This document discusses LGBTQ health topics including definitions, prevalence, health concerns, and recommendations. It defines terms like transgender, non-binary, and intersex. It states that about 9 million people in the US identify as LGBTQ. It outlines higher rates of mental health issues, substance abuse, and suicide among LGBTQ youth and discusses recommendations to support LGBTQ health and safety in schools.
This document provides an overview of a symposium on culturally effective care for LGBT populations. It begins with an agenda that includes differentiating key terms, defining intersectionality, identifying health disparities and social determinants of health, and applying concepts through a case study. The document then defines various terms related to gender identity, sexual orientation, sex, and development. It reviews the history of pathologization of LGBT identities in medicine and mental health. Statistics on demographics and health disparities experienced by LGBT populations are presented. Strategies for providing culturally effective care include creating an inclusive environment, building trust, ensuring confidentiality, and using inclusive language. Local and national resources for LGBT care are also listed.
This document discusses LGBT health disparities. Minority stress from discrimination and stigma experienced by LGBT individuals can negatively impact their mental and physical health, contributing to higher rates of issues like substance abuse, HIV/AIDS, and depression. Health disparities also stem from a lack of healthcare providers with cultural competence regarding LGBT health issues. The document advocates for healthcare professionals to receive more training to address assumptions and biases, and to help reduce health disparities facing the LGBT community through informed, inclusive, and non-judgmental care.
This document discusses issues related to providing competent healthcare to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. It identifies some of the key risk factors LGBTQ youth face like marginalization and increased health risks. It also discusses how lack of provider training and homophobia can negatively impact LGBTQ health outcomes. The document provides guidance on creating an LGBTQ-affirming clinical environment including ensuring confidentiality, using inclusive forms and language, and displaying supportive materials. It also offers suggestions for discussing sensitive topics like gender identity, sexual orientation, and sexuality with LGBTQ youth patients.
Gender Dysphoria is characterized by a marked incongruence between one's experienced gender and assigned gender. It was formerly called Gender Identity Disorder. The DSM-5 criteria focus on clinically significant distress resulting from this incongruence. Treatment may involve psychotherapy, hormone therapy, surgery, and social gender transition. A multidisciplinary team approach is important. While distressing for affected individuals, gender diversity is a normal variation of human experience, and transitioning improves well-being for many.
This document provides information to help healthcare providers offer culturally competent care to LGBT individuals. It defines key terms related to sexual orientation and gender identity, discusses minority stress and health issues that may affect LGBT clients, and offers guidance on language use, gender transition, and addressing myths and assumptions. The roles of stigma, discrimination and heterosexism in negatively impacting mental health are also covered.
Sexual Orientation, Gender Identity And Adolescent Health 10.6.07Knoll Larkin
This document provides an overview of key terms and definitions related to sexual orientation and gender identity, with a focus on the experiences and health issues faced by LGBT youth. It discusses concepts like coming out, preferred language, challenges LGBT youth face in schools, homes, and healthcare settings, and health concerns including substance abuse, violence, HIV risk, and mental health issues. The document concludes with standards of care recommendations and resources for creating inclusive environments and supporting LGBT youth.
Overview of recommendations for quality care at the end of life for Lesbian, Gay, Bisexual, Transgender, and Questioning or GenderQueer patients. Caring as a cultural competency.
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
This document provides an overview of a symposium on culturally effective care for LGBT populations. It begins with an agenda that includes differentiating key terms, defining intersectionality, identifying health disparities and social determinants of health, and applying concepts through a case study. The document then defines various terms related to gender identity, sexual orientation, sex, and development. It reviews the history of pathologization of LGBT identities in medicine and mental health. Statistics on demographics and health disparities experienced by LGBT populations are presented. Strategies for providing culturally effective care include creating an inclusive environment, building trust, ensuring confidentiality, and using inclusive language. Local and national resources for LGBT care are also listed.
This document discusses LGBT health disparities. Minority stress from discrimination and stigma experienced by LGBT individuals can negatively impact their mental and physical health, contributing to higher rates of issues like substance abuse, HIV/AIDS, and depression. Health disparities also stem from a lack of healthcare providers with cultural competence regarding LGBT health issues. The document advocates for healthcare professionals to receive more training to address assumptions and biases, and to help reduce health disparities facing the LGBT community through informed, inclusive, and non-judgmental care.
This document discusses issues related to providing competent healthcare to lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. It identifies some of the key risk factors LGBTQ youth face like marginalization and increased health risks. It also discusses how lack of provider training and homophobia can negatively impact LGBTQ health outcomes. The document provides guidance on creating an LGBTQ-affirming clinical environment including ensuring confidentiality, using inclusive forms and language, and displaying supportive materials. It also offers suggestions for discussing sensitive topics like gender identity, sexual orientation, and sexuality with LGBTQ youth patients.
Gender Dysphoria is characterized by a marked incongruence between one's experienced gender and assigned gender. It was formerly called Gender Identity Disorder. The DSM-5 criteria focus on clinically significant distress resulting from this incongruence. Treatment may involve psychotherapy, hormone therapy, surgery, and social gender transition. A multidisciplinary team approach is important. While distressing for affected individuals, gender diversity is a normal variation of human experience, and transitioning improves well-being for many.
This document provides information to help healthcare providers offer culturally competent care to LGBT individuals. It defines key terms related to sexual orientation and gender identity, discusses minority stress and health issues that may affect LGBT clients, and offers guidance on language use, gender transition, and addressing myths and assumptions. The roles of stigma, discrimination and heterosexism in negatively impacting mental health are also covered.
