Health Equity Series: Responding to LGBT Health Disparities August 2012

Lesbian, gay, bisexual, and transgender (LGBT) individuals experience poorer health outcomes than their heterosexual peers .These poor outcomes are a result of differences in access to health coverage; limited availability of culturally competent health care services; absence of medical settings that are affirming and free of discrimination; scarcity of medical staff trained in LGBT health issues; health behaviors that do not foster good health; and social and economic systems that have not supported and protected minorities .This paper draws on research from multiple sources, therefore a variety of terms are used to describe sexual and gender minorities (SGM) . The background section of this paper presents definitions of the terms used, as well and an explanation of why one overarching term was not selected . Following the background, this issue brief explores common experiences among LGBT individuals that impact their ability to lead healthy lives . This paper concludes with a review of current policies in Missouri, and offers policy recommendations that will lead to greater health equity and improved health outcomes for all Missourians

Identifying Barriers In Black Communities That Hinder The Engagement In LGBT Affirming Behaviors. Clinical Implications For Understanding Barriers to Attaining Adequate Social Support When Working With LGBT People Of Color.

Institutional oppression and social inequality have been a topic of importance for decades within the literature. These adverse events may lead to many mental health problems, segregation between identity groups, and a hostile environment. This study aims to analyze the barriers in Black communities that may prevent Black communities from providing adequate social support or advocating for LGBT people of color. The primary question is: Does religious beliefs and levels of engagement in intergroup dialogue and intergroup contact impact the likelihood of engagement in LGBT affirming behaviors. Participants (n = 276) completed an anonymous online survey, and linear regression results indicated significant contributions from intergroup dialogue, intergroup contact, and lower religion with LGBT affirming behaviors. Intergroup dialogue suggested the strongest contribution to engagement in LGBT affirming behaviors. A moderation analysis was also conducted to determine if intergroup dialogue and intergroup contact would moderate the relationship between high religiosity and low engagement in LGBT affirming behaviors. Results suggested that the intergroup dialogue moderating variable was significant, and the moderating intergroup dialogue variable was not significant

Examining the Development of Positive Space in Health and Social Service Organizations: A Canadian Exploratory Study

All health care sectors are currently examining factors that influ- ence delivery of high-quality services for diverse groups with an understanding that minority populations experience barriers to service access that contribute to well-documented ill health and health inequities. with a goal of understanding dynamics that can improve access to care in the home care sector, this qual- itative exploratory study examined processes to create inclusive, positive space for diverse lesbians, gay men, bisexuals, transgen- der, and queer (lgbtq) people in community-based health and social service agencies. a purposeful sample of eight key infor- mants from agencies in toronto, ontario, canada, which offer programs and services to lgbtq communities, completed in-depth interviews. conventional content analysis and a critical lens were used. themes offered insight into the histories, challenges, and turn- ing points which shaped the development of lgbtq-positive spaces in these organizations. community engagement and leadership emerged as relevant, as did strategies to embed lgbtq voices and visibility within everyday organizational functioning. given the gap in literature addressing lgbtq access to home care and the unique dynamics that shape care in the home, implications address the application of these study findings for creating positive space in the home care sector

Protecting and Advancing Health Care for Transgender Adult Communities

Discrimination, stigma, and violence, along with other social, political, and economic factors, significantly affect the physical, mental, and behavioral health of transgender adults. Research demonstrates that, compared with the general population, transgender people suffer from more chronic health conditions and experience higher rates of health problems related to HIV/AIDS, substance use, mental illness, and sexual and physical violence, as well as higher prevalence and earlier onset of disabilities that can also lead to health issues. In addition to poorer health outcomes, transgender people also encounter unique challenges and inequalities in their ability to access health insurance and adequate care. The public health and economic crises spurred by the COVID-19 pandemic have only exacerbated existing disparities and barriers to care for transgender people, especially transgender people of color.While robust laws that protect transgender people from discrimination based on gender identity are essential to providing greater legal safeguards, such tools must be paired with enforcement mechanisms and in-practice policies that are affirming, inclusive, and culturally competent. Adopting both nondiscrimination laws and inclusive policies will be critical for improving health outcomes and the daily lives of the estimated 1.4 million adults identifying as transgender in the United States.To examine the health conditions that transgender adults face, this report incorporates storytelling to elevate their lived experiences

Getting Sexual and Gender Minority Health “Into the Brick and Mortar”: A Mixed Methods Implementation Study

Sexual and gender minorities (SGM) have unique health risks and health care needs, but medical students receive little training on SGM health (Obedin-Maliver, et al., 2011). This mixed methods study sought to learn from curricular champions in diverse settings to apply lessons learned at the George Washington University (GW). Exploratory models that included eight potential predictor variables for six criterion variables were tested using multiple linear regression. Criterion variables were: knowledge, attitudes, and clinical preparedness measured by the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS; Bidell, 2017); attitudes measured by the Attitudes Toward LGBT Patients Scale (ATLPS; Wilson et al., 2014); and beliefs and behaviors measured by the Gay Affirming Practice Scale (GAPS; Crisp, 2006). Models were reduced for each criterion variable until all independent variables in the model explained \u3e2% variance in the sample. Reduced Models explained approximately half of the total variance in the sample for three of the six criterion variables. All independent variables that were tested were included in at least one Reduced Model—suggesting that sociodemographic factors and lived experiences influence medical student competency in caring for SGM patients. Qualitative findings emphasized the importance of empowered, motivated individuals; institutional support; and inclusive planning and implementation processes. Engaging key stakeholders at GW to improve coverage of unique SGM health along with enhanced experiential opportunities would strengthen GW medical school student preparedness to care for SGM patients

