Mca1 Project


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Samuel Merritt ABSN Culture Project

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Mca1 Project

  1. 1. LGBT Community Emily Allen Whitney Burton Danielle Friedman Rebecca Heilman Sarah Rose
  2. 2. The LGBT Community <ul><li>There are an estimated 8.8 million people that identify themselves as gay, lesbian, bisexual, or transexual in the United States. </li></ul><ul><li>In California, an estimated 5.2% (1,338,164 people) of the population identifies themselves as gay, lesbian, or bisexual. </li></ul><ul><li>The ability to provide culturally competent care for this people group is crucial in the U.S. and even more so here in California. </li></ul>
  3. 3. Homosexual Males and Females <ul><li>Homosexual: characterized by a tendency to have sexual attraction toward another person of the same sex. </li></ul><ul><li>This community is one that is very diverse in race, age, and ethnicity. They come from many different walks of life and socioeconomic statuses. </li></ul>
  4. 4. The Homosexual Culture <ul><li>The LGBT people group values </li></ul><ul><ul><li>Community </li></ul></ul><ul><ul><li>Democracy </li></ul></ul><ul><ul><li>Equal Rights </li></ul></ul><ul><ul><li>The queer culture and heritage </li></ul></ul><ul><ul><li>Creativity </li></ul></ul>
  5. 5. Bisexuality Basics <ul><li>Bisexuality: “the potential to feel attracted to and to engage in sensual or sexual relationships with people of either sex” </li></ul><ul><li>Since most people are socialized as heterosexuals, bisexuality can be a part of a process of acknowledging one’s own homosexuality </li></ul><ul><li>Kinsey Study: 15-25% of women and 33-46% of men are bisexual </li></ul>(“Bisexuality Basics”, 2007) .
  6. 6. Bisexuality Basics <ul><li>Unfortunately, since bisexuality doesn’t fit into either category of hetero- or homosexuality, the category of bisexuality is often ignored. </li></ul><ul><li>Bisexuals are often assumed to be either heterosexual or homosexual, since there is no stereotypical bisexual appearance or behavior. </li></ul>(“Bisexuality Basics”, 2007)
  7. 7. Biphobia <ul><li>Bisexuality does not fit into the “either/or” heterosexist framework </li></ul><ul><li>Bisexuals cannot be defined by their partner, because they can have a same-sex partner, an opposite sex partner, or can be involved with both sexes at the same time </li></ul><ul><li>Bisexual men and women often feel invisible within this framework </li></ul>(“Bisexuality Basics”, 2007)
  8. 8. Myths About Bisexuality <ul><li>Bisexuals are confused about their sexuality, and haven‘t made up their minds </li></ul><ul><li>Bisexuality implies that the person is involved with a man and a woman simultaneously </li></ul><ul><li>Bisexuals can only have committed relationship with an “opposite sex” partner </li></ul><ul><li>Bisexuals have a “homosexual side” and a “heterosexual side” </li></ul>(“Bisexuality Basics”, 2007)
  9. 9. Bisexuality Stereotypes <ul><li>People become bisexual because it’s trendy and gets attention. </li></ul><ul><li>Bisexuality is a phase, especially in college-aged teens </li></ul><ul><li>Bisexual = available </li></ul><ul><li>Common names: </li></ul><ul><ul><li>“ fence-sitters” </li></ul></ul><ul><ul><li>“ switchhitters” </li></ul></ul><ul><ul><li>“ AC/DC” </li></ul></ul>(“Bisexuality Basics”, 2007)
  10. 10. Health Concerns for LGBT <ul><li>Alcohol Use: </li></ul><ul><ul><li>Bisexual and lesbian women report the highest rates of alcohol use and heavy drinking (which may be related to stress), compared to heterosexual and lesbian women </li></ul></ul><ul><li>Tobacco Use: </li></ul><ul><ul><li>Bisexual and lesbian women have higher rates of smoking than heterosexual women </li></ul></ul><ul><li>Substance Use: </li></ul><ul><ul><li>Bisexual and lesbian women have higher rates of drug use than heterosexual women </li></ul></ul>(“Health Concerns for Bisexuals”, 2010)
