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Trans youth lack access to trans-affirming care, which may put them at risk for HIV

One-quarter of youth were less inclined to discuss GSM (gender and sexual minority) identity and sexual health with their primary care providers due to concern that their provider would disclose this information to parents.

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Many trans youth lack access to trans affirming care, which may put them at risk for HIV. This is according to a study that explored trans youth’s perceptions regarding encounters with primary care providers (PCPs) related to gender and sexual minority (GSM) identity and sexual health.

In “Perceived Barriers to HIV Prevention Services for Transgender Youth”, which appeared in LGBT Health, C.B. Fisher, A.L. Fried, M. Desmond, K. Macapagal and B. Mustanski engaged youth aged 14-21 (N = 228; 45% trans masculine, 41% trans feminine, 14% gender nonbinary) and asked them to complete a survey on GSM identity disclosure and acceptance, gender-affirming services, sexual health attitudes and behaviors, and interactions with PCPs involving GSM identity and concerns about stigma and confidentiality.

A factor analysis yielded three scales: GSM Stigma, Confidentiality Concerns, and GSM-Sexual Health Information. Items from the GSM Stigma scale showed that nearly half of respondents had not disclosed their GSM identity to their PCP due to concern about an unaccepting PCP. One-quarter of youth were less inclined to discuss GSM identity and sexual health with their PCP due to concern that their provider would disclose this information to parents; these concerns were greater among adolescents <18 and those not out to parents about their gender identity. Only 25% felt their PCP was helpful about GSM-specific sexual health issues. Youth who were out to parents about their gender identity and had received gender-affirming hormone therapy were more likely to report receiving GSM-specific sexual health information.

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For the researchers, “trans youth may not discuss their GSM identity or sexual health with PCPs because they anticipate GSM stigma and fear being ‘outed’ to parents.” And so “PCPs should receive transgender-inclusive training to adequately address youths’ sexual health needs and privacy concerns.”

Health & Wellness

Sexual minority women less likely to receive appropriate sexual, reproductive health support

A research emphasizes the importance of considering both sexual orientation and recent sexual behaviors when addressing the sexual and reproductive health needs of sexual minority women.

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Lesbian women were less likely to report receiving a birth control prescription or birth control counseling compared with heterosexual women. This is according to a new study that used data from the National Survey of Family Growth 2006-2015 in the US, and which highlighted sexual and reproductive health care disparities among women.

In “Do Sexual Minorities Receive Appropriate Sexual and Reproductive Health Care and Counseling?”, Bethany Everett, PhD, University of Utah (Salt Lake City) and colleagues from the University of Wisconsin (Madison) and the University of Chicago (IL) investigated sexual orientation disparities in the use of sexual and reproductive health services and receipt of contraceptive counseling in clinical settings in the past 12 months.

The researchers also explored whether having male sex partners influenced sexual minority women’s use of sexual and reproductive health services and the types of sexual health information that they received.

The findings – published in Journal of Women’s Health, a peer-reviewed publication from Mary Ann Liebert, Inc. –  noted that in a clinical setting, lesbian women were less likely to report receiving birth control counseling at a pregnancy test, and lesbian women without recent male sex partners were less likely to report receiving counseling about condom use at an STI-related visit compared with heterosexual women.

However, they were more likely to report having received sexually transmitted infection (STI) counseling, testing, or treatment, after adjusting for sexual partners in the past 12 months.

“This new research emphasizes the importance of considering both sexual orientation and recent sexual behaviors when addressing the sexual and reproductive health needs of sexual minority women,” said Susan G. Kornstein, MD, editor in chief of Journal of Women’s Health and executive director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA. “Using inclusive sexual and reproductive health counseling scripts may facilitate the delivery of appropriate sexual health-related information.”

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Trauma increases heart disease risk in lesbians, bi women

Women were 30% more likely to suffer from anxiety if they experienced any forms of adulthood trauma and 41% more likely to be depressed if they faced childhood trauma.

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Trauma, including abuse and neglect, is associated with higher cardiovascular disease risk for lesbian and bi women.