Sexual Orientation, Gender Identity And Adolescent Health 10.6.07Knoll Larkin
This document provides an overview of key terms and definitions related to sexual orientation and gender identity, with a focus on the experiences and health issues faced by LGBT youth. It discusses concepts like coming out, preferred language, challenges LGBT youth face in schools, homes, and healthcare settings, and health concerns including substance abuse, violence, HIV risk, and mental health issues. The document concludes with standards of care recommendations and resources for creating inclusive environments and supporting LGBT youth.
Overview of recommendations for quality care at the end of life for Lesbian, Gay, Bisexual, Transgender, and Questioning or GenderQueer patients. Caring as a cultural competency.
Jill Blumenthal MD of UC San Diego presents "Free to Be You and Me: Providing Culturally-Sensitive Patient Care to Transgender Individuals" at AIDS Clinical Rounds
This document discusses several case reports of female-to-male transgenders in India and the challenges they face. It describes families' reluctance to accept their transgender children and the psychological distress it can cause. It also outlines medical transition options for female-to-male transgenders like testosterone therapy, mastectomy, and hysterectomy. Issues at various life stages and concerns about social and legal gender recognition are also summarized.
1) Gender issues in health include biological, physical and social differences between males and females that can impact health outcomes.
2) Key statistics provided on population and vital statistics for India show males outnumber females and females have lower sex ratios and higher mortality rates.
3) Many health conditions like heart disease, stroke, malaria and tuberculosis disproportionately impact males and females due to differences in risk factors, social roles and access to care.
Gender issues can impact health in several ways. Biologically, men and women have differences in chromosomes, hormones, physiology and risk factors for certain diseases. Socially, gender roles and inequalities influence access to resources and health outcomes. For many diseases like heart disease, stroke and tuberculosis, prevalence and mortality rates differ between men and women. Gender also affects exposure and vulnerability to conditions like malaria, HIV and road traffic accidents. Addressing gender in health policies, programs and research is crucial to promote equality and improve health for all.
This document discusses gender dysphoria and related topics. It begins by defining key terms like sex, gender, gender identity, gender expression, and gender dysphoria. It then discusses the epidemiology of gender dysphoria, noting prevalence rates. Salient features of gender dysphoria in children, adolescents, and adults are outlined based on DSM-5 criteria. The development and course of gender dysphoria over the lifespan is described. Functional consequences, common comorbidities, and differential diagnoses are also summarized.
Good afternoon. How may I assist you?
- Use gender-neutral terms like “patient,” “client,”
“individual,” etc.
- Ask for their name and how they would like to be
addressed.
- If you are unsure, politely ask how they would like to
be addressed.
- Respect how they identify themselves.
USE CORRECT PRONOUNS
• Ask for and use the pronouns (he/him, she/her,
they/them) that the person uses for themselves.
- If you make a mistake, apologize and use the correct
pronouns going forward.
- Do not make assumptions based on a person’
Primary Care and Child/Adolescent Psychiatry Conference - May 1, 2015A.C. Demidont
This document discusses providing respectful care to transgender patients. It begins with a case scenario where a transgender woman named Claire is checking in for an appointment but her medical records still list her name and gender as her birth name and male sex. The document then discusses barriers transgender people face to healthcare like discrimination, lack of insurance coverage, and lack of provider training. It provides best practices for clinics like using preferred names and pronouns, maintaining privacy, and creating an inclusive environment through policies and staff training. The goal is for healthcare providers to understand transgender identities and issues in order to eliminate discrimination and disparities in care.
This document discusses communicating effectively with diverse patient groups. It covers recognizing different cultural perspectives and health disparities related to factors like race, ethnicity, gender identity, sexual orientation, religion and age. Key points include being aware of one's own biases, treating all patients with equal respect, using interpreters for language barriers, asking patients about their preferences, and adapting communication styles to different age groups and their developmental levels.
This document discusses homosexual tendencies and provides two case studies. It explores whether homosexuality is psychological, physical, innate, or environmental. Environmental factors like hostile family dynamics or seduction by gay communities can potentially influence homosexual tendencies. The document notes that counseling using personality tests can help homosexual individuals understand themselves without necessarily requiring long-term psychiatric assistance. It emphasizes having sympathy for homosexual individuals rather than viewing them as abnormal.
This chapter discusses sexual behavior, norms, and fertility. It covers topics like sexual attitudes, extramarital affairs, adolescent premarital sex, sexually transmitted diseases (STDs), sex education approaches, and theories around sex and sexual reproduction. The document provides an overview of these topics and includes definitions for terms like cultural universals, the incest taboo, and contraception. It also discusses factors that influence sexuality and compares virginity pledges and their effectiveness.
This document summarizes the symptoms, diagnostic criteria, prevalence, and treatment approaches for gender identity disorder according to the DSM-IV. It describes symptoms in children, adolescents, and adults which include a strong desire to be the opposite sex and discomfort with one's biological sex. Treatment involves psychotherapy, hormone therapy, and potentially sexual reassignment surgery, with the goal of helping individuals live comfortably in their identified gender.
Gender identity and sexual orientation chapter 9tmbouvier
Gender identity is a person's internal sense of themselves as male, female, or other. It may not align with their physical sex. Gender identity is influenced by hormones and social/cultural factors. Sexual orientation describes who one is emotionally, romantically, and sexually attracted to. Terms like transgender, cisgender, bisexual and lesbian are used to describe identities. Coming out is accepting and sharing one's identity with others.
