Session i important consideration in addressing the health needs of the latino lgbtq community daniel rivas
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Addressing the Health Needs of the LGBT Latinx Community
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Session i important consideration in addressing the health needs of the latino lgbtq community daniel rivas
- 1. Addressing the Health Needs of the LGBTQ Latinx Community Daniel Rivas, MD Sea Mar Community Health Centers Burien, WA
- 2. What does it mean to be Latino/Latina/Latin@/Latinx?
- 3. What does it mean to be LGBTQ?
- 6. Collecting the Data HRSA UDS
- 7. Less Access to Health Care 0% 5% 10% 15% 20% 25% 30% 35% 40% No Health Insurance Delay or Not Seek Healthcare Delay or Not Fill Prescriptions No Regular Source for Basic Healthcare Latino Heterosexual Latino LGB Black Heterosexual Black LGB White Heterosexual White LGB Center for American Progress
- 9. Diagnosis of HIV in Adults 2014 11201 9008 7552 4654 2108 1159 1115 0 2000 4000 6000 8000 10000 12000 Black MSM White MSM Latino MSM Black Women, Heterosex. Black Men, Heterosex. Latina Women, Heterosex. White Women, Heterosex. CDC
- 10. Rate of HIV Diagnosis 2008-2013 0 5 10 15 20 Latinos Non-Latino Whites Per 100,000 US-Born MSM Foreign-Born MSM Unknown Birth MSM Other Non-Latino Whites CDC
- 13. Immigration Status as a Barrier to Access to Services
- 19. Considerations for LGBTQ Latinx Patients in the Clinic Pregunte y dígalo Deje que su proveedor sepa si usted es LGBT. Su proveedor apreciará la conversación. ¡Comience hoy! COM 762
- 20. Local Resources
Editor's Notes
- Defining this population Discuss some of the health data. Review disparities. Propose ways to improve health and healthcare for this population No financial disclosures.
- Latino/a – person of origin or decent from a Latin American country Broad group –wide range of races, cultures, & lang (Argnt/DR/Guate). Latino –used for whole population, but biased for the masculine Latinao –gender neutral, still emphasizes gender binary: masc/fem Latinx –inclusive for all genders incl. those who may not identify a gender During presentation, may go back/forth depend on source of data or context
- Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Queer, less specific term that means anything other than a cisgender heterosexual. Some people use it as an umbrella term to include the spectrum of LGBT+, while others use it to define anything that is not included as part of the LGBT. Queer has been historically and is used as a derogatory slur, and some are trying to reclaim it. Many LGBT people still consider it derogatory.
- Overlapping and interdependent systems of discrimination or disadvantages experienced by an individual or social group as part of multiple social categories, incl., but not limited to race, class, gender, etc. Consider all the disparities and challenges faced by Latinx people in the US, then LGBTQ people A LGBTQ Latinx person may have to face disparities and challenges by both groups.
- Both data are self-reported, usually check boxes on a form Some data on Latinos: Race/Ethnicity confusing, Hispanic vs Latino Less date on LGBTQ - SO/GI Data historically not collected. Person may not want to disclose SO/GI. SO/GI identities –not always correlate with behaviors Person may not identify LGBTQ, still have same sex encounters –communities of color
- Recognize the need for data to identify health needs of specific communities. EHR generates data.. – HRSA (Health Resources & Serv Admin/HHS), UDS (Uniform Data System) – Collection of demog such as race, sex, age, &health measures like tobacco use, asthma, diabetes, cancer screens, etc. New HRSA Requirements starting this year to collect SO/GI data. Step in the right direction. Are people going to disclose?
- LGBTQ Latinx people are most likely to not have health insurance and not have regular source of basic healthcare LGBTQ, including Latinos, more likely to delay or not seek healthcare, or delay or not fill prescriptions
- LGBTQ Latinx people have: higher rates of STIs & HIV Higher rates of Mental health disorders Higher rates of substance abuse Not a lot of data on other health outcomes for LGBTQ Latinx
- MSM – Men who have sex with men 23% of new all HIV infections were in Latinos, but represent 17% of the population Even though absolute number of new infections in White and Black MSM, HIV disproportionately affects Latino MSM because represent a smaller portion of US population
- Rate of HIV per 100,000: Latinos 18.7, Whites, 6.6 MSM Latinos represent 2/3 of new HIV diagnoses in Latinos ½ of new diagnoses in MSM Latinos are foreign born, or unknown birth (may have additional challenges) 24.4% other – including heterosexual transmission and IVDU for both M&F
- LGBTQ Latinx people high rates of risky behaviors when compared to other populations More likely to abuse alcohol, use tobacco, be involved with intimate partner violence, and have unprotected sex with casual partner.
- Higher rates of poverty (28% for trans* latinx, 15% for the gen trans* pop, & 7% for gen pop) More likely to experience discrimination (racism, homophobia). Less visibility in media – important to have someone to identify with, characters, celebrities, - not stereotyped LGBTQ health resources may not be accessible due to language barriers, insurance, etc.
- Immigration status is an independent barrier for access to health insurance, access to a medical provider, and underutilization of health services. Remember intersectionality: undocumented, Latina, transgender women, who does not speak english – very difficult to access healthcare services that are cultural and medically competent.
- Survey of Latinx in Community Health Centers in LA and New York Experiences of social discrimination (racism and homophobia) increased risky behaviors , including binge drinking, unprotected receptive anal intercourse with a casual partner. Suggestive of “maladaptive coping strategy” in response to stress of social discrimination. Documented in other marginalized communities.
- When compared to LGBT populations who experienced a supportive environment, LGBT populations who experienced rejection were: 8.4 times more likely to have attempted suicide 5.9 times more likely to have severe depression 3.4 times more likely to use drugs 3.4 times more likely to have risky sex
- Reduce social stressors for marginalized patients, and provide accepting and welcoming environment – key to reducing behavioral risk factors Providing culturally sensitive, inclusive, and competent care
- Make all spaces inclusive: Health clinic, but our schools, work environments Gender neutral single-stall restrooms . Symbols that denote inclusive space (clues). Forms are gender neutral, options for legal/preferred name, pronouns Non-discrimination policies that are inclusive & posted/accessible. Staff training in cultural sensitivity
- Going to doctor can be frightening. Patient vulnerable, may not want to disclose SO/GI for fear of judgment, but important info for health assess, make medical decisions for risk factors. Important clinics safe space. LGBTQ patient may come across providers who: -have outright have discriminatory views; open but not knowledgeable; -open & knowledgeable but not experts (when/where to refer); experts. Most providers have little to no formal training on LGBTQ health. LGBT health: Trans* hormone therapies; Cancer screenings (Trans* and Lesbian patients); STI screening (diff recs for MSM)
- International standard terminology and guidelines for LGBTQ health are published in US/Europe in English. Pronouns/terminology doesnt translate as easily. Difficulty in adapting to other ethnic/racial populations. Language barrier and immigration status = decreased access to care Intersectionality. Finding provider with LGBTQ health knowledge, access care from lack of insurance, providers who speak spanish.