It Hurts: Prejudice in GLBT HealthcareCultural Competence Resources for GLBT Health

Jacqueline Leskovec, MLIS, MA, RNOutreach, Planning & Evaluation CoordinatorNational Network of Libraries of MedicineGreater Midwest Region

Objectives

Participants will be able:• To identify barriers to quality healthcare for the GLBT

population• To identify 3 specific areas of health disparities in the GLBT

population• To identify 3 culturally competent health information

resources for the GLBT community

Definitions

prej·u·dice• injury or damage resulting from some judgment or action of

another in disregard of one's rights; especially : detriment to one's legal rights or claims

dis·crim·i·na·tion• the process by which two stimuli differing in some aspect are

responded to differently

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http://m-w.com

Non-discrimination• All College policies, practices, and procedures are

administered in a manner consistent with our Catholic identity. With the foregoing understanding, Saint Mary’s College will not engage in discrimination based on gender, race, national origin, religion, age, mental or physical disability, all as provided by law. Based on our Catholic values, the College also commits to avoiding discrimination based on sexual or political orientation.

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Who We Are

This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-LM-6-3503

with the University of Illinois at Chicago.

And you?

Some considerations:• Student/Studies? Faculty/Department? Public?• Why are you here?• What is your experience/knowledge regarding GLBT/health

disparities?• What do you expect to take away from this session?

What are health disparities?• Differences in the incidence, prevalence, mortality, and burden

of diseases and other adverse health conditions that exist among specific population groups in the United States• Incidence: probability of being diagnosed with a disease• Prevalence: likelihood of having a disease• Mortality: another term for death

Center to Reduce Cancer Health Disparities (CRCHC)

What is culturally competent healthcare?• Culturally competent healthcare means optimizing quality care

by being respectful of and responsive to the cultural factors that influence patients’ attitudes and behaviors at the institutional and the individual level.

The Mautner Projecthttp://www.mautnerproject.org/

Why cultural competency?• Quite simply, healthcare services that are respectful of and

responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes.

The Office of Minority Healthhttp://www.minorityhealth.hhs.gov/

The Purnell Model for Cultural CompetenceLarry Purnell, PhD, RN FAAN

Learning about culture

Global Society • Community

• Family • Person

• Spirituality• Death rituals• Pregnancy• Nutrition• High-risk behaviors• Biocultural ecology• Workforce issues• Family roles and organization• Communication• Overview/heritage• Healthcare practitioners• Healthcare practices

Major Assumptions• All health care professions need similar information about

cultural diversity.• One culture is not better than another; they are just different.• Differences exist among, between & within cultures.• Cultures change slowly over time in a stable society.• If clients are coparticipants in care and have a choice in health-

related goals, plans and interventions, health outcomes will be improved.

• Culture has powerful influence on one’s interpretation of an responses to health care.

• Individuals and families belong to several cultural groups.• Caregivers who can assess, plan & intervene in a culturally

competent manner will improve the care of their clients.

Why GLBT health?• Improve the health, safety, and well-being of gay, lesbian,

bisexual, and transgender (GLBT) individuals.• Reduce disease transmission and progression• Increase mental and physical well-being• Reduce healthcare costs• Increase longevity

Healthy People 2020http://healthypeople.gov

A Few Terms• Gender• Gender identity• Gender expression• Sexual orientation• Lesbian• Gay

• Homosexual• Intersex• WPW/MSM• Transgender• M2F/F2M• Queer

GLAAD Media Reference Guide: Lesbian, Gay and Bisexual Glossary of Termshttp://www.glaad.org

Sexuality

Identity

AttractionBehavior

Some Significant Dates• 1969: Stonewall Riots• 1970s: Boston Women’s Health Collective• 1973: Diagnostic and Statistical Manual• 1977: Lesbian and Gay Health Foundation• 1980s: GRID, ARC, AIDS/HIV; Gay Men’s Health Crisis• 1997: “Yep, I’m Gay”• 1999: Institute of Medicine Report on Lesbian Health• 2001: Healthy People 2010 Companion Document• 2010: Healthy People 2020

Reflection• What was your first introduction to GLBT

persons/culture/issues?• How old were you?• Was it positive? Negative?• Was it a non-issue?

Social Determinants• Social stigma• Rejection by family members• Abuse and violence• Unfair treatment in the legal system, state/federal• Hiding some or all aspects of one’s life• Lacking health insurance• Shortage of culturally competent health providers

Health Disparities: A Sample• 30% of lesbians lack health insurance• The largest percentage of persons diagnosed with AIDS and

persons with an AIDS diagnosis who have died have been MSM

• Estimated 40% of homeless youth are GLBT• 24% transgender persons reported being denied equal

treatment in doctor’s office or hospital• 45% bisexual women reported suicidality• Gay men: increased risk of anal cancer

HIV/AIDS• June 1981: First article about AIDS in the medical literature• 597,499 cumulative deaths (2007)

• MSM largest diagnosed/died: 308,000 (2006)• Misinformation regarding transmission• 2010: Promising research & daily pill

*CDC. HIV among Gay, Bisexual and Other Men Who Have Sex with Men (MSM).