Mental health issues are more prevalent in the LGBT community compared to heterosexual individuals. Some reasons for this include lack of acceptance leading to bullying, difficulties with self-acceptance and coming out, less stable same-sex relationships, and pressures to conform to gender norms. Inadequate mental health services also contribute, as providers often lack training about LGBT issues and clients face discrimination. Improving services requires educating providers, hiring LGBT staff, and making LGBT healthcare a priority.
Bullying and depression among transgender youthRachel Watkins
Bullying is a relevant issue for this population and we must find ways to advocate for them in order to increase their safety. This presentation will discuss the negative impacts of bullying as well as clinical applications for this population.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, sexual orientation, transgender, cisgender, and more. It explores how gender identity may differ from biological sex and can be shaped by both nature and nurture. It also addresses obstacles faced by transgender individuals like access to healthcare and discrimination. The document aims to increase understanding of diverse identities and lifestyles.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, transgender, cisgender, sexual orientation, gay, lesbian, bisexual and provides explanations of gender identities and sexual orientations. It discusses the challenges transgender individuals face, such as establishing their gender identity, social and medical transitions, and discrimination. It also outlines special health considerations for lesbian, bisexual and transgender individuals. The document promotes inclusion and combating homophobia and transphobia through advocacy and education.
This document outlines a framework for measuring women's access to quality, gender-sensitive health services. The framework includes 5 components: 1) Comprehensiveness of information, 2) Comprehensiveness of women's health services, 3) Respect for women's human rights, 4) Technical competence of providers, and 5) Infrastructure and facilities. Each component contains several indicators to assess gender equality and women's human rights in health services, such as availability of women providers, informed consent practices, integration of related services, and infrastructure meeting gender needs. The framework aims to evaluate health services based on women's experiences and promote equitable, rights-based care for women.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, sexual orientation, and various gender identities. It explores how gender identity may differ from biological sex and can be shaped by both nature and nurture. It also examines sexual orientations like bisexuality and the challenges lesbian and bisexual women face. The document outlines the experiences of transgender individuals and obstacles they face accessing healthcare and dealing with discrimination. It emphasizes the need to counter homophobia, heterosexism, and transphobia through advocacy and policy change.
Gender identity and sexual orientation chapter 9tmbouvier
Gender identity refers to a person's internal sense of gender, which may or may not align with their sex assigned at birth. It is influenced by both biological and sociocultural factors. Sexual orientation describes a person's romantic and sexual attraction to others, and terms like gay, lesbian, bisexual are used. Both gender identity and sexual orientation exist on spectrums, and people face challenges with discrimination, health issues, and coming out to others.
TRANSGENDER SEX EDUCATION [Autosaved].pptxsindhukumari11
This document discusses educating transgender children and supporting their development. It defines key terms like transgender, gender identity, and terms used to describe individuals assigned male or female at birth who identify with another gender. It outlines objectives like defining transgender, discussing physical and psychosocial development, and counseling for gender changes. It also discusses transition periods, safe school environments, mental health care, and supporting families of transgender individuals.
This document discusses gender identity disorders/gender dysphoria. It defines gender dysphoria as distress from a mismatch between biological sex and gender identity. Epidemiology shows prevalence is higher in male-assigned individuals. Etiology may include biological factors like brain organization and genetics. Treatment involves psychotherapy, hormone therapy, and sometimes surgery. Nursing diagnoses for patients include anxiety, stress, and low self-confidence related to their gender identity.
UN WOD 2024 will take us on a journey of discovery through the ocean's vastness, tapping into the wisdom and expertise of global policy-makers, scientists, managers, thought leaders, and artists to awaken new depths of understanding, compassion, collaboration and commitment for the ocean and all it sustains. The program will expand our perspectives and appreciation for our blue planet, build new foundations for our relationship to the ocean, and ignite a wave of action toward necessary change.
Indira awas yojana housing scheme renamed as PMAYnarinav14
Indira Awas Yojana (IAY) played a significant role in addressing rural housing needs in India. It emerged as a comprehensive program for affordable housing solutions in rural areas, predating the government’s broader focus on mass housing initiatives.
This document discusses several case reports of female-to-male transgenders in India and the challenges they face. It describes families' reluctance to accept their transgender children and the psychological distress it can cause. It also outlines medical transition options for female-to-male transgenders like testosterone therapy, mastectomy, and hysterectomy. Issues at various life stages and concerns about social and legal gender recognition are also summarized.
1) Gender issues in health include biological, physical and social differences between males and females that can impact health outcomes.
2) Key statistics provided on population and vital statistics for India show males outnumber females and females have lower sex ratios and higher mortality rates.
3) Many health conditions like heart disease, stroke, malaria and tuberculosis disproportionately impact males and females due to differences in risk factors, social roles and access to care.
Gender issues can impact health in several ways. Biologically, men and women have differences in chromosomes, hormones, physiology and risk factors for certain diseases. Socially, gender roles and inequalities influence access to resources and health outcomes. For many diseases like heart disease, stroke and tuberculosis, prevalence and mortality rates differ between men and women. Gender also affects exposure and vulnerability to conditions like malaria, HIV and road traffic accidents. Addressing gender in health policies, programs and research is crucial to promote equality and improve health for all.
