why lgbt health? If we don t talk about LGBT health LGBT patients become invisible and their health concerns are ignored

Transcription

1

2 why lgbt health? If we don t talk about LGBT health LGBT patients become invisible and their health concerns are ignored If you think that you don t have any lesbians or gay men as patients, it s because people perceive you as not being sensitive we won t share with you unless we feel safe. (Tiemann et al) and LGBT physicians and medical students are also rendered invisible.

3 competent care for lgbt patients Competent care of LGBT patients requires that physicians be: Knowledgeable about the health care issues Up-to-date on appropriate prevention and health promotion practices, and the most effective treatments Aware of their own beliefs and values and how these might be affecting patient care Elimination of discrimination & stigmatization Full and equal access to health care services Creation of health care environments in which LGBT patients feel safe coming out to their providers

4 lgbt discomfort in health care environents Many LGBT individual fear coming out to their health care practitioners Gay men were more likely to perceive their HCP as sensitive to their health concerns (Stein et al) 53-72% of lesbians were uncomfortable coming-out to their HCP (Solarz) trans people routinely experience discrimination and are often unable to access health services (Bauer et al) There is evidence that HCP lack understanding and can behave insensitively (Kaiser Permanente) Primary care in women s health in particular tends to be focussed on reproductive health, and assumes women are having sex with men Lesbians often receive unsolicited birth control counselling

5 Confidentiality Social knowing -> your assumptions? their concerns? Out-ness Coming out of the closet: risks/benefits Sexual identity sexual behaviour!! Lack of community supports, safe spaces outmigration, closeting, lack of critical mass, travel to urban centres for services/supports/social Homophobia, bullying Rural communities not necessarily more homophobic than urban! (but sometimes)

6 Rural boys suicidal ideation and attempts than urban boys Boys teen pregnancy involvement Both boys and girls binge drinking in past month, other drugs Girls more likely to have sex < 14 yrs Few differences in harassment compared to urban High levels of harassment regardless! ~87% verbal H, 45% physical H, 22% assaulted Poon & Saewyc, AJPH, 2009

7 Public perceptions about LGBT folks in the community shape how LGBT folks think about disclosure to HCP (Finnis, 2001) Visible and overt supportive messaging from HCP to counter this HCP are in a position to be highly influential in dismantling barriers to quality health care for members of the [queer] communities (Vervoort, n.d.)

8 LGBTTTIQQA Sexual identity Sexual desire Sexual behaviour/expression Sexual orientation Gender identity Gender expression

9 L G BT T T I Q Q A esbian ay isexual ransgender ransexual wo-spirited ntersex ueer uestioning lly

10 lgbt health: social, not biological Most health needs are the same, but require a shift in context Some health needs are unique to LGBT populations Stigmatization and marginalization (the impact of homo/bi/transphobia and heterosexism) are the primary reasons for the health disparities in LGBT communities

11 lgbt as a determinant of health being LGB or T is not a biological or genetic risk risk arises from socio-cultural factors Sexual orientation and gender identity as determinants of health Sexual behaviour Social behaviour, peer influences Gender performance, alteration, transition Health-seeking behaviour Social supports

12 Socio-cultural shifts in attitudes towards homosexuality and non-normative genders have occurred over decades Generational differences in the formative experiences of LGBT folks Differential trust/mistrust of authority figures and institutions Varying experience with families of origin, communities, religions, workplaces, etc

13 specific health issues HIV/AIDS and STDs Risks are different for LGBT than for heterosexual populations Depends on sexual behaviours The gender of one s partner itself is not a risk! Side effects of long-term HAART Cancer Eg. Anal cancer, breast cancer, AIDS-associated cancers, lung cancer Less frequent screening because of distrust of HCP

14 specific health issues Mental health, substance use, suicidality, body image & eating disorders Cardiovascular risk in lesbians Smoking, obesity, metabolic syndrome Disparity between biological sex and gender presentation in transgendered patients Preventive care for the relevant biological issues Risks associated with hormone therapy Sexual activity 92% of all elders do not use condoms or SS practices 48% of older LGB adults do not

15 communication: avoiding assumptions Don t assume: all patients are heterosexual all patients use traditional labels married people are monogamous sexual orientation based on appearance sexual behaviour based on sexual identity sexual behaviour and identity are static bisexual identity is only a phase transgender patients are gay, bisexual, or lesbian

16 communication: inclusive language Instead of: Are you married? Boyfriend/girlfriend Are you the mother/father? Who is the real mother/father? Do you live with your mother and father? Do you use birth control? Use: Do you have a spouse or significant other? partner, dating someone Are you the parent or guardian? Who is the biological mother/father? Who is at home with you? What kind of safer sex practices do you use? Does not assume gender of partner. Inclusive of different types of families. Useful if genetic information is needed. Does not assume gender of parents or structure of household. Does not assume nature of sexual encounters. SOURCE: Primary Care for Lesbians and Bisexual Women, American Family Physician (2006), Vol: 74 Issue: 2,

17 communication: dynamic interactions Ensure that questions are open-ended and apply to all Use the same language and terminology the patient does to describe self, sexual partners, relationships and identity Use the patient s preferred name, pronoun, regardless of what the birth certificate says If a patient seems offended by something, simply apologize and ask what terminology is preferred Ask appropriate questions according to context Friends and partners of LGBT clients should be given the respect and privileges given to a spouse or relative

18 Inclusive intake Positive interactions with all members of the health care team Physical & visual environment Sensitivity, warmth, openness, nonjudgmental communication

19 Change forms to ensure inclusion of LGBT folks Don t make assumptions in your intake interviews Use inclusive language partner instead of husband, wife, or spouse parent instead of mother or father Offer more options than simply M/F Consider simply using Gender: Remember transgender is not a sexual orientation!

20 Get the entire health care team on-board Patients encounter others (receptionists, nurses, etc) before they see you Negative first impressions can undermine patients comfort, trust Challenge discrimination when you see it Work to build capacity Spearhead trainings, workshops, build alliances between HCP

21 Display images of diverse LGBT people and families This is actually just good practice overall LGBT-relevant brochures, magazines, pamphlets, community flyers in the waiting area, exam rooms The bathroom problem Display symbols or statements of welcome in waiting rooms, websites, written materials But be SURE you can deliver!

22 ALWAYS use open, inclusive, non-judgmental communication with ALL patients! Don t wait until you know a pt is LGBT! LGBT patients may not come out to you at all if you have not used inclusive communication practices from the outset. Ask patients about sexual identity, orientation, partners, children or desire for children LGBT folks have families too! Be knowledgeable about specific health issues

23 Inclusive communication (with all patients) Welcoming environment Familiarity with community resources Check your biases, don t be judgemental Build your knowledge base

24 ebook available through NOSM library