Lesbian, Gay, Bisexual And Transgender Health Research Articles

‘There’s Nothing Clinical About It’: LGBT Health and the Atmosphere of the Clinic

ABSTRACT Over the last decade, several former Australian AIDS Councils (turned LGBT health organisations) have opened dedicated primary healthcare clinics for lesbian, gay, bisexual and transgender (LGBT) people. Operating at the intersection of medical practice and queer politics, these clinics try to enact a type of care that is attuned to the power relations between LGBT people and medicine. Drawing on the concepts of affective atmospheres (Anderson, 2009, “Affective Atmospheres.” Emotion, Space and Society 2 (2): 77–81. https://doi.org/10.1016/j.emospa.2009.08.005) and queer feelings (Ahmed 2014, The Cultural Politics of Emotion. Edinburgh University Press. https://www.jstor.org/stable/10.3366/j.ctt1g09 × 4q), this article argues that senses of the feelings and emotions of LGBT people evoked by mainstream medical spaces are central to the design of LGBT clinics. This analysisis based on situated interviews with practice managers which examined the affective intent of LGBT clinics. By examining how practice managers consider location, the curation of art and health promotion materials, and the employment of peer workers, this article argues that LGBT clinics are helping to make LGBT health a tangible and meaningful subcategory of public health by designing spaces in which medicine can be encountered within a ‘queer atmosphere’.

LGBT Health Care Access: Considering the Contributions of an Invitational Approach

Lesbian, gay, bisexual and transgender (LGBT) people have historically, and continue today to encounterbarriers to accessing health services. This has been attributed to the well-documented heterosexism,homophobia, biphobia, and transphobia that shape all health and social institutions. In this paper,invitational theory offers insight into the challenges faced by a childbearing lesbian couple to accesssupportive health care, and sheds light on inequities faced by LGBT people when accessing health care inCanada. The author draws on critical feminist research and invitational concepts to build an understandingof four dimensions of this couple’s access to supportive care. The invitational approach is combined withan explicitly critical stance to highlight gender and other relations of power, and to provide a theoreticalrationale for incorporating invitational concepts into equity-related research, including a currentapplication focused on improving LGBT home care access in the Canadian context. Given the deeplyembedded structural inequities that hinder the creation of intentionally inviting environments for diversegroups, this research has implications both for shedding light on areas in need of health care accessresearch, as well as for integrating invitational approaches that align with critical pedagogies into healthcare education.

Medical Students’ Attitudes Towards, and Knowledge of LGBT Persons in Guyana

ABSTRACT Evidence from industrialized countries show that discrimination and experienced and/or perceived negative encounters with healthcare workers affect frequency and type of healthcare sought by lesbian, gay, bisexual and transgender (LGBT) persons. In Guyana, and the wider English-speaking Caribbean region, there is a dearth of research on how healthcare workers and students perceive and interact with LGBT patients. This study investigated the attitudes and knowledge with regards to LGBT health among students at a medical school in Guyana by using quantitative, self-administered online surveys. We analyzed data using SPSS for descriptive and analytic calculations, and results showed that students held moderately prejudiced attitudes toward LGBT persons. Religiosity and heterosexual orientation were the main factors found to be associated with negative attitudes. Knowledge levels were also moderate with pronounced deficiencies in certain areas, and almost all students had not received LGBT-specific medical education, but most indicated a desire for such education.

LGBT Medical Education Assessment in West Virginia

BACKGROUND Lesbian, gay, bisexual and transgender (LGBT) individuals experience healthcare disparities related to their physical, mental, behavioral, and sexual health. Educating medical students about how to address this public health issue is a priority of the Association of American Medical Colleges and all medical schools across the country. Yet, the training to care for LGBT patients has been inconsistent, and it is unknown how comprehensively these competencies are being addressed at the two allopathic medical schools in West Virginia (WV). METHODS An online questionnaire was distributed to medical students at the two allopathic medical schools in WV to evaluate perceptions of the curricula with respect to care for LGBT patients. RESULTS Medical students (N-91) felt prepared to address 9 of 16 LGBT-specific subject areas. The majority of students felt prepared to discuss sexual orientation (64/91; 70.3%) and human immunodeficiency virus (60/91; 65.9%). Fewer students felt prepared to discuss sex-reassignment surgery (17/91; 18.7%) and transitioning (21/91; 23.1%). Overall, 82.4% of respondents reported feeling "comfortable" or "somewhat comfortable" with LGBT health issues. Medical school education helped 59.3% of respondents feel "more comfortable" and 65,9% of respondents feel "more prepared" to provide medical care to LGBT patients. CONCLUSION Our data suggests that medical school curricula in WV has increased student-rated comfort and preparedness in providing medical care to LGBT patients, but should be further developed and standardized to reduce the perceived knowledge gaps.