This document discusses gender dysphoria and related topics. It begins by defining key terms like sex, gender, gender identity, gender expression, and gender dysphoria. It then discusses the epidemiology of gender dysphoria, noting prevalence rates. Salient features of gender dysphoria in children, adolescents, and adults are outlined based on DSM-5 criteria. The development and course of gender dysphoria over the lifespan is described. Functional consequences, common comorbidities, and differential diagnoses are also summarized.
Good afternoon. How may I assist you?
- Use gender-neutral terms like “patient,” “client,”
“individual,” etc.
- Ask for their name and how they would like to be
addressed.
- If you are unsure, politely ask how they would like to
be addressed.
- Respect how they identify themselves.
USE CORRECT PRONOUNS
• Ask for and use the pronouns (he/him, she/her,
they/them) that the person uses for themselves.
- If you make a mistake, apologize and use the correct
pronouns going forward.
- Do not make assumptions based on a person’
Primary Care and Child/Adolescent Psychiatry Conference - May 1, 2015A.C. Demidont
This document discusses providing respectful care to transgender patients. It begins with a case scenario where a transgender woman named Claire is checking in for an appointment but her medical records still list her name and gender as her birth name and male sex. The document then discusses barriers transgender people face to healthcare like discrimination, lack of insurance coverage, and lack of provider training. It provides best practices for clinics like using preferred names and pronouns, maintaining privacy, and creating an inclusive environment through policies and staff training. The goal is for healthcare providers to understand transgender identities and issues in order to eliminate discrimination and disparities in care.
This document discusses communicating effectively with diverse patient groups. It covers recognizing different cultural perspectives and health disparities related to factors like race, ethnicity, gender identity, sexual orientation, religion and age. Key points include being aware of one's own biases, treating all patients with equal respect, using interpreters for language barriers, asking patients about their preferences, and adapting communication styles to different age groups and their developmental levels.
This document discusses homosexual tendencies and provides two case studies. It explores whether homosexuality is psychological, physical, innate, or environmental. Environmental factors like hostile family dynamics or seduction by gay communities can potentially influence homosexual tendencies. The document notes that counseling using personality tests can help homosexual individuals understand themselves without necessarily requiring long-term psychiatric assistance. It emphasizes having sympathy for homosexual individuals rather than viewing them as abnormal.
This chapter discusses sexual behavior, norms, and fertility. It covers topics like sexual attitudes, extramarital affairs, adolescent premarital sex, sexually transmitted diseases (STDs), sex education approaches, and theories around sex and sexual reproduction. The document provides an overview of these topics and includes definitions for terms like cultural universals, the incest taboo, and contraception. It also discusses factors that influence sexuality and compares virginity pledges and their effectiveness.
This document summarizes the symptoms, diagnostic criteria, prevalence, and treatment approaches for gender identity disorder according to the DSM-IV. It describes symptoms in children, adolescents, and adults which include a strong desire to be the opposite sex and discomfort with one's biological sex. Treatment involves psychotherapy, hormone therapy, and potentially sexual reassignment surgery, with the goal of helping individuals live comfortably in their identified gender.
Gender identity and sexual orientation chapter 9tmbouvier
Gender identity is a person's internal sense of themselves as male, female, or other. It may not align with their physical sex. Gender identity is influenced by hormones and social/cultural factors. Sexual orientation describes who one is emotionally, romantically, and sexually attracted to. Terms like transgender, cisgender, bisexual and lesbian are used to describe identities. Coming out is accepting and sharing one's identity with others.
Mental health issues are more prevalent in the LGBT community compared to heterosexual individuals. Some reasons for this include lack of acceptance leading to bullying, difficulties with self-acceptance and coming out, less stable same-sex relationships, and pressures to conform to gender norms. Inadequate mental health services also contribute, as providers often lack training about LGBT issues and clients face discrimination. Improving services requires educating providers, hiring LGBT staff, and making LGBT healthcare a priority.
Bullying and depression among transgender youthRachel Watkins
Bullying is a relevant issue for this population and we must find ways to advocate for them in order to increase their safety. This presentation will discuss the negative impacts of bullying as well as clinical applications for this population.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, sexual orientation, transgender, cisgender, and more. It explores how gender identity may differ from biological sex and can be shaped by both nature and nurture. It also addresses obstacles faced by transgender individuals like access to healthcare and discrimination. The document aims to increase understanding of diverse identities and lifestyles.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, transgender, cisgender, sexual orientation, gay, lesbian, bisexual and provides explanations of gender identities and sexual orientations. It discusses the challenges transgender individuals face, such as establishing their gender identity, social and medical transitions, and discrimination. It also outlines special health considerations for lesbian, bisexual and transgender individuals. The document promotes inclusion and combating homophobia and transphobia through advocacy and education.
This document outlines a framework for measuring women's access to quality, gender-sensitive health services. The framework includes 5 components: 1) Comprehensiveness of information, 2) Comprehensiveness of women's health services, 3) Respect for women's human rights, 4) Technical competence of providers, and 5) Infrastructure and facilities. Each component contains several indicators to assess gender equality and women's human rights in health services, such as availability of women providers, informed consent practices, integration of related services, and infrastructure meeting gender needs. The framework aims to evaluate health services based on women's experiences and promote equitable, rights-based care for women.
Gender identity and sexual orientation chapter 9tmbouvier
This document discusses gender identity and sexual orientation. It defines key terms like gender identity, sexual orientation, and various gender identities. It explores how gender identity may differ from biological sex and can be shaped by both nature and nurture. It also examines sexual orientations like bisexuality and the challenges lesbian and bisexual women face. The document outlines the experiences of transgender individuals and obstacles they face accessing healthcare and dealing with discrimination. It emphasizes the need to counter homophobia, heterosexism, and transphobia through advocacy and policy change.
