HIV and other STI rates increasing among young men of color, stable in other populationsLGB high school students more likely to engage in unhealthy risk behaviors such as tobacco use, alcohol and other drug use, sexual risk behaviors, suicidal behaviors and violence LGBT youth are 2 to 3 times more likely to attempt suicideLGBT youth are more likely to be homelessLesbian, gay, bisexual and transgender people delay or avoid accessing healthcare services due to fear of stigma Additional disparities in health care treatment and outcomes for LGBT people of color
A March 2011 report by the Institute of Medicine (IOM) concludes that LGBT individuals have unique health experiences and needs, that clinicians are poorly equipped to address their health statusDecember 2011, the US Department of Health and Human Services issued a list of activities and policy recommendations to improve LGBT health, including the need for competency training in the healthcare setting.In 2012 the Joint Commission, which accredits hospitals across the country, will begin to require hospitals to demonstrate how they are specifically responding to needs of LGBT patients as part of the more comprehensive provider/patient communications standards for accreditation. Knowing who the LGBT patient population is, what their needs are and how to communicate effectively are what is needed to reduce disparities and improve health outcomes.
Narrative in healthcare are the stories that we tell and the stories that surround us. Telling and listening to stories are central in the patient-provider relationship. Whenever there is interaction in healthcare, what the provider “knows” about who the person is influences the questions asked during a visit, influence the interpretation of the answers, and the recommendations for care. The stories told about health and wellness are also key in large scale public health campaigns to promote healthy behaviors. Educational media campaigns are constructed by local and national health departments and community based organizations to communicate images and narratives of desired health outcomes. Narratives frame our discourses on health from both the individual and population perspective.
LGBT individuals have problems with communicating with their health care providers: providers have negative attitudes, doctors not knowledgeable about LGBT health issues, and doctors do not ask about LGBT specific questions during visit. Gay and Lesbian adolescents likely to delay disclosure of sexuality to provider. Majority of adults do not disclose to provider about sexuality.Providers not trained to educate on unique aspects of LGBT health
Do the requisite indication that this is work we intend to publish and that you and I are in the midst of amassing a database of advertisements.
What is out there contribute to the construction of LGBT health narratives Jay: This is what we may call the “additive” approach, linking osteoporosis to HIV.
Ads campaign on subways and television created to remind young MSM that HIV is a big deal…sense of complacency now that HIV can be managed with medication, but there are other health issues that can come from being HIV positive, hence “it is not *JUST* HIV”.Deficit based modelFocus on negative aspects of HIV transmissionFear based campaignBacklash from advocates and the publicJustification from NYC DOH that attention was needed to the problemLifetime risk of HIV vs. diabetes, cancer, heart disease…Young LGBT of color seen as ignorant about the dangers of HIVSome of the other things to worry about may be side effects of the anti-retroviral medications….
Anti homophobia campaignOn subways and FacebookWide spread campaign to create narratives/social norms around LGBT relationships based on strengths of love, respect, commitment and trustActors, not in a real relationship
More of the story behind this couple and their relationship…started with being “all about the sex” but now relationship is about respect and trustPhotos also help to tell the story of who they are and how they live…normal “couple” shots found in advertisements to normalize the relationships between LGBT of color
Testing Makes Us Stronger national campaign was created by the CDC to build on the strengths of young black gay and bisexual men. Subway print campaign, also uses social media. Focus on young MSM of color to “get tested” and know their HIV status. NYC DOH also had a recent campaign around this issue—based on data that some who have HIV don’t know it.
Theywanted to show black gay couples who are loving and supportive andto document a diverse range of strong men in community. What to do after you get tested???
RealTalk DC, part of MetroTeenAIDS—organization focused on youth of color and educating and preventing HIV. Teens take an active role in creating materials. Community based participatory approach.Uses You Tube, texting, Twitter, Facebook to communicate peer-to-peer information
Peer-to-peer approach bypasses need for “cultural competency” in communication, and also provides accurate information from health care professionals. Emerging model for constructing health narratives for LGBT youth of color.
So what is the current status of LGBT youth of color today on issues of their health? What is their story? I will now present results from the Social Justice Sexuality Survey that will begin to tell the tale.
89% report good, very good or excellent health.
69% feel just as good as others a lot or most of the time.
Constructing (new) LGBT Youth of Color Health Narratives
Martine Hackett Antonio (Jay) Pastrana, Jr.Hofstra University John Jay College, CUNY ESS Annual Conference February 25, 2012
1. From individual perspective: Health providers for LGBT populations need to understand the stories of LGBT youth of color to communicate effectively and to provide appropriate care.2. From a population perspective: Effective construction of prevention messages and health policies require accurate knowledge of LGBT youth of color health beliefs and attitudes.
What are the current health narratives for LGBT youth of color as constructed by public health authorities? What are the interactions and experiences of LGBT youth of color with their health and the health care system? How could new narratives inform healthcare communication for LGBT youth of color?
Mixed-method approach, which encompassed secondary data analysis of a nation-wide survey of LGBT people of color (N=4,953) and selected youth of color (ages 18-24) from that sample. Ultimately, 959 cases were selected for analysis. Purposeful sample of 4 health campaigns (2010- 2012) from local health departments, Centers for Disease Control and Prevention and GHMC were analyzed for how LGBT youth of color health narratives were constructed in the media.
HIV main focus: emphasis on testing and education Focus on individual responsibility for health: what happens after you get tested? Though more campaigns are using strength-based approaches, a fear-centered deficit model and images pack a bigger punch Little to no representation of health issues for lesbians and transgender Health issues that LGBT youth of color at greater risk for not addressed: chronic disease, mental health, homelessness
Self-Reported General HealthLGBT Youth of Color (N = 959) Poor 2% Fair 9% Excellent 22% Good 33%Very Good 34%
Self-Reported Mental Health "Felt just as good as others" LGBT Youth of Color (N = 959)Most of the Time 39.5A Lot of the Time 29.5 Sometimes 23.7 Never 7.3
Self-Reported Mental Health "Felt hopeful about the future" LGBT Youth of Color (N = 959)Most of the Time 44.4A Lot of the Time 28.3 Sometimes 22.8 Never 4.5
Perceived comfort level of medical provider at last visit LGBT Youth of Color (N = 959) Did not know 36.7 Ignored 12.7 Uncomfortable 6.6Seemed comfortable 44.1
Source of Health Information LGBT Youth of Color (N = 959) Other 4.8 Friends 6.4 Family 20 Online 22.1A Medical Professional 36.3 0 5 10 15 20 25 30 35 40
Healthcare provider comfort level with LGBT youth of color needs to improve Health information is heard from different places, not just from medical professionals Most LGBT youth of color have positive perceptions of their own health, have a positive sense of self and are hopeful about the future
Would allow LGBT youth of color to own their stories about health andwellness from where they are, not where they should be.Would use narratives of their experiences to frame health messagesusing friends, family and online sources.Would reflect a contemporary, holistic image of LGBT youth of color inhealth communication materials.Where LGBT youth of color bring their authoritative selves and havean active role in patient-provider communication.Addresses other pressing health issues beyond HIV at community andpolicy levels.