This is according to preliminary research presented in Chicago in the US, at the American Heart Association’s Scientific Sessions 2018, a global exchange of the latest advances in cardiovascular science for researchers and clinicians. The research – led by researchers from the Columbia University – showed that sexual minority women with increased severity of childhood, adulthood or lifetime trauma had higher risk for post traumatic stress disorder (PTSD) and a perception of less social support.

For this, the researchers studied 547 sexual minority women. They measured three forms of childhood trauma: physical abuse, sexual abuse and parental neglect; three forms of adult trauma: physical abuse, sexual abuse and intimate partner violence; and lifetime trauma, which was the sum of childhood and adulthood trauma. They analyzed how increasing trauma severity was associated with higher report of several cardiovascular risk factors.

They found that women were 30% more likely to suffer from anxiety if they experienced any forms of adulthood trauma and 41% more likely to be depressed if they faced childhood trauma.

Other findings included:

  • 22% more likely to be depressed if they had experienced more forms of lifetime trauma.
  • 44% more likely to report overeating in the past three months if they experienced increased forms of childhood trauma.
  • 58% more likely to have diabetes if they experienced increasing severity of childhood trauma, and lifetime trauma notably increased their risks of obesity and high blood pressure.
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These findings suggest healthcare providers should screen for trauma as a cardiovascular disease risk factor in this population, according to the researchers.

The results were presented at the American Heart Association Scientific Sessions in Chicago.

The research was recognized as the “Cardiovascular Stroke Nursing Best Abstract Award.”

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Health & Wellness

Attitudes toward sexual minorities, HIV-positive people among physicians are changing

Research finds that there have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents.

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Medical practitioners are among the sources of LGBT- and HIV-related discrimination; but this may be changing… even if slowly.

This is according to “Physician Attitudes Toward Homosexuality and HIV: The PATHH-III Survey“, a study by R. Marlin, A. Kadakia, B. Ethridge and W.C. Mathews, and published in LGBT Health.

The study eyed to (1) to evaluate current physician attitudes toward homosexuality and homosexual, transgender, and HIV-positive individuals; and (2) to compare current attitudes of those from prior surveys of the same population, the San Diego County medical community.

For this study, an online survey was conducted during November-December 2017 to assess general attitudes toward homosexuality and medically focused items that addressed homosexual orientation, transgender identity, and HIV. Responses were weighted for nonresponse. Predictors of stigma were assessed using generalized linear models. Trends across three surveys of the same population in 1982, 1999, and 2017 using common items were assessed using unweighted responses.

Of 4,418 physicians, 491 (11.1%) responded (median age 55 years, 38% female and 8.7% gay or bisexual). Regarding admission to medical school, 1% opposed admitting a homosexual applicant, 2% a transgender applicant, and 5% an HIV-positive applicant. Regarding consultative referral to a pediatrician, 3% would discontinue referral to a homosexual pediatrician, 5% to a transgender pediatrician, and 10% to an HIV-positive pediatrician. Regarding discomfort treating patients, 7% reported discomfort treating homosexual patients, 22% transgender patients, and 13% HIV-positive patients. Earlier year of graduation from medical school, male gender, and heterosexual orientation were significant predictors of stigma-associated responses.

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Compared with the results from surveys in 1982 and 1999, the current results suggest substantively less stigma associated with homosexuality and HIV.

Even with health insurance, lesbian, gay and bi adults more likely to delay medical care

For the researchers, it is worth noting that – finally – “there have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents.”

There’s hope yet, after all.

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Health & Wellness

Family acceptance of LGBT identity linked to lower stress

According to the researchers, the family provides a foundation of support, and if those who identify as LGBT are comfortable disclosing to their family, they seem to have a protective stress profile.

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Those who identify as LGBT and have come out to their family carry less stress hormones than those who have not come out, which may ultimately benefit their health. This is according to a study by Ohio University Associate Professor of Psychology Dr. Peggy Zoccola with Andrew Manigault M.S., published in the October issue of Psychosomatic Medicine, journal of the Psychosomatic Society.