Gender identity and sexual orientation chapter 9tmbouvier
Gender identity refers to a person's internal sense of gender, which may or may not align with their sex assigned at birth. It is influenced by both biological and sociocultural factors. Sexual orientation describes a person's romantic and sexual attraction to others, and terms like gay, lesbian, bisexual are used. Both gender identity and sexual orientation exist on spectrums, and people face challenges with discrimination, health issues, and coming out to others.
TRANSGENDER SEX EDUCATION [Autosaved].pptxsindhukumari11
This document discusses educating transgender children and supporting their development. It defines key terms like transgender, gender identity, and terms used to describe individuals assigned male or female at birth who identify with another gender. It outlines objectives like defining transgender, discussing physical and psychosocial development, and counseling for gender changes. It also discusses transition periods, safe school environments, mental health care, and supporting families of transgender individuals.
This document discusses gender identity disorders/gender dysphoria. It defines gender dysphoria as distress from a mismatch between biological sex and gender identity. Epidemiology shows prevalence is higher in male-assigned individuals. Etiology may include biological factors like brain organization and genetics. Treatment involves psychotherapy, hormone therapy, and sometimes surgery. Nursing diagnoses for patients include anxiety, stress, and low self-confidence related to their gender identity.
UN WOD 2024 will take us on a journey of discovery through the ocean's vastness, tapping into the wisdom and expertise of global policy-makers, scientists, managers, thought leaders, and artists to awaken new depths of understanding, compassion, collaboration and commitment for the ocean and all it sustains. The program will expand our perspectives and appreciation for our blue planet, build new foundations for our relationship to the ocean, and ignite a wave of action toward necessary change.
Indira awas yojana housing scheme renamed as PMAYnarinav14
Indira Awas Yojana (IAY) played a significant role in addressing rural housing needs in India. It emerged as a comprehensive program for affordable housing solutions in rural areas, predating the government’s broader focus on mass housing initiatives.
A Guide to AI for Smarter Nonprofits - Dr. Cori Faklaris, UNC CharlotteCori Faklaris
Working with data is a challenge for many organizations. Nonprofits in particular may need to collect and analyze sensitive, incomplete, and/or biased historical data about people. In this talk, Dr. Cori Faklaris of UNC Charlotte provides an overview of current AI capabilities and weaknesses to consider when integrating current AI technologies into the data workflow. The talk is organized around three takeaways: (1) For better or sometimes worse, AI provides you with “infinite interns.” (2) Give people permission & guardrails to learn what works with these “interns” and what doesn’t. (3) Create a roadmap for adding in more AI to assist nonprofit work, along with strategies for bias mitigation.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Christina Parmionova
The best available, up-to-date information on all fishing and related vessels that appear on the illegal, unregulated, and unreported (IUU) fishing vessel lists published by Regional Fisheries Management Organisations (RFMOs) and related organisations. The aim of the site is to improve the effectiveness of the original IUU lists as a tool for a wide variety of stakeholders to better understand and combat illegal fishing and broader fisheries crime.
To date, the following regional organisations maintain or share lists of vessels that have been found to carry out or support IUU fishing within their own or adjacent convention areas and/or species of competence:
Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
The Combined IUU Fishing Vessel List merges all these sources into one list that provides a single reference point to identify whether a vessel is currently IUU listed. Vessels that have been IUU listed in the past and subsequently delisted (for example because of a change in ownership, or because the vessel is no longer in service) are also retained on the site, so that the site contains a full historic record of IUU listed fishing vessels.
Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
Food safety, prepare for the unexpected - So what can be done in order to be ready to address food safety, food Consumers, food producers and manufacturers, food transporters, food businesses, food retailers can ...
This report explores the significance of border towns and spaces for strengthening responses to young people on the move. In particular it explores the linkages of young people to local service centres with the aim of further developing service, protection, and support strategies for migrant children in border areas across the region. The report is based on a small-scale fieldwork study in the border towns of Chipata and Katete in Zambia conducted in July 2023. Border towns and spaces provide a rich source of information about issues related to the informal or irregular movement of young people across borders, including smuggling and trafficking. They can help build a picture of the nature and scope of the type of movement young migrants undertake and also the forms of protection available to them. Border towns and spaces also provide a lens through which we can better understand the vulnerabilities of young people on the move and, critically, the strategies they use to navigate challenges and access support.
The findings in this report highlight some of the key factors shaping the experiences and vulnerabilities of young people on the move – particularly their proximity to border spaces and how this affects the risks that they face. The report describes strategies that young people on the move employ to remain below the radar of visibility to state and non-state actors due to fear of arrest, detention, and deportation while also trying to keep themselves safe and access support in border towns. These strategies of (in)visibility provide a way to protect themselves yet at the same time also heighten some of the risks young people face as their vulnerabilities are not always recognised by those who could offer support.
In this report we show that the realities and challenges of life and migration in this region and in Zambia need to be better understood for support to be strengthened and tuned to meet the specific needs of young people on the move. This includes understanding the role of state and non-state stakeholders, the impact of laws and policies and, critically, the experiences of the young people themselves. We provide recommendations for immediate action, recommendations for programming to support young people on the move in the two towns that would reduce risk for young people in this area, and recommendations for longer term policy advocacy.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
1. LGBTQ HEALTH: WHO, WHAT, WHERE
AND WHY WE SHOULD CARE
LAURA C. HEIN PHD, RN, FAAN
2. OBJECTIVES
• Introduce you to LGBTQ terminology
• Discuss historical and contemporary health concerns of
the LGBTQ community
• Discuss facilitators and barriers to health
• Present current legal and regulatory standards related
to LGBTQ health with recommended practice protocols
• Is your facility compliant?
