Cultural Competence Resources for GLBT Health. Delivered at the Diverse Students' Leadership Conference, St Mary's College, Notre Dame, IN. March 2011.

1. It Hurts: Prejudice in GLBT Healthcare Cultural Competence Resources for GLBT Health Jacqueline Leskovec, MLIS, MA, RN Outreach, Planning & Evaluation Coordinator National Network of Libraries of Medicine Greater Midwest Region

2. 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

3. 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 2/18/11 http://m-w.com

4. 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. St Mary’s College Employee Handbook

5. 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.

6. 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?

7. 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)

8. 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 MautnerProject http://www.mautnerproject.org/

9. 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 Health http://www.minorityhealth.hhs.gov/

10. The Purnell Model for Cultural Competence Larry Purnell, PhD, RN FAAN

11. 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

12. 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.

13. 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 2020 http://healthypeople.gov

14. 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 Terms http://www.glaad.org

16. 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

17. Reflection What was your first introduction to GLBT persons/culture/issues? How old were you? Was it positive? Negative? Was it a non-issue?

18. 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

19. 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

20. 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).

21. Story Time for Disparities

22. Resources Websites, organizations, providers & more

23. 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 2/18/11

24. MedlinePlus® Medlineplus.gov http://www.nlm.nih.gov/medlineplus/gaylesbianandtransgenderhealth.html Search function

25. 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 2/18/11

26. CDC Lesbian, Gay, Bisexual and Transgender Health http://www.cdc.gov/lgbthealth/ HIV/AIDS http://www.cdc.gov/hiv/ Includes FAQs, Stats

27. 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

28. 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/

29. 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

30. 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/

31. 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”

32. Other Resources Professional/Organizations, etc.

33. 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

34. 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/

35. 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

36. a Welcoming environment

37. 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

38. 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

39. “You Count” Mówimypopolsku Euvorbescromâneşte Puhumme suomea

40. “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?

41. 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

42. 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 2/18/11

43. 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

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

45. Wrap-up Questions? Comments? Other Resources?

46. 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.