Assessing the Health Care Experiences of Rural Men Who Have Sex with Men (MSM).

Research investigating the health care experiences of men who have sex with men (MSM) predominately concerns urban populations. This study examines the health care experiences of MSM residing in rural Oklahoma. A total of 40 MSM (aged 21 through 66) living in rural areas were interviewed. Data were analyzed using a qualitative approach to identify emerging concepts. Three themes emerged from the data: First, participants cited cultural differences related to religious conservative ideologies as a central motif of health care experiences. Next, doctor-patient relationship quality was a contributing factor to health care experiences. Last, health care experiences were predicated on the idea of doctors' knowledge of lesbian, gay, bisexual and transgender (LGBT) health issues. Certain health care aspects regarding the rural experiences of MSM that were identified differed between rural and urban MSM. Implications include support for programs that bridge the gap between practitioners and patients, while better informing both MSM and health care providers of current LGBT health issues.

Sexual and gender minority sleep: A narrative review and suggestions for future research.

This article reviews a growing body of research that examines sleep among lesbian, gay, bisexual and transgender (LGBT) populations. An extensive search of the literature was conducted using multiple medical and psychological search engine platforms. In total, this search yielded 31 reports that included sleep data collected from sexual and gender minority participants. Overall, research findings are mixed and include several publications of studies conducted in the same sample. Our review suggests that sleep health among LGBT individuals may be an unmet health need. Critically, sleep disturbances affected LGBT subgroups differently based on sex/gender and diverse sexual orientations (e.g., bisexual women). Although not directly tested, evidence from parallel LGBT health research suggests that minority stress may contribute to these observed sleep disparities and will need to be directly assessed in future studies. In sum, continued investigation of sleep disparities among sexual and gender minority communities is needed, as is the inclusion of sleep health in theoretical models of LGBT health disparities. Given the importance of sleep in overall mental and physical health, addressing sleep health may serve to promote and protect healthy functioning among LGBT individuals.

Provider and LGBT Individuals' Perspectives on LGBT Issues in Long-Term Care: A Systematic Review.

Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals' perspectives of LGBT issues in LTSS in the United States. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.

White Paper from a CTSA Workshop Series on Special and Underserved Populations: Enhancing Investigator Readiness to Conduct Research Involving LGBT Populations.

Despite the significant health disparities experienced by lesbian, gay, bisexual and transgender (LGBT) populations, few investigators affiliated with NIH-funded Clinical and Translational Science Award (CTSA) programs are conducting research related to this underserved population. We provide recommendations shared during a half-day workshop aimed at increasing researcher readiness to conduct LGBT research. This workshop was presented as part of a series on conducting research with underserved populations offered by the Recruitment, Retention, and Community Engagement Program of the Center for Clinical and Translational Science at the University of Illinois at Chicago. Six LGBT health research experts provided focused presentations. The workshop presentations included a summary of significant health inequality issues, theoretical models relevant to research on LGBT health, best practices in measuring sexual orientation and gender identity, recommendations for recruitment and retention, a discussion of community engagement, and ethical considerations in conducting LGBT research. We provide a summary of recommendations to guide future research, training, and public policy related to LGBT health. The information can increase capacity among CTSA affiliated researchers in conducting research in this special population.