3. DEFINITIONS
• Gay, Lesbian
• Exclusive physical and emotional attraction to members of one’s
own sex
• Bisexual
• Physical and emotional attraction to members of both sexes
• Transgender (gender identity)
• A person who feels his or her body is not the sex it should be,
regardless of transformational hormone or surgical status
• Cis-Gender
• A person whose gender identity matches their sex at birth
LGBTIQ
4. • MtF = Male-to-Female (she) transwoman
• Born with male anatomy, female gender
• FtM = Female-to-Male (he) transman
• Born with female anatomy, male gender
LGBTIQ
Transgender
(gender identity)
5. • Intersex
• The vogue term for hermaphrodite. People born with
the sexual characteristics of both sexes
• Questioning
• People who suspect they might be LGBT, but are not
yet certain
• Queer
• Inclusive term of the LGBTIQ community
• Unique paradigm
Definitions LGBTIQ
6.
7. PREVALENCE - 9 MILLION LGBT PEOPLE IN THE U.S.
Homosexual (gay/lesbian is preferred term)
• 3.4% self-identify as LGBT (Gates & Newport 2012)
• 1 in 5 - 20.8% of males in the U.S. reported either
homosexual behavior or homosexual attraction
since age 15 (Sell, Wells & Wypij, 1995)
• 17% of women and 6% of men have engaged in same-sex
behavior. However, 7% of women and 4% of men identify
as gay or bisexual (Copen et al. 2016).
Remember there are 320 million people in the U.S.
8. TRANSGENDER POPULATION SIZE
• ~1.4 million adults self-identify as trans in
the U.S.
• Crissman et al. 2017; Flores et al., 2016; Meerwijk & Sevelius,
2017
9. GENDER NON-CONFORMITY OR GENDER
DYSPHORIA
GENDER NON-
CONFORMITY
• the extent to which a person’s
gender identity, role, or
expression differs from the
cultural norms prescribed for
people of a particular sex
(IOM, 2011 definition)
GENDER DYSPHORIA
• discomfort or distress that is
caused by a discrepancy
between a person’s gender
identity and that person’s sex
assigned at birth (and the
associated gender role and/or
primary and secondary sex
characteristics) (WPATH, 2011)
10. TRANSGENDER HEALTH – YOUTH
• Protections under Title VII and Title IX of the Civil
Rights Act. Affirmed by DOJ filing in G.G. v.
Gloucester County School Board (2015). Case on
appeal to SCOTUS. Oral arguments Feb. 2017.
“There is a public interest in ensuring that all
students, including transgender students, have
the opportunity to learn in an environment free
of sex discrimination.” (DOJ)
11. TRANSGENDER HEALTH –
RESTROOM ACCESS
• April 8, 2015 – EEOC has ruled that an
employers refusal to allow a transgender
employee access to restrooms consistent with
his or her gender is sex discrimination under
Title VII.
• EEOC case: Lusardi v. AMRDEC
12. WHAT ABOUT SCHOOL? TITLE IX
• Title IX protects students, faculty and
employees from sex discrimination in any
federally funded education program or
activity.
• However… schools are still not safe.
13. EARLY SOCIAL TRANSITION
• Child lives as gender that matches their identity
• Trial run - name, attire, social roles at school, in community
• Reversible
• Family decision whether to disclose to others or not
• Approx. 25% of children who were assessed for gender
dysphoria grew up to be cis-gender gay vs. transgender.
14. CHILDREN AND YOUTH
• EARLY medical and mental health
services
• Family support is critical to positive health outcomes
• Puberty experienced congruent with gender (delay
until sure)
• Reduces need for later medical interventions
• Prevents unwanted sex characteristics (i.e.
breasts)
• Decreases stress, anxiety, depression
15. REPARATIVE THERAPY
• = Efforts to change the sexual orientation or gender
identity
• Condemned by all mainstream professional
organizations as harmful including the APA, AMA, Am
Acad of Pediatrics, AAN, ISPN etc.
• Related to depression, anxiety and suicide
• George Rekers (prof emeritus from USC SOM) –
published case where he conducted reparative
therapy. This is what he did….
16. PUBERTY BLOCKING – GNRH
AGONISTS
• Ideally begun in Tanner 2 stage (early start of puberty).
• Can begin in Tanner 3-5 – goal is to stop puberty/
prevent secondary gender characteristics i.e. height,
breasts etc.
• GnRH Agonists - Leuprorelin; Triptorelin; Goserelin;
Histrelin implants
• Very expensive. Cost is between $500 and $1500 month.
• Insurance rarely covers this cost
• Effects are totally REVERSIBLE
17. IRREVERSIBLE HORMONE EFFECTS
• ESTROGEN
• Breast development
• Nipple enlargement
• Loss of erection
• Testicular atrophy
• ? sterility
• TESTOSTERONE
• Uterine atrophy
• Facial and body hair
• Deepened voice
• Clitoral enlargement
• ? sterility
18. FIRST DO NO HARM….
There is harm related to NOT intervening
• Suicide ~ 44%
• Depression
• Anxiety
• Homelessness
• ETOH, drug use
• Sex work
• HIV
19. OVERREPRESENTED HEALTH
PROBLEMS
• HIV/ AIDS
• Trauma/ Victimization
• Mental Health Concerns
• Addictions
• Is this because they’re LGBT? –or- because of the
context within which LGBT people must exist?