  11. 11. Health Concerns for LGBT <ul><li>Sexual Health: </li></ul><ul><ul><li>Bisexual and lesbian women report higher risk sexual behavior than heterosexual women </li></ul></ul><ul><ul><li>Bisexual and lesbian women have the highest rates of combining substance use and sex </li></ul></ul><ul><ul><li>Bisexual and gay men who have sex with other men have an increased risk of HIV infection </li></ul></ul><ul><ul><li>Bisexual and gay men are more likely to report having a sexually transmitted infection </li></ul></ul><ul><ul><li>Bisexual men report less risky sexual behavior with males than do homosexual men </li></ul></ul>(“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  12. 13. Health Concerns for LGBT <ul><li>Cancer: </li></ul><ul><ul><li>Both men and women who have receptive anal sex with men are at a higher risk for anal cancer and HPV infection </li></ul></ul><ul><ul><li>Smoking is also a risk factor for anal cancer, and bisexual men and women have higher rates of smoking </li></ul></ul>(“Health Concerns for Bisexuals”, 2010) (“Health With Pride”, 2010) (“The Health Needs of Gay Men”, 1994)
  13. 14. Health Concerns for LGBT <ul><li>Fitness: </li></ul><ul><ul><li>Some bisexual and gay men feel pressured to achieve the perfect body, and turn to compulsive exercising, eating disorders, and steroid use. </li></ul></ul><ul><li>Nutrition: </li></ul><ul><ul><li>Bisexual and lesbian women eat fewer fruits and vegetables than heterosexual women and are more likely to struggle with healthy eating. </li></ul></ul>(“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  14. 15. Health Concerns for LGBT <ul><li>Weight: </li></ul><ul><ul><li>Bisexual and lesbian women have higher rates of obesity, compared to heterosexual women </li></ul></ul><ul><ul><li>More bisexual women are underweight than lesbian or heterosexual women </li></ul></ul><ul><li>Heart Health: </li></ul><ul><ul><li>Bisexual women report higher rates of heart disease than heterosexual women </li></ul></ul><ul><ul><li>Risk factors include smoking, high blood pressure, BMI, high cholesterol, and alcohol use </li></ul></ul>(“Health Concerns for Bisexuals”, 2010)
  15. 16. Health Concerns for LGBT <ul><li>Depression & Anxiety: </li></ul><ul><ul><li>Bisexual and gay men and women report higher levels of both depression and anxiety than heterosexuals </li></ul></ul><ul><ul><li>This problem can be more severe for bisexual men and women who lack strong support systems, or who remain in denial </li></ul></ul><ul><ul><li>Adolescents and young adults have a high risk of suicide </li></ul></ul>(“Health Concerns for Bisexuals”, 2010) (“The Health Needs of Gay Men”, 1994)
  16. 17. Health Concerns for LGBT <ul><li>Mental Health: </li></ul><ul><ul><li>Bisexual women have the lowest levels of emotional support </li></ul></ul><ul><ul><li>Bisexual and gay men have lower social support levels than do heterosexual men </li></ul></ul><ul><ul><li>Bisexual men and women have the lowest emotional well-being of any sexual orientation group </li></ul></ul><ul><ul><li>Bisexual men and women report higher levels of self-harm and suicidal thoughts and attempts than heterosexuals </li></ul></ul>(“Health Concerns for Bisexuals”, 2010) (“Health With Pride”, 2010) (“The Health Needs of Gay Men”, 1994)
  17. 19. Health Care Implications for Bisexuals, Lesbians, and Gays <ul><li>87% of gay, lesbian, and bisexuals reported to have been discriminated against within the health care system </li></ul><ul><li>70% report to have been insulted based on their sexual orientation </li></ul><ul><li>The overall response of the health care system to the needs of homosexual and bisexual patients has been minimal </li></ul>(Robinson & Cohen, 1996)
  18. 21. Health Care Implications for Bisexuals, Lesbians, and Gays <ul><li>As nurses we must: </li></ul><ul><li>Advocate for all clients regardless of sexual orientation </li></ul><ul><li>Remove any personal prejudices from our care and challenge homophobia and biphobia whenever it is encountered. </li></ul><ul><li>Explore new ways to serve this often marginalized part of society. </li></ul>(Robinson & Cohen, 1996)