Queering the Medical Curriculum: How to Design, Develop, Deliver and Assess Learning Outcomes Relevant to LGBT Health for Health Care Professionals

This article was migrated. The article was marked as recommended. Lesbian, gay, bisexual and transgender (LGBT) persons have specific healthcare needs, and experience unique barriers in accessing health services. Research has suggested that medical practitioners are inadequately prepared to address the needs of the LGBT population. While some strategies for training such practitioners within medical schools have been proposed, few have been evaluated, and the best approach to training physicians in LGBT-focused care has yet to be determined. The purpose of this paper is to assess the effectiveness of the LGBT-focused curriculum currently delivered at the Northern Ontario School of Medicine, specifically in terms of its perceived contribution to students' understanding of LGBT health issues. Results showed that the curriculum introduced at NOSM was effective in increasing knowledge medical students had on LGBT health issues regardless of their pre-existing level of awareness of LGBT health issues. Further, the study found that the level of experience and expertise of the facilitator helping deliver the curriculum was key in achieving this educational goal. We also evaluated three assessment modalities (Multiple Choice Questions (MCQ), Objective Structured Clinical Examination (OSCE), and Clinical Decision-Making Cases (CDM)) for validity and reliability in testing the course objectives. Results indicate that outcomes can be reliably assessed by these three types of assessments.

Legal and Policy Issues for LGBT Patients with Cancer or at Elevated Risk of Cancer.

To understand the major legal and policy issues for lesbian, gay, bisexual and transgender (LGBT) cancer patients. LGBT health policy research. Major policy issues include discrimination, lack of cultural competency and clinically appropriate care, insurance coverage, family recognition, and sexual orientation and gender identity data collection. Nurses play a major role in providing affirming and competent care to LGBT cancer patients. Using correct names and pronouns with transgender patients, and collecting sexual orientation and gender identity data can send an affirming message to LGBT patients, as well as inform decision support and preventive screenings, and improve treatment outcomes.

Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa

BackgroundSexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people’s healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment.MethodsA qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care.ResultsAll interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients’ identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system.ConclusionSexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa.

Implementation of teaching on LGBT healthcare.

Lesbian, gay, bisexual and transgender (LGBT) patients represent an important proportion of the population. Despite the health inequalities and barriers to health care noted within this group, there is little evidence of LGBT-focused education within medicine, dentistry or nursing. We introduced and evaluated the effect of a half-day teaching session focused on LGBT health care, delivered to year-2 students. Initial informal discussion with year-2 and year-3 students suggested that the awareness of health inequalities other than sexual health was limited, and that students had little awareness of other issues such as gender dysphoria and heterosexism. We therefore targeted these areas when developing the material. There is little evidence of LGBT-focused education within medicine, dentistry or nursing INNOVATION: The session was divided into two sections: a lecture and a workshop. The lecture provided an introduction to issues around legislation, transgender health and health inequalities, whereas the workshops involved a role-play focused on gender dysphoria, followed by small group discussions on topics such as heterosexism and sexual identity. Volunteer peer facilitators, some of whom identified as LGBT, undertook a 2-hour training session to ensure that they were comfortable with both the material and the group facilitation. Students completed a short questionnaire before and after the session. Feedback was gathered from 350 students between 2012 and 2015. Sixty-ninepercent of students rated their competency level higher after the workshop, suggesting that they felt better prepared to consult with LGBT patients. Written comments suggested that the sessions are useful for students in terms of improving awareness of health inequalities and enabling consultation skills practice in an informal environment.

Health-care disparities stemming from sexual orientation of Italian patients with Multiple Sclerosis: A cross-sectional web-based study

Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Thus, we investigated concerns experienced by LGBT patients with multiple sclerosis (MS). We conducted a web-based survey using a multi-choice questionnaire published in an Italian social-network (www.smsocialnetwork.com) for MS patients. The survey investigated: socio-demographic factors, lifestyle habits, MS-related health status and LGBT specific issues (e.g. friendliness to their sexual orientation and eventual homophobic behaviors in the MS Center). Among MS patients willing to use psychological services, LGBT patients were associated with a smaller number of psychological consultations, compared to heterosexuals (Coeff.=−0.449; p<0.001; 95%CI=−0.682 to −0.217). LGBT patients were more likely to change MS Center, compared to heterosexuals (OR=2.064; p=0.046; 95%CI=1.011–4.212). The number of MS Center changes was associated with MS Center friendliness (p=0.037; rho=−0.229) and with the occurrence of homophobic behaviors (p=0.036; rho=0.234). LGBT MS patients more frequently changed MS Center and had a reduced use of psychological services, compared to heterosexuals. The attitude towards LGBT MS patients might affect resource utilizations and LGBTs health status.