Approaching Trans Healthcare Competency: The Implementation of Trans Health Education for Medical Providers in Appalachia

Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training)

LGBT Trainee and Health Professional Perspectives on Academic Careers—Facilitators and Challenges

Purpose: Diversity efforts in the academic medicine workforce have often neglected the identification and inclusion of lesbian, gay, bisexual, and transgender (LGBT) health professionals. Many of these professionals have served as educators, researchers, administrators, and leaders at their academic institutions, but their perspectives on the barriers to and facilitators of pursuing academic careers, as well as the perspectives of trainees, have not been explored. Methods: We applied a purposeful convenience sampling strategy to collect quantitative and qualitative data among LGBT health care professionals (HCP) and trainees. The authors identified trends in data using bivariate analyses and consensual qualitative research methods. Results: We analyzed data from 252 surveys completed by HCPs and trainees and a subset of 41 individuals participated in 8 focus groups. Among survey participants, 100% identified as lesbian, gay, and bisexual (LGB) or queer; 4.5% identified along the trans-spectrum; 31.2% identified as a racial or ethnic minority; 34.1% identified as faculty; and 27.4% as trainees. Eighty-one percent of trainees were interested in academia and 47% of HCPs held faculty appointments. Overall, 79.4% were involved in LGBT-related educational, research, service, or clinical activities. Facilitators of academic careers included engagement in scholarly activities, mentorship, LGBT-specific networking opportunities, personal desire to be visible, campus opportunities for involvement in LGBT activities, and campus climate inclusive of LGBT people. Barriers included poor recognition of LGBT scholarship, a paucity of concordant mentors or LGBT networking opportunities, and hostile or non-inclusive institutional climates. Conclusion: LGBT trainees and HCPs contribute significantly to services, programs, and scholarship focused on LGBT communities. LGBT individuals report a desire for a workplace environment that encourages and supports diversity across sexual orientation and gender identities. Institutional policies and programming that facilitate LGBT inclusion and visibility in academia may lead to greater faculty work satisfaction and productivity, higher retention and supportive role modeling and mentoring for the health professions pipeline.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140160/1/lgbt.2015.0024.pd

Gender Equity in the Workplace: Intersectional and Gender & Sexuality Diverse Approaches

Workplaces are increasingly looking to expand their equity and diversity work to understand how to address aspects of identity that intersect with gender or sexuality, and with genders and sexualities beyond binary (M/F) understandings. There are solid business and moral cases that can be made for this expansion. The Sexualities and Genders Research Stream at WSU approach this area from a social justice lens, reflecting WSU's key commitment to the principle of Equity. WSU is emerging as a national leader for research into intersectionality and the inclusion of trans* and gender diversity, in gender equity across the sector

Experiences of Queer Women and Nonbinary Individuals with Mental Health Care Services During the COVID-19 Pandemic

Background: The COVID-19 pandemic has had a negative effect on mental health. Queer women and nonbinary individuals disproportionately experience mental health issues when compared to heterosexuals, often facing challenges in receiving care from providers who are sensitive to their concerns and competent in their care. Objective: To report experience of queer women and nonbinary individuals in the United States with mental health care services before and during the pandemic. Methods: Data were gathered via a 43-item survey about experiences with mental health care services before and during the pandemic that was posted on four social media sites, and flyers hung in university student centers and businesses friendly to LGBTQ individuals. Queer women and nonbinary individuals between the ages of 18 and 75 were invited to participate. Descriptive statistics and Spearman’s correlations were used for data analysis. Results: There were 175 participants who met inclusion criteria and were included in the analysis. During the pandemic, more survey participants received mental health services compared with before the pandemic. How they received care significantly changed from before the pandemic (mostly in-person) to during the pandemic (mostly remote). Participants reported being seen significantly more frequently for mental health care during the pandemic compared to before. A higher percentage of participants received both psychotherapy and medication during the pandemic compared with before. They were generally satisfied with their mental health care; however, satisfaction was significantly higher during the pandemic. Conclusion: During the pandemic, compared with before, significantly more participants received mental health care and there were significantly more virtual mental health visits, more frequent mental health visits, more intensive therapies, and higher patient satisfaction. Telehealth care was perceived to be beneficial by most participants

Jumping Beyond the Broom: Why Black Gay and Transgender Americans Need More Than Marriage Equality

Calls for a policy agenda to address the economic, educational, and health disparities among gay and transgender African Americans, who face multiple structural biases based on race/ethnicity, class, sex, gender identity, and sexual orientation