11/15/2012
Making it Better:
What health professionals can do to make
their practice more inclusive of the LBGT
community
Lauren B. Hannahs
Director of LGBT Affairs
301 Peabody Hall
Agenda
Identify social and health issues that are particularly
important for the LGBT community
Discuss how to create a nonjudgmental and secure
environment for LGBT patients
Describe the US Department of Health and Human Services
recent recommendations to improve the lives of LGBT people
Why this is important
40% of participating physicians reported they had no formal training –
either in medical school, residency or from CME or post-graduate
training – on LGBT health issues. Both the Institute of Medicine and the
US Department of Health and Human Services (HHS), in separate
communications, recently recognized a lack of training of health
professionals as a significant barrier to LGBT people receiving quality
healthcare (GLMA collaborative survey, 2011).
The growing number of individuals identifying as LGBT.
Lesbian/Gay 2% (384)
Bisexual 1% (192)
Questioning/Unsure 0.6% (117)
Transgender 0.1% (19), Genderqueer 0.2% (39), Other 0.1% (19)
(UF SERU, 2011)
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11/15/2012
Sex vs. Gender
Sex
classification of male/female based on
biological, chromosomal, anatomical attributes
Gender
social/cultural classification of
man/woman.
Gender identity
refers to a person’s internal, deeply felt
sense of being either a boy/man, girl/woman,
something other, or in between.
Gender Expression
refers to how people express their gender
identity. Everyone expresses their gender
identity in different ways: for example, in the
way they dress, the length of their hair, the
way they act or speak and in their choice of
whether or not to wear make-up.
Sex vs. Gender
LGBTQQIAAP
Lesbian
Gay
Bisexual
Transgender
Queer
Questioning
Intersex
Asexual
Ally
Pansexual
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Climate
Homophobia
A range of negative attitudes and feelings toward people who are
identified or perceived as being LGB. Definitions refer variably to
antipathy, contempt, prejudice, aversion, irrational fear, and hatred.
Transphobia
A range of negative attitudes and feelings towards transgender
identified individuals, based on the perceived or actual expression of
their internal gender identity.
Heteronormativity/Heterosexism
The cultural, institutional, and individual beliefs and practices that
assume that heterosexuality is the only natural, normal, acceptable
sexual orientation.
Lesbian & Bisexual Women
•
•
•
•
•
Heart Disease
Cancer
Depression & Anxiety
Polycystic Ovary Syndrome
Risk: lack of fitness, smoking, drug and alcohol
abuse, DV.
Gay & Bisexual Men
•
•
•
•
•
•
•
•
•
•
HIV/AIDS, Safe Sex
Substance Use
Depression/Anxiety
Hepatitis Immunization
STDs
Prostate, Testicular, and Colon Cancer
Alcohol
Tobacco
Fitness (Diet and Exercise)
Anal Papilloma
LGB Health Issues
-
www.womenshealth.gov
GLMA
• General lack of trust for healthcare providers due
to socio-political climate of society.
• Lack of preparation in medical schools around
LGBT issues
• Inappropriate questions
• Living lives of secrecy and silence
• Aging population issues
• Access to healthcare in relationship to marriage
laws
• Student financial dependence on family in
relationship to their level of “out-ness”
Who is Transgender?
Umbrella Term
An umbrella identity term taken by people who do not conform to
heterosexual and/or gender binary norms; a reclaimed
derogatory slur taken as a political term to unite people who are
marginalized because of their non-conformity to dominant gender
identities and/or heterosexuality.
Includes: genderqueers, cross-dressers, drag queens,
transsexuals.
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11/15/2012
Names and Pronouns
Reflecting the gender expression that the student is presenting.
Respectful practice is to refer to someone with their chosen
name and pronoun, regardless of paperwork that says
otherwise.