  19. 22. Health Care for the Transgender Community <ul><li>Transgendered individuals identify with a gender that differs from their genetic or biological sex which includes FTM and MTF persons </li></ul><ul><ul><li>Female-to-Male (FTM) - individuals born physiologically female but who identify with male gender roles </li></ul></ul><ul><ul><li>Male-to-Female (MTF) - individuals born physiologically male but who identify with female gender roles </li></ul></ul><ul><li>May identify as gay, lesbian, bisexual, transsexual, or heterosexual </li></ul>
  20. 23. Health Care for the Transgender Community <ul><li>Many &quot;transition&quot; to assume a life more congruent with their gender identity by: </li></ul><ul><ul><li>Gender Role Changing- adopting the dress of and social roles associated with the opposite biological sex </li></ul></ul><ul><ul><li>Hormone Therapy - used to achieve some of the secondary sexual characteristics associated with the opposite biological sex </li></ul></ul><ul><ul><li>Gender Reassignment Surgery- surgically removing or reconstructing genitalia to functionally resemble the reproductive organs of the opposite biological sex </li></ul></ul>(“Transgender Health,” 2005)
  21. 24. Health Care for the Transgender Community <ul><li>Lack of: </li></ul><ul><ul><li>population-based studies </li></ul></ul><ul><ul><li>health surveys with gender-variance variables </li></ul></ul><ul><ul><ul><li>Statistical and epidemiological data specific to the TG community is- </li></ul></ul></ul><ul><ul><ul><ul><li>Minimal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Inconsistent </li></ul></ul></ul></ul><ul><li>A Step in the Right Direction </li></ul><ul><ul><li>In 2002, FTM and MTF gender identifications became reporting options in publically funded HIV counseling and testing sites in California </li></ul></ul>(Keller, 2009)
  22. 25. Cultural Considerations of the TG Community <ul><li>Economic marginalization </li></ul><ul><ul><li>Employment discrimination </li></ul></ul><ul><ul><ul><li>33% of TG individuals report job discrimination </li></ul></ul></ul><ul><ul><li>Lower levels of education </li></ul></ul><ul><li>Societal marginalization </li></ul><ul><ul><li>Stigmatized, fringe group </li></ul></ul><ul><ul><li>Frequent estrangement from family and former friends </li></ul></ul><ul><li>Professional marginalization </li></ul><ul><ul><li>Sex work </li></ul></ul><ul><ul><ul><li>estimates range from 42-59% for subgroups in TG community </li></ul></ul></ul><ul><ul><ul><ul><li>Mental health disorders </li></ul></ul></ul></ul><ul><ul><ul><ul><li>HIV/STDs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Virus-related Cancers </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Substance abuse </li></ul></ul></ul></ul><ul><li>Transphobia prevents many transgendered individuals from seeking and/or receiving comprehensive health care </li></ul>(Keller, 2009)
  23. 26. Health Care Needs Unique to the Transgendered Client <ul><li>Appropriate care of the original biological sex </li></ul><ul><li>Appropriate care of anatomical changes resulting from- </li></ul><ul><ul><li>Hormone Therapy (HT) </li></ul></ul><ul><ul><li>Gender Reassignment Surgery (GRS) </li></ul></ul>(“Transgender Health,” 2005)
  24. 27. Health Care Needs Unique to the Transgendered Client <ul><li>Mental Health Care </li></ul><ul><ul><li>Required prior to: </li></ul></ul><ul><ul><ul><li>Hormone Therapy (HT) </li></ul></ul></ul><ul><ul><ul><li>Gender Reassignment Surgery (GRS) </li></ul></ul></ul><ul><ul><li>Provider: </li></ul></ul><ul><ul><ul><li>Evaluates patient's mental state and coexisting psychiatric conditions </li></ul></ul></ul><ul><ul><ul><ul><li>TG patient's suffer disproportionately from mental illness </li></ul></ul></ul></ul><ul><ul><ul><li>Evaluates patient’s eligibility for HT or GRS </li></ul></ul></ul><ul><ul><ul><li>Provides access to supportive resources </li></ul></ul></ul>(“Transgender Health,” 2005)