A Brief Learning Experience Designed to Increase Nursing Students’Knowledge of and Attitudes Toward LGBT Health Care

This study examined the effect of a brief learning experience on nursing students’ knowledge of and attitudes toward providing care to Lesbian, Gay, Bisexual and Transgender (LGBT) individuals. The Nursing Students’ Knowledge of and Attitudes toward LGBT Healthcare (NKALH) survey was administered to a convenience sample of 41 senior nursing students enrolled in a community health course. At pretest, there were significant knowledge deficits (20% of the questions were answered correctly) and low attitude scores toward LGBT healthcare needs existed. At posttest, students’ knowledge scores increased to 84%; attitude scores increased slightly, but not significantly (p = 0.07). Among the students who participated in the study, none felt they would be unable to care for an LGBT individual.

Advancing LGBT Health at an Academic Medical Center: A Case Study.

Academic health centers are strategically positioned to impact the health of lesbian, gay, bisexual and transgender (LGBT) populations by advancing science, educating future generations of providers, and delivering integrated care that addresses the unique health needs of the LGBT community. This report describes the early experiences of the Penn Medicine Program for LGBT Health, highlighting the favorable environment that led to its creation, the mission and structure of the Program, strategic planning process used to set priorities and establish collaborations, and the reception and early successes of the Program.

Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap

BackgroundPeople who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town’s medical curriculum.MethodsA curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment.Results127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed.ConclusionAt present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as well as providing them with specific LGBT health knowledge. Educating health professions students on the health needs of LGBT people is essential to improving this population’s health by providing competent and non-judgmental care.

Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities

There are significant health disparities according to sexual orientation and gender identity, particularly in mental health; however, very few mental health professionals specialise in caring for lesbian, gay, bisexual and transgender (LGBT) communities. The purpose of this study was to explore how providers with LGBT-focused practices have developed their capacity for working with these populations. Eight semi-structured interviews were conducted with practising mental health service providers with extensive experience serving LGBT individuals. Participants represented four professional disciplines: psychiatry (n = 2); social work (n = 3); psychotherapy (n = 2), and psychology (n = 1). The data were analysed for themes that were identified using a descriptive phenomenological approach. All providers self-identified as members of LGBT communities; however, most agreed that this membership was not necessary to provide supportive, appropriate care for LGBT individuals. Providers described their self-identity as members of LGBT communities, associated lived experiences and recognition of the need for mental health services that are sensitive to the unique needs of LGBT individuals as influential factors in their career decisions. The lack of training opportunities and resources specific to the provision of LGBT-sensitive mental health services was highlighted. Provider recommendations included the introduction of mandatory LGBT health content in education curricula that addresses basic LGBT-related terminology, appropriate interview questions to facilitate the disclosure of sexual orientation and gender identity, information regarding the health impact of heterosexism and homophobia, and specific health care needs of sexual and gender identity minority people. Data from this study suggest there are few opportunities for medical providers to access training and gain expertise in the provision of care to LGBT people. Additional research is needed to consider whether the lack of LGBT health content in medical and psychiatric training programme curricula indirectly contributes to the health disparities experienced by these populations.

Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community

This study examined the extent of tobacco industry funding of lesbian, gay, bisexual and transgender (LGBT) organisations and whether leaders of these organisations thought tobacco was a priority health issue for their community. We interviewed leaders of 74 LGBT organisations and publications in the USA, reflecting a wide variety of groups. Twenty‐two percent said they had accepted tobacco industry funding and few (24%) identified tobacco as a priority issue. Most leaders did not perceive tobacco as an issue relevant to LGBT identity. They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. The minority who embraced tobacco control saw the industry as culpable and viewed their own roles as protecting the community from all harms, not just those specific to the gay community. Lesbian, gay, bisexual and transgender tobacco‐control advocates should reframe smoking as an unhealthy response to the stresses of homophobia to persuade leaders that tobacco control is central to LGBT health.