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Lgbt Health Edited


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Lgbt Health Edited

  1. 1. <ul><li>New York Study (July 2008) of 452 men who had had sex men within the past year: </li></ul><ul><li>61% had disclosed that they were gay to their doctors </li></ul><ul><li>78% of men who self-identified as “homosexual” told their doctors </li></ul><ul><li>0% of men who self-identified as “bisexual” told their doctors </li></ul>Source: NY Times based on data from NY Department of Health and Mental Hygiene
  2. 2. <ul><li>The survey found that the following percentages of men who had slept with men within the past year had told their doctors: </li></ul><ul><li>40% of African-American men </li></ul><ul><li>52% percent of Latino men </li></ul><ul><li>53% percent of Asian-American </li></ul><ul><li>81% of Caucasian men. </li></ul><ul><li>Black and Latino men were most likely to consider themselves “bisexual” </li></ul>
  3. 3. <ul><li>Why is this important? </li></ul><ul><li>Who was tested for HIV? </li></ul><ul><li>63% of men who disclosed to their doctor about having sex with men </li></ul><ul><li>36% of men who did not disclose to their doctor about having sex with men </li></ul><ul><li>Note question of causation vs. correlation </li></ul>
  4. 4. <ul><li>Is there such thing as “LGBT Health Care?” </li></ul><ul><li>What does medicine have to do with people’s sex lives? </li></ul><ul><li>Arguments for this idea: </li></ul><ul><li>1) Greater/lesser pre-test probabilities </li></ul><ul><li>2) Mental health issues/Addiction </li></ul><ul><li>3) Unique legal challenges/access </li></ul><ul><li>4) Extra provisions for privacy </li></ul><ul><li>5) Helps identify disparities in research/tx </li></ul><ul><li>6) Fostering rapport/comfort </li></ul><ul><li>7) Early id of intra-communal pandemics </li></ul><ul><li>8) Intersex and transgender health: Unique treatments and procedures </li></ul>
  5. 5. <ul><li>Is there such thing as “LGBT Health Care?” </li></ul><ul><li>Arguments against this idea: </li></ul><ul><li>1) People might not want to talk about their sexuality or be treated differently </li></ul><ul><li>2) Sexuality is somewhat fluid </li></ul><ul><li>3) Failing to consider certain diagnoses (i.e. lesbians and pap smears) </li></ul><ul><li>4) Correlation vs. causation (gayness doesn’t cause disease, </li></ul><ul><li>independent risk factors do). </li></ul><ul><li>5) Avoiding social bias. HIV= “gay men’s disease” </li></ul><ul><li>Bottom Line: Providers who consider “LGBT–specific” health care, should use it as category only to help provide treatment and support, not to bias or otherwise harm. </li></ul>
  6. 6. <ul><li>Sex : the anatomic distinction between male and female. </li></ul><ul><li>Gender : the societal construct that is associated with men (masculinity) and women (femininity). </li></ul>
  7. 7. <ul><li>Sexual orientation is &quot;an enduring pattern of emotional, romantic, and/or sexual attractions to men, women, or both sexes.“ </li></ul><ul><li>MSM - men who have had sex with men, regardless of self-identified sexual orientation (also MSW, WSW, WSM) </li></ul><ul><li>WSM/W- women of have had sex with man and women, regardless of self-identified sexual orientation (also MSM/W) </li></ul>
  8. 8. <ul><li>The Kinsey scale (1948) attempts to describe a person's sexual history or episodes of their sexual activity at a given time </li></ul><ul><li>More fluid model of sexuality: </li></ul><ul><li>37% of men and 10% of women had at least one homosexual experience that brought them to orgasm </li></ul>
  9. 9. <ul><li>Designation of “7” (asexual) was later added to scale. </li></ul>
  10. 10. <ul><li>11.6% of white males (ages 20-35) were given a rating of 3. </li></ul><ul><li>10% of American males surveyed were &quot;more or less exclusively homosexual for at least three years between the ages of 16 and 55&quot; (in the 5 to 6 range). </li></ul><ul><li>7% of single females (ages 20-35) and 4% of previously married females (ages 20-35) were given a rating of 3 </li></ul><ul><li>3 to 9% of females (aged 20-35) were more or less exclusively homosexual in experience/response (5 or 6) </li></ul>
  11. 11. <ul><li>Homosexual (1869) </li></ul><ul><ul><li>Term coined in Hungary by Karl-Maria Kertbeny </li></ul></ul><ul><ul><li>Argued homosexuality was inborn. First to make classically liberal argument that consensual sex doesn’t harm others, and ought to be legal. Believed Prussian Sodomy law violated rights of man. </li></ul></ul><ul><ul><li>Later used in the 1900s as a clinical term, particularly in the context of psychological disease. </li></ul></ul><ul><li>Faggot (1890) </li></ul><ul><ul><li>Bundle of sticks used to start a fire, kindling </li></ul></ul><ul><li>Queer (1910) </li></ul><ul><ul><li>cwer : crooked, not straight </li></ul></ul><ul><ul><li>quare : unusual </li></ul></ul><ul><li>Gay (1940) </li></ul><ul><ul><li>Preferred over the clinical term &quot;homosexual” </li></ul></ul><ul><ul><li>Did not emphasize being strange or odd </li></ul></ul>