STORY TIME FOR DISPARITIES

RESOURCES

Websites, organizations, providers & more

Healthy People 2020• HealthyPeople.gov• Lesbian, Gay, Bisexual, and Transgender Health• Ways to address health disparities in LGBT persons:

• Expansion of domestic partner health insurance coverage• Establishment of LGBT health centers• Dissemination of effective HIV/STD interventions

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MedlinePlus®• Medlineplus.gov

• http://www.nlm.nih.gov/medlineplus/gaylesbianandtransgenderhealth.html

• Search function

National Institutes of Health• National Institutes of Health: Gay/Lesbian Health• http://health.nih.gov/topic/GayLesbianHealth• Related Topics• Men's Health• Reproduction and Sexual Health• Women's Health

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CDC• Lesbian, Gay, Bisexual and Transgender Health

• http://www.cdc.gov/lgbthealth/

• HIV/AIDS• http://www.cdc.gov/hiv/• Includes FAQs, Stats

ACOG • ACOG WEBTREATS: Lesbian & Bisexual Health

• http://www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=2519

• Fact Sheet: Lesbian Teens• http://

www.acog.org/departments/adolescentHealthCare/TeenCareToolKit/lesbianTeens.pdf

• ACOG WEBTREATS: Transgender Health• http://

www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=2517

AIDS/HIV• AIDS.gov: http://aids.gov• AIDSinfo / infoSIDA: http://aidsinfo.nih.gov

• Twitter: @AIDSgov• HIV glossary - iPhone, iPod Touch and iPad • AIDSinfo Mobile• Homework help

• GMHC: http://www.gmhc.org/

Specific Populations• Child Welfare Information Gateway: Gay and Lesbian Adoptive

Parents• http://www.childwelfare.gov/

• GLSEN• http://www.glsen.org/

• SAGE: Services & Advocacy for GLBT Elders• http://www.sageusa.org

• LGBT aging project• http://www.lgbtagingproject.org /

• Lesbian, Gay, Bisexual, and Transgender Health Sciences Librarians MLA Special Interest Group• http://lgbt.mlanet.org

• American Academy of Pediatrics: Four Stages of Coming Out• http://www.healthychildren.org

More…• BiNet USA

• http://www.binetusa.org/• Accord Alliance

• http://www.accordalliance.org/• Lesbian Health & Research Center

• http://www.lesbianhealthinfo.org/• The Mautner Project

• http://www.mautnerproject.org/

Pubmed®• http://pubmed.gov• Search tips: using MeSH

• “Gay”, "Transgender" and "intersex" are not MeSH Subject Headings.

• "Transgender*" returns: "transgender[All Fields] OR transgender/questioning[All Fields] OR transgender/transsexual[All Fields] OR transgender/transsexual/queer[All Fields] OR transgendered[All Fields] OR transgenderism[All Fields] OR transgenderists[All Fields] OR transgenders[All Fields]

• “Also try” and “Search details”

OTHER RESOURCESProfessional/Organizations, etc.

Training• The Fenway Institute

• Learning Modules on LGBT Health• Mautner Project

• Removing the Barriers: Providing Culturally Competent Care to Lesbians and Women Who Partner with Women

• GLMA• Tobacco use and Interventions for Lesbian, Gay, Bisexual, and

Transgender (LGBT) Individuals

Professional/Organizations• Gay & Lesbian Medical Association

• http://www.glma.org/• American Institute of Bisexuality

• http://www.bisexual.org/• Intersex Society of North America

• http://www.isna.org/• National Coalition for LGBT Health

• http://lgbthealth.webolutionary.com• World Professional Association for Transgender Health

• http://www.wpath.org/

Subgroups• AMA GLBT Advisory Committee

• http://ama-assn.org• American Academy of Physician Assistants LGBT Caucus

• http://www.lbgtpa.org• AMSA Gender and Sexuality Committee & Interest Group:

Gender & Sexuality• http://www.amsa.org

A WELCOMING ENVIRONMENT

Recent Advances• Affordable Care Act

• Improving healthcare & fighting disparities• Respecting the Rights of Hospital Patients to Receive Visitors

and to Designate Surrogate Decision Makers for Medical Emergencies• Presidential Memorandum - Hospital Visitation

• Domestic Partnerships, Civil Unions, etc.• Health insurance for partners• Legal protections

• Human Rights Campaign http://www.hrc.org• Laws & Elections-State Laws

Healthcare Equality• Healthcare Equality Index 2010

• http://www.hrc.org• Four main policy areas

• patient non-discrimination• visitation,• cultural competency training• employment non-discrimination.

• Joint Commission

“You Count”• Mówimy po polsku

• Eu vorbesc româneşte

• Puhumme suomea

“Local” Centers• Howard Brown Health Center/LCCP

• http://www.howardbrown.org/• Chicago, IL

• Center on Halsted• http://www.centeronhalsted.org/• Chicago, IL

• Others near you?

Safe Zones• LGBT people are everywhere• Don’t assume sexual orientation• Non-gender specific language is welcoming

• If you don’t know, ask• Offensive language or insensitive jokes hurt• Validate gender expression

Coming Soon!• LGBT Health Awareness Week NOW!

• March 28-April 1, 2011• “Come Out for Health”

• Trans Bodies, Trans Selves• AMSA• Fall 2011

• Institute of Medicine LGBT Health Report• March 2011

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Quiz!• Name 3 social determinants /cultural factors that impact GLBT

health• Name 3 specific areas of health disparities in the GLBT

population• Name 3 culturally competent health information resources for

the GLBT community

Extra point?• Who is arguably SMC’s most famous lesbian graduate?

Wrap-up• Questions?• Comments?• Other Resources?

Thanks• Jacqueline Leskovec, MLIS, MA, RN

• Outreach, Planning & Evaluation Coordinator• National Network of Libraries of Medicine• Greater Midwest Region

• leskovec@uic.edu• http://nnlm.gov/gmr/

• Presentation is available on slideshare.net : leskovec (author)

This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-LM-6-

3503 with the University of Illinois at Chicago.