20. HIV/ AIDS
• A missing generation of gay men due to AIDS
• HIV+ the norm in some areas
• Homelessness/ poverty – survival sex
• Street hormones (trans)
21. TRAUMA/ VICTIMIZATION
• Parental abuse
• Increased prevalence of verbal and physical abuse and
heightened suicidal ideation among those who disclosed their
s.o. to their families
• Hate crimes
22. MENTAL HEALTH –
DEPRESSION & ANXIETY
Additional stress d/t image
management related to s.o./g.i.
• LGBT children often grow up in a
society that says that they should not
exist and/or should not act on their
feelings.
• These societal mores can be internalized =
internalized homophobia
23. DEPRESSION
• Prevalence of depression 17.2% higher than in U.S.
adult men in general
• Distress & depression associated w/:
• lack of a partner;
• not identifying as gay, queer, or homosexual;
• experiencing multiple episodes of antigay
violence in the previous 5 years; and
• very high levels of community alienation
Mills 2004
24. LGBT YOUTH VICTIMIZATION
• 25% of gay youth (16% lesbian) have been
threatened or injured with a weapon on school
property.
• 3x higher than hetero rate for boys; 4x higher than
hetero for girls.
• 13% gay (16% lesbian) youth didn’t go to school
because of safety issues (O’Malley, 2014)
• 3x the hetero rate
Sample was of YRBS HS students
25. MENTAL HEALTH - SUICIDE
• LGB youth = 30%
attempted suicide (double
the hetero rate)
• School bullying increased
the risk of suicide (Bouris et al,
2016)
26. TRANSGENDER SUICIDE
U.S. TRANS/GQ DATA
• 42% attempted
suicide
• Those who reported
moderate to severe
rejection by their
family were more
likely to attempt
suicide (OR 2.0 to 3.2
27. ADDICTIONS
• Young LGBT (most prevalent)
• Lesbian/ female Bi – principally ETOH
• Gay/ MtF Transgender –
• Ecstasy (and other Rave drugs)
• Risk = hyperthermia;
• Poppers (amyl nitrate) – enhanced
sexual experience
• Risk = an MI, priapism
Ecstacy: MDMA
28. CDC RECOMMENDATIONS FOR
SCHOOLS TO SUPPORT LGBTQ HEALTH
1. Identify “safe spaces”
2. Prohibit harassment and bullying
3. Facilitate access to health & psych providers not on school
property who are LGBTQ affirming
4. Encourage professional development on safety for all
students
5. Provide health education curricula with inclusive
terminology
Demisse et al., 2013
29. CASE 1
• A 15yo questioning female student presents to the school nurse
asking him to sponsor a Gay Straight Alliance (GSA) at their
school. The best school nurse answer:
A. “yes, of course I’ll sponsor a GSA”
B. “I’d like to but I’ll need to talk to the principal first”
C. “I think I’d like to talk to your parents first – we’ll be back in
touch”
D. “You really need to talk to our school psychologist about this”
30. SC CODE 59-32-30A(5)
LOCAL SCHOOL BOARDS TO IMPLEMENT COMPREHENSIVE
HEALTH EDUCATION PROGRAM; GUIDELINES AND
RESTRICTIONS
• (5) The program of instruction provided for in
this section may not include a discussion of
alternate sexual lifestyles from heterosexual
relationships including, but not limited to,
homosexual relationships except in the context
of instruction concerning sexually transmitted
diseases.
31. CASE 2
• 30yo transman who initiated social gender affirmation 5 years
ago, chest construction at 25yo, testosterone from 25-28yo. He
grew a beard and stopped taking T. Beard growth persisted. No
menstruation for 5 years. He would like the option to become
pregnant in the future because he wants children but has legal
concerns related to adoption. As the NP you first:
A. Conduct an exam and draw labs
B. Conduct an exam, draw labs and refer to endocrinology
C. Conduct an exam, draw labs and refer to GYN
32. YOUR PATIENT WANTS TO
TRANSITION – NOW WHAT?
1. Google “WPATH
Guidelines”
2. Refer to a Psych NP
or other mental
health provider
3. Start hormone
therapy
www.wpath.org
The pdf is free
33. RESEARCH ON HORMONES – IS IT
SAFE?
FTM
• No increase in CAD found in
876 FTM pts (Gooren, 200)
MTF
• Increased risk of CAD at
high doses.