MTF = male-to-female
FTM = female-to-male
He/him, she/her, ze/hir, they/them
**When in doubt it is better to ask than to assume.**
Transgender Health Priorities
As established by the National Coalition for LGBT Health
Violence and Murder Prevention
HIV/AIDS and other STD Prevention & Treatement
Substance Abuse Prevention & Treatment
Depression, Suicidal Ideation & Suicide Prevention
Lack of Health Insurance and Underinsurance
Lack of Health Insurance Coverage for Trans Health
Services
Gender Identity Disorder (GID) as the Principal
Diagnostic Means Determining Access to Trans Health
Services
Transgender Health Priorities
As established by the National Coalition for LGBT Health
Lack of FDA approval for Transgender Hormonal Therapy
Widespread Injection Silicone Use, esp. among Transwomen
of color
The continuing misclassification of sex reassignment surgery
as experimental by the centers for Medicare & Medicaid
Lack of Training in U.S. Medical Schools for Trans Health
Service Delivery and Working with Transgender Patients
Medical, Mental Health and Substance Abuse Treatment
Provider Insensitivity and Hostility to transgender people
Tobacco Use
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11/15/2012
Transgender Health Priorities
As established by the National Coalition for LGBT Health
Medical, Mental Health and Substance Abuse Treatment
Provider Insensitivity and Hostility to transgender people
Recognizing reasons for lack of visibility & discomfort visiting the
health care center
Appropriate current health-related questions
Resist well-intended curiosity
Transgender Health Priorities
As established by the National Coalition for LGBT Health
Lack of Health Insurance and Underinsurance & Lack of
Health Insurance Coverage for Trans Health Services
Access to hormones and surgery
Financial expense due to lack of medical coverage
Lack of family support
DIY techniques that are potentially dangerous
Transgender Health Priorities
As established by the National Coalition for LGBT Health
Gender Identity Disorder (GID) as the Principal Diagnostic
Means Determining Access to Trans Health Services
Patholigizing of transgenderism as a disorder
Effects on individuals
Lack of knowledge/access to psychologists who serve
transgender patients
**Recent changes to DSM-V indicates removal of the
word “disorder” from classification.**
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11/15/2012
Misconceptions
“Lesbian, gay, bisexual = Transgender.”
Transgender people identify with all sexual orientations
“All transgender people experience gender dysphoria.”
Gender dysphoria is common but not all transgender individuals
feel the sense of being in the “wrong body.”
The experience of one transgender person is the same for
all.
The transgender experience is unique to every individual, no two
experiences are the same.
NIHIOM Recommendations
Recommendation 1. NIH should implement a
research agenda designed to advance knowledge
and understanding of LGBT health.
Recommendation 2. Data on sexual orientation and
gender identity should be collected in federally
funded surveys administered by the Department of
Health and Human Services and in other relevant
federally funded surveys.
Recommendation 3. Data on sexual orientation and
gender identity should be collected in electronic
health records.
Recommendation 4. NIH should support the
development and standardization of sexual
orientation and gender identity measures.
Recommendation 5. NIH should support
methodological research that relates to LGBT health.
Recommendation 6. A comprehensive research
training approach should be created to strengthen
LGBT health research at NIH.
Recommendation 7. NIH should encourage grant
applicants to address explicitly the inclusion or
exclusion of sexual and gender minorities in their
samples.
Best Practices
Prominently post the hospital’s nondiscrimination policy or
patient bill of rights
Create or designate unisex or single-stall restrooms
Avoid assumptions about sexual orientation and gender
identity
Recognize that self-identification and behaviors do not
always align
Be aware of misconceptions, bias, stereotypes, and other
communication barriers
Recognizing parental relationship and level of “out-ness”
Become familiar with online and local resources available
for LGBT people
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11/15/2012
Questions
LGBT Affairs
301 Peabody Hall
LBH@multicultural.ufl.edu
352-392-1218 x265
Resources
Spectrum
spectrumgainesville@yahoo.com
http://spectrumgainesville.tumblr.com
• Gator Allies Program
• Trans at UF
National Center for Transgender Equality
www.transequality.org
Gay & Lesbian Medical Assoc.
www.glma.org
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