  12. 12. <ul><li>Friend of Dorothy ” and “Family” (1950) </li></ul><ul><ul><li>Code name for gay men </li></ul></ul><ul><ul><li>No fear of revelation </li></ul></ul><ul><ul><li>During a period of social stigma and repression </li></ul></ul><ul><ul><li>Unclear origin: </li></ul></ul><ul><ul><ul><li>Wizard of Oz </li></ul></ul></ul><ul><ul><ul><li>Dorothy Parker </li></ul></ul></ul><ul><li>Queer (1985) </li></ul><ul><ul><li>Reclaimed in late 20 th century to be more inclusive term with more fluid boundaries </li></ul></ul><ul><li>LGBT (1990) </li></ul><ul><ul><li>“ Lesbian and Gay” was not inclusive of all groups within the community </li></ul></ul>
  13. 13. <ul><li>Lesbian </li></ul><ul><li>Gay </li></ul><ul><li>Bisexual </li></ul><ul><li>Transgender </li></ul><ul><li>Queer </li></ul><ul><li>Questioning </li></ul><ul><li>Intersex </li></ul>
  14. 14. <ul><li>“ Variations in Sex Development” </li></ul><ul><li>Intersex describes a person whose sex chromosomes, genitalia, and/or secondary sex characteristics are determined to be neither exclusively male nor female. </li></ul>
  15. 15. <ul><li>5-alpha reductase deficiency </li></ul><ul><li>Androgen insensitivity </li></ul><ul><li>Congenital adrenal hyperplasia </li></ul><ul><li>Hypospadias </li></ul><ul><li>Kallmann syndrome </li></ul><ul><li>Klinefelter syndrome </li></ul><ul><li>Mullerian agenesis </li></ul><ul><li>Mosaicism involving sex hormones </li></ul>
  16. 16. <ul><li>An individual who challenge traditional gender roles and the assumption that sex determines gender. Regardless of the motivation, a person who wears clothes, make-up, etc. which are considered by culture appropriate for the opposite gender, but not one’s own. </li></ul><ul><li>Transvestites : Transgenders who dress in clothing of the opposite sex. Note: Only about 10% are gay. </li></ul><ul><li>Transsexuals : Transgenders who actually change their anatomy to the opposite sex. (MTF, FTM) </li></ul>
  17. 17. <ul><li>A person who is generally satisfied with their gender identity, but who finds satisfaction in dressing in the clothing of the opposite gender. </li></ul><ul><li>Majority of Transvestites are straight men who enjoy wearing articles of women’s clothing. </li></ul>
  18. 18. <ul><li>A person who employs dramatic mannerisms, clothes, and makeup of the opposite sex, often for its entertainment or shock value. </li></ul><ul><li>Majority of Drag Queens and Kings are gay men/women. </li></ul><ul><li>“ You are born with a sex, </li></ul><ul><ul><li>the rest is drag.” </li></ul></ul><ul><ul><li>-Rupaul </li></ul></ul>
  19. 19. <ul><li>Created by Gilbert Baker in 1978 </li></ul><ul><li>Represents diversity in the gay community </li></ul><ul><li>Red: Life </li></ul><ul><li>Orange: Healing </li></ul><ul><li>Yellow: Sunlight </li></ul><ul><li>Green: Nature </li></ul><ul><li>Blue: Harmony </li></ul><ul><li>Purple: Spirit </li></ul>
  20. 20. <ul><li>Nazi concentration camp badge used to identify gay men </li></ul><ul><li>Originally intended as a badge of shame, has become an international symbol of gay pride and the gay rights movement </li></ul>
  21. 21. <ul><li>2004-05 California Quality of Life Survey: </li></ul><ul><li>47%of self-identified lesbians and 33% of self-identified gay men live with their partners </li></ul><ul><li>An additional 15% of lesbians and 15% of gay men report a serious dating partner. </li></ul><ul><li>Results show that education and earnings are not significant predictors of being in a co-residential relationship for lesbians and gay men, in contrast to heterosexuals. </li></ul><ul><li>However, employment status, race, and geography were similar predictors of relationship status across sexual orientation groups. </li></ul>
  22. 22. <ul><li>Defense of Marriage Act (1996) </li></ul><ul><li>No state need treat a relationship between persons of the same sex as a marriage, even if the relationship is considered a marriage in another state. </li></ul><ul><li>2. The Federal Government may not treat same-sex relationships as marriages for any purpose, even if concluded or recognized by one of the states. </li></ul>
