1. Module from the ADIEM LGBT Residency Curriculum
1/16/2018 4:14 AM
Academy of Diversity and Inclusion in Emergency Medicine Double Vulnerable Adolescents, Advanced Age, People of Color and LGBT
Module from the ADIEM LGBT Residency Curriculum
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2. Instructors Thea James Paul Krieger Joel Moll
* No financial conflicts of interest

3. PowerPoint Presentation
Today’s Session
Section
Leader
Introduction
Joel Moll
ADIEM Modules
Small Group Cases
All Faculty
PowerPoint Presentation
Post Test & Review
Thea James
Summary and Questions
Paul Krieger

4. Question for you
Who are you?
Faculty
Residents
Students
Other

5. ADIEM Curriculum Modules
Introduction to LGBT Health in EM
Ethics and Legal Considerations
Healthcare disparities of gay men and lesbians
Transgender Health
Pediatric and Adolescent LGBT
Geriatric LGBT

6. Case Discussions

7. LGBT People of Color

8. LGBT and People of Color
Subject to same disparities as all LGBT people
Cultural beliefs may conflict with LGBT status
Less likely confide sexuality to physician
1 in 3 LGBT families are of color

9. African American and HIV
Among all gay and bisexual men, African Americans are the racial/ethnic group most affected by HIV.
Young African American gay and bisexual men accounted for the highest number of new HIV infections
recent study of gay and bisexual showed a 19% increase in self-reported sex without condoms in HIV-positive African American gay and bisexual men—from 47% in 2005 to 56% in 2011.

11. CDC: Why LGB URM men high risk HIV
Small population size and the prevalence of HIV in that population, African American gay and bisexual men have a greater statistical risk of being exposed to HIV
Sexual relationships with older men, more likely to have HIV, also may increase risk for exposure
Younger African American men less likely to know status
Stigma, discrimination, conflicts with cultural beliefs

12. Best Practices Create safe environment for disclosure
Consider conflicts in community and sexuality
Encourage to know HIV status
Counsel of safer sex, PrEP and PEP

13. LGBT Youth

14. LGBT Youth Who are todays youth?
7-8.7% of adolescents report having at least 1 same sex partner or romantic interest.
Although fewer identify as being homosexual, bisexual or unsure (1-3%).
Only 16% told there physician they were gay

15. Youth Disparities Twice as likely to have attempted suicide
Twice as likely to experiment with drugs and alcohol
More likely to be physically abused
Twice as likely to have been verbally harassed or physically assaulted
20-40 % of homeless youth are LGBT
Substance abuse, risky sexual behavior, mental health disorders, victimization
25% report missing school because they feel unsafe.
1/5 transgender youth, shelters often will not accept them
25% of gay teens kicked out of there home
Increased risk of mental health disorders
7x more likely to be victims of violance and crime

16. Growing up LGBT in America
LGBT Youth
Non-LGBT Youth
Non-accepting families 26%
School/bullying problems 21%
Fear of being out or open 18%
Classes/exams/ grades 25%
College career 14%
Financial pressures related to college or job
90% negative messages, 70% messages
Many say school except them
90% out to friends
16% tell there doctors

17. Best Practices Use Open Ended Questions
Screening for STD’s and pregnancy
PrEP and PEP
Screen for Suicidal ideation and depression
Appropriate referrals and community resources
Consider assessing home situation and support system
Discuss recommended vaccinations
Hepatitis A and B, HPV
Know privacy rights for minors

18. Mature LGBT

19. LGBT Maturity 1.5 million LGB Americans over the age of 65
37% of LGB-identified adults have had a child at some time in their lives, compared to 74% of all Americans
Elder LGB individuals are twice as likely to live alone and be single, and may be estranged from what biological family

20. LGBT extended care facility residents, only 22% felt comfortable being open about their sexuality and 43% reported mistreatment based on their sexuality.
Over half of LGB people over age 65 are depressed, 39% have contemplated suicide, and 53% feel isolated.

22. Concerns with Death or Disability
Marriage equality
Advanced Directives
Hospital Visitation
Child guardianship
ECF Separation
Death tax
Probate
Estranged Family threat

23. Best Practices Screen for Suicidal ideation and depression
Consider social factors, isolation, in long term care decisions
Mature LGBT should consult lawyer for estate and disability planning
CMS mandates choice of visitation

24. Module Post Test
1. Which group has the highest rate of new HIV infection among LGBT individuals?
A. Latino Bisexual men of all ages
B. African American young men (age 13-24)
C. Men age 55 or greater
D. Women under age 18

25. Module Post Test
2. Compared to heterosexuals of the same age, LGBT individuals over >65 have a very high rate of
A. HIV infection
B. Heart disease
C. Intimate Partner Violence
D. Depression and Suicidal Ideation

26. Module Post Test 3. What percentage of homeless youth are LGBT? A. 40%

27. Summary LGBT patients are ubiquitous to EM
Additional barriers and challenges exist for those who are double vulnerable
LGBT URM carry a heavy burden of HIV
LGBT Youth have social challenges in addition to health disparities
vulnerable to STD and homelessness
Mature LGBT very high rates of depression
Mature LGBT less support and resources, less legal recognition and protection

28. Coming Next Year… Transgender Health in Emergency Medicine
With approval from SAEM Program Committee
Transgender Health in Emergency Medicine

29. Questions? Thank you! Thea James tljlcj@gmail.com Paul Krieger
Joel Moll