• Increased risk of CA at low
doses
• If prior MI – PO estradiol
does not incr. or decr. risk
for further emboli
34. WPATH Standards of Care
The criteria for hormone therapy are as follows:
• Persistent, well-documented gender dysphoria;
• Capacity to make a fully informed decision and
to consent for treatment;
• Age of majority in a given country (if younger,
follow the Standards of Care outlined in section
VI);
• If significant medical or mental health concerns
are present, they must be reasonably well
controlled
35. HORMONES FTM - OPTIONS
• Injectable Testosterone
• Testosterone Enanthate or Cypionate 100-200 mg IM q 2 wks (20 -22g x 1 ½”
needles)
• Transdermal Testosterone
• Androderm TTS 2-8mg daily
• Topical testosterone gels in packets and pumps, multiple formulations (Testim,
Androgel) 5 to 10 gm (50 to 100 mg of testosterone) applied topically daily
• Axiron 2% pump gel for axillary application 1 pump to each axilla daily
• Testosterone Pellet
• Testopel- implant 6-10 pellets q 3 to 6 months
• Buccal Testosterone
• Striant 30 mg buccal system q 12 hours
Rx information taken from
Cavanaugh 2016
39. MTF SURGICAL OPTIONS (~30%)
• Removal of scrotum & penis
• Creation of vagina, labia, clitoris
& mons
• Breast augmentation
• Tracheal shave
• Facial feminization
• Brow
• nose
Taken from Schechter 2017 p.37
40. FTM SURGICAL OPTIONS (~30%)
• Phalloplasty with
urethral reconstruction
& creation of scrotum
(uncommon)
• Chest reconstruction
41. STAGED SURGERIES
• Genital FtM
• Tissue removal from
donor site
• Urethral reconstruction
• Implant prosthesis
• Chest Contouring FtM
• Mastectomy
• Revision of prior surgery
to decrease scarring and
remove arm flaps
42. YOU’RE AN ORG LEADER/ MANAGER
WHAT CAN YOU DO?
• Know the law and standards related to LGBTQ
patients
• Train your staff – receptionist to CNO
• Work on the culture of your organization to
make it safe.
43. • The patient-centered communication standards
for Hospitals (CAMH).
• Elements of performance 28 and 29 under
RI.01.01.01, require access to a support person
and non-discrimination of care.
The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and FamilyCentered Care
for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Oak Brook, IL, Oct. 2011.
LGBTFieldGuide.pdf.
Joint Commission Standards (2011)
44. RI.01.01.01 ELEMENT 29
“No longer considered to be simply a patient’s
right, effective communication is now accepted
as an essential component of quality care and
patient safety.”
45. HOSPITAL VISITATION
• January 2010 Centers for Medicare and
Medicaid Services (CMS) regulation required
hospitals to permit patients to designate
visitors & prohibits discrimination in
visitation based on so/gi. 42 C.F.R. §
482.13
• Compliance with requirements for Medicare Conditions
of Participation (CoPs)
46. HOSPITAL VISITATION
• July 2011 Joint Commission standard – prohibition
on discrimination based on orientation or gender
identity.
• “Prohibit discrimination based on age, race,
ethnicity, religion, culture, language, physical or
mental disability, socioeconomic status, sex,
sexual orientation, and gender identity or
expression.” RI.01.01.01 EP29 (p.48 of Joint
Commission LGBT doc).
47. CMS – EQUAL COVERAGE TO CARE IN
THE SAME NURSING HOME AS A
SPOUSE
• Aug. 29, 2013 - CMS announced the guarantee
of Medicare coverage applies to ALL spouses
regardless of sexual orientation.
• Prior to this same-sex spouses with Medicare Advantage plans
were not eligible to live in the same nursing home as their
spouse.
48. FMLA
• All spouses are now covered under FMLA if the employer is FMLA
covered. (3/15 injunction against same sex spouses dissolved by
SCOTUS Obergefell ruling)
FMLA may be used for
• The birth of a child, adoption or foster parent;
• To care for a spouse, son, daughter, or parent who has a serious
health condition;
• For a serious health condition that makes the employee unable to
perform the essential functions of his or her job; or
• For any qualifying exigency arising out of the fact that a spouse, son,
daughter, or parent is a military member on covered active duty or
call to covered active duty status.
http://www.dol.gov/whd/regs/compliance/whdfs28.pdf
49. AFFORDABLE CARE ACT
• Section 1557 – Civil Rights provisions
of the Act.
• Applies civil rights protections to the Health
Insurance Marketplace created by the ACA –
and includes LGBT people
50. ACA & PREVENTIVE CARE
May 2015 DOL Guidance on the ACA
confirms
• Plans cannot limit sex-specific preventive
services by gender identity. If a provider
orders the service it is considered
appropriate.
http://www.dol.gov/ebsa/faqs/faq-aca26.html
51. THE LAW
SC ANTI- TRANSGENDER BILL
• S.1203 defeated May 4, 2016
TITLE IX - EDUCATION
• Grimm v. Glouchester
(2015)
• Appealed to SCOTUS
• Administrative
guidance
TITLE VII - EEOC
• Macy v. Holder (EEOC, 2012) –
gender non-conformity = gender.
52. HOW DO I FIND AN
AFFIRMING PROVIDER?
GLMA.org
• Then click on: Resources – For Patients – Find a
Provider
• A searchable provider directory (location, specialty,
transition care etc.).
Provider Directory at the Harriet Hancock LGBT
Center
53. RESOURCES
Locally
• Harriet Hancock LGBT Center
• IRIS = LGBT group on campus
Nationally
• The Trevor Project – suicide hotline for LGBT youth www.thetrevorproject.org 1-
866-488-7386
• Trans Lifeline http://www.translifeline.org 1-877-565-8860
Providers GLMA.org
https://glmaimpak.networkats.com/members_online_new/members/dir_provider.
asp
54. HOW CAN AN LGBT PERSON KNOW IF
SOMEONE IS SAFE TO TALK TO?
• Go with your instincts
• If you get a bad vibe from someone – trust your instincts and get
out of there.
• Look for these symbols
55. WHAT WE CAN DO AS NURSES
• Be Authentic
• Encourage Authenticity in others
• Share
• Be flexible, scootch over a little, share the bench ≈ share the power