  25. 28. Current Health Care Barriers to the TG Community <ul><li>Medical care </li></ul><ul><ul><li>Bias and discrimination in the medical community </li></ul></ul><ul><ul><li>Delayed medical care </li></ul></ul><ul><ul><li>Lack of gender-variance variables in health surveys </li></ul></ul><ul><ul><li>Lack of cohort studies and lack of research on long-term hormone effects </li></ul></ul><ul><li>Mental Health </li></ul><ul><ul><li>Few providers who are experienced with TG patients </li></ul></ul><ul><ul><li>Reluctance to seek care; limited access to care due to insurance policies </li></ul></ul><ul><ul><li>Negative exposure to insensitive providers </li></ul></ul><ul><ul><li>Negative reaction to sex and gender transitioning from peers </li></ul></ul><ul><li>Hormone Therapy </li></ul><ul><ul><li>May not be covered by insurance </li></ul></ul><ul><ul><li>Risks associated with unsupervised therapy; increased risk of some forms of cancer </li></ul></ul><ul><li>Surgical Intervention </li></ul><ul><ul><li>Cost prohibitive </li></ul></ul><ul><ul><li>Few experienced surgeons </li></ul></ul><ul><ul><li>Post-operation complications </li></ul></ul>(Slide taken directly from “Transgender Health,” 2005)
  26. 30. Tips for Working with TG Clients <ul><li>Welcome transgender people by advertising services in the LGBT community and prominently displaying transgender-positive cues in your organization </li></ul><ul><li>The Golden Rule- Treat transgender clients as you would want to be treated </li></ul><ul><li>Remember to always refer to transgender clients using the name and pronoun that corresponds with their gender identity </li></ul><ul><li>If uncertain about a person's gender identity, ask politely for clarification </li></ul><ul><li>Help establish an effective policy for addressing discriminatory comments or behaviors in your organization </li></ul><ul><li>Always focus on providing excellent care and refrain from indulging in questions out of curiosity </li></ul><ul><li>Remember it is inappropriate to ask transgender clients their genital status if it is unrelated to their care </li></ul><ul><li>Always adhere to HIPAA guidelines- Never disclose a client's transgender status to anyone who does not have the explicit right to know </li></ul><ul><li>Become knowledgeable about transgender health care issues </li></ul>(Slide directly quoted from “10 Tips for Working,” 2002)
  27. 31. References <ul><li>Brown University Health Education. Health Concerns for Bisexuals . 2010. Retrieved from </li></ul><ul><li>Center for Disease Control. Lesbian, Gay, Bisexual, and Transgender Health . 2010. Retrieved from </li></ul><ul><li>Gates, G.J. (2006). Same Sex Couples and the Gay, Lesbian, Bisexual Population: New Estimates from the American Community Survey . Los Angeles. The Williams Institute, UCLA School of Law </li></ul><ul><li>Gay and Lesbian Medical Association. (n.d.). Mission. Retrieved from </li></ul><ul><li>“ Health With Pride- Bisexual Health”. Retrieved from </li></ul><ul><li>Robinson, G. & Cohen, M. (1996). Gay, lesbian, and bisexual health care issues and medical curricula . Canadian Medical Association Journal, 155(6), 709-711. </li></ul><ul><li>UC Riverside LGBT Resource Center. Bisexuality Basics . 2010 . </li></ul>
  28. 32. References <ul><li> (2005). In S. J. Swierzewski (Ed.), Transgender health . Retrieved from transgender/index.shtml. </li></ul><ul><li>Keller, K. (2009). Transgender health and HIV . Retrieved from </li></ul><ul><li>Taylor, A.,Robertson, A. (1994) The health needs of gay men: a discussion of the literature and implications for nursing. Journal of Advanced Nursing, 20(3):560-6. </li></ul><ul><li>Transgender Law Center (2002). 10 tips for working with transgender individuals . Retrieved from Provider%20fact%20sheet.pdf </li></ul><ul><li>Transgender Health Care Access Project. (2002). Medi-Cal and gender reassignment procedures . Retrieved from pdf/MediCal% 20Fact%20Sheet.pdf </li></ul><ul><li>Transgender Law Center (2002). Transgender health care access project . Retrieved from http://www.transgenderlaw </li></ul><ul><li>The Royal College of Nursing. (2003). The Nursing Care of Lesbian and Gay Male Patients or Clients. Retrieved from /0007/78577/002018.pdf </li></ul>