  23. 23. <ul><li>Very difficult to wade through, as federal laws pertaining to marriage may be roughly categorized into two groups: </li></ul><ul><li>1) Legal benefit guaranteed to married couples by federal law, and denied to all U.S. same-sex couples. </li></ul><ul><li>(Example: Social Security pensions, Immigration sponsorship ) </li></ul><ul><li>2) Legal benefit guaranteed to married couples by federal law. States may or may not choose to extend such rights gay couples. </li></ul><ul><li>(Example: Emergency medical decisions, Joint parenting rights) </li></ul>
  24. 24. <ul><li>Create an advanced health care directive to authorize power of attorney and health care proxy </li></ul><ul><li>Especially important for people in same-sex partnerships </li></ul>
  25. 25. Laws Regarding Same-Sex Partnerships in the United States ██  Same-sex marriages ██  Unions granting rights similar to marriage ██   Unions granting limited/enumerated rights ██   Foreign same-sex marriages recognized ██  Statute bans same-sex marriage ██  Constitution bans same-sex marriage ██  Constitution bans same-sex marriage and other kinds of same-sex unions
  26. 26. <ul><li>In Massachussetts and California, same-sex couples, including out-of-state couples, may marry and enjoy the state-wide privileges of marriage. </li></ul><ul><li>Such marriages are recognized by Rhode Island, New York, New Mexico </li></ul>
  27. 27. <ul><li>California Constitutional Amendment, Proposition 8, “Marriage Protection Act” requires over 50% of vote. </li></ul><ul><li>California Voter’s Opinions Regarding Prop 8: </li></ul>Date of Opinion Poll Conducted by Sample size In favor Against 5/23/2008 LA Times 834 54% 35% 7/17/2008 The Field Poll 672 42% 51% 8/27/2008 Public Policy Center 1,052 40% 54%
  28. 28. <ul><li>Domestic partnerships were authorized in 2003, under Gray Davis, and will be in place regardless of result of Proposition 8. They allow for rights equivalent to marriage in terms of: </li></ul><ul><li>Child custody </li></ul><ul><li>Child and spousal support obligations, </li></ul><ul><li>The right to make funeral arrangements, </li></ul><ul><li>Community property and spousal support, access to family court, </li></ul><ul><li>State court testimonial privileges </li></ul><ul><li>Access to married student housing a </li></ul><ul><li>Mutual responsibility for debts </li></ul>
  29. 29. <ul><li>Benitez v. North Coast Women’s Health Care </li></ul><ul><li>Guadalupe Benitez had PCOS and required intrauterine insemination </li></ul><ul><li>Disclosed that she was a lesbian to her doctor, who refused to conduct insemination for religious reasons </li></ul><ul><li>August 18: California Supreme Court rules that doctor violated Unruh Civil Rights Act </li></ul>
  30. 30. <ul><li>&quot;All persons within the jurisdiction of this state are free and equal, and no matter what their sex, race, color, religion, ancestry, national origin, disability, sexual orientation, or medical condition are entitled to the full and equal accommodations, advantages facilities, privileges, or services in all business establishments of every kind whatsoever.&quot; Civil Code section 51(b) </li></ul><ul><li>Involves Question of Conflicting Rights: Does the patient have the right not be discriminated against? Does the doctor have the right to refuse to do a procedure that violates her religious beliefs? </li></ul>
  31. 31. <ul><li>An estimated 1 million U.S. veterans are gay or lesbian </li></ul><ul><li>Since 1994, over 11,400 gay men and women have been dismissed from the army for homosexuality under “Don’t Ask, Don’t Tell” </li></ul><ul><li>300 have been health care professionals </li></ul><ul><li>Gay patients in military will likely be less willing to talk about their sexuality and/or abuse and harassment </li></ul>
  32. 32. <ul><li>Since 1983, American Association of Blood Banks and FDA bar any man who’s had sex with a man after 1977 from donating blood </li></ul><ul><li>May donate organs under special circumstances </li></ul><ul><li>May not donate semen if MSM in past 5 years . Not strictly enforced for private clinics who inform patients. </li></ul><ul><li>Women who had sex with MSM must wait one year before blood donation donation </li></ul>
  33. 33. <ul><li>FDA argues: </li></ul><ul><li>Higher pre-test probability of HIV/Hep C and Hep-C more false negatives </li></ul><ul><li>Opponents argue: </li></ul><ul><li>1) New tests very sensitive </li></ul><ul><li>2) Severe blood shortage greater suffering </li></ul><ul><li>3) MSM with stable partners have low risk of HIV. </li></ul><ul><li>4) Rule should focus on hx of risky sexual behavior, rather than sexuality </li></ul>
  34. 34. <ul><li>Some slides adapted from presentation available on AMSA website </li></ul><ul><li>Disclosure: Work for political organization that advocates against Prop 8. </li></ul>