federal Regulations, at 42 CFR (h) and 42 CFR 485(f)

Healthcare Equality Index 2010 Published by the Human Rights Campaign, a LGBT civil rights organization Created to gain a baseline understanding of existing healthcare industry policies on issues of concern to the LGBT community and to measure improvement from year to year Annual online survey open to all What is rated? o Patient non-discrimination o Employee non-discrimination o Visitation Policies o Diversity/Cultural Competency Training (Human Rights Campaign, 2011)

Gay and Lesbian Medical Association (GLMA) o “Works to ensure equality in healthcare for LGBT individuals and healthcare providers” (GLMA, 2011) o Lesbian Health Fund: the only US fund dedicated to funding research on lesbian and bisexual women’s health o On-line culturally competent healthcare provider directory Membership to GLMA not required to be listed; providers self-identify as culturally competent o

LGBT Youth-Specific Health Risks Suicide is the 3 rd leading cause of death among 15 to 24 year olds 1 LGBTQ youth are up to 4x more likely to attempt suicide than their heterosexual peers because of the ways they are treated in their homes, schools, and various communities 2 LGB youth who come from highly rejecting families are more than 8x as likely to have attempted suicide than LGB peers who reported no or low levels of family rejection 1 CDC 2007; Massachusetts Youth Risk Behavior Survey 2009

LGBT Youth-Specific Health Risks Higher rates of smoking, drinking or other drug use, risky sexual behaviors, suicidal behaviors and violence among gay or bisexual teens than among straight peers CDC, 2011 Higher rates of homelessness as compared to straight peers Center for Population Research in LGBT Health, 2011

The Trevor Project The leading national organization focused on suicide and crisis prevention efforts among lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth The Trevor Lifeline is the nation’s only 24/7 suicide and crisis prevention lifeline for LGBTQ youth: U.TREVOR Dear Trevor is a non-time sensitive question and answer forum for questions related to sexual orientation, gender identity, and non-immediate needs

References/Resources Gay and Lesbian Medical Association The Trevor Project The Williams Institute Human Rights Campaign : Healthcare Equality Index Joint Commission : Advancing Effective Communication, Cultural Competence, and Patient- and Family- Centered Care: Meeting the Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients and Families. ommunication/

References/Resources American Cancer Society Cancer Facts for Lesbian and Bisexual Women cancer-facts-for-lesbians-and-bisexual-women Cancer Facts for Gay and Bisexual Men ncer-facts-for-gay-and-bisexual-men The Fenway Institute _ins_fenway_home&JServSessionIdr004=rmo8rp3t23.app205a Institute of Medicine The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Lesbian-Gay-Bisexual-and-Transgender-People.aspx