The study eyed to discuss how feeling able to comfortably talk about your sexual identity with family members specifically, appears to be most linked to output of the stress hormone cortisol; a hormone that if too much is produced can damage an individual’s health.

For the study, Zoccola had 121 sexual minority adults ages 18 to 35 take a survey about their depression and anxiety levels, sociodemographic factors and how much support they felt. They were also asked how out they were to family, friends, acquaintances, coworkers and clergy in religious organizations, as well as provided their age when they came out. Following the survey, 58 individuals from the group were randomly selected to provide a saliva sample to show their cortisol levels.

The results of Zoccola’s research showed that the more open people were to disclosing their sexuality with their family, the lower cortisol levels they had.

“The real stress punch seems to be with the family,” said Zoccola when referencing how greater disclosure of a LGBT individual’s sexuality to their family is strongly linked to lower cortisol.  “For these emerging adults, the family provides a foundation of support… If they’re comfortable disclosing to their family, they seem to have a protective stress profile.”

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Zoccola said that there has been sparse research on how the aspects of coming out by LGBT adults affect the release of stress hormones; but earlier studies have shown that if people who identify as sexual minorities feel acceptance from their families, they have higher self-esteem, lower depression and substance use rates and are less likely to think about suicide.

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Health & Wellness

Even with health insurance, lesbian, gay and bi adults more likely to delay medical care

A study shows bisexuals have among the greatest need for regular health care, but are the least likely to get it. And even if they have a high-quality insurance plan through an employer, health equity is far from a reality for many LGBTQ patients.

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Even when lesbian, gay and bisexual adults have rates of health insurance coverage on par with or better than that of straight men and women, they are still more likely to wait to see the doctor when they need medical care. This is according to a policy brief by the UCLA Center for Health Policy Research

According to Susan H. Babey, a co-author of the study, Disparities in Health Care Access and Health Among lesbians, Gay Men, and Bisexuals in California, one reason cited in other research is that sexual minorities sometimes experience discrimination when they seek health care.

“Sexual minorities who have had a bad experience with a medical provider because of their sexual orientation may try to avoid repeating it,” said Babey, who is also co-director of the Chronic Disease Program at the Center.

The UCLA study looks at differences in access to care, behaviors that negatively affect health (such as smoking or not exercising) and health problems that can result from those behaviors (such as developing hypertension or being overweight), based on people’s sexual orientation. The findings show that 24% of bi men and 22% of straight men say they do not have a doctor they regularly see, compared with only 13% of gay men; but 20% of gay men and 21% of bi men delayed seeking health care in the past year, compared with 13% of straight men.

Thirteen percent of straight women and 15% of lesbians reported that they do not have a doctor they regularly see, while a higher percentage of bisexual women, 22%, said they do not have one. However, 29% of lesbians and bisexual women said they delayed seeking medical care in the past year compared with just 18% of straight women.

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The study uses data from the combined 2011 to 2014 California Health Interview Survey. Data on transgender people is not included because the survey only began collecting transgender data in 2015-16. More than one million California adults, 4.5% of the state’s adult population, identify as lesbian, gay, homosexual or bi, according to the survey.

Other key findings from the research:

  • Bi people have the worst overall access to a doctor they see on a regular basis and high rates of unhealthy behaviors. Among lesbian/gay, bi and straight adults, bi men and women are the least likely to have a regular source of care, are most likely to delay care and are mostly likely to seek care in an emergency room. Bi men have higher rates of unhealthy behaviors in four of the five categories analyzed in the study. Among women, bi in the study have higher rates of smoking and binge drinking, and are more likely to eat fast food two or more times a week.
  • Gay men report better overall health and fewer behaviors that lead to obesity and hypertension than straight men. Sixty-one percent of gay men said they considered themselves to be in excellent or very good health, compared to 52% of straight men and 44% of bi men. Gay men are less likely to drink sugary beverages daily and were less likely to binge drink than straight and bi men. Twenty-seven percent of straight men in the study were obese, compared with 21% of gay men and 20% of bi men.
  • Straight women have the best access to a doctor they see on a regular basis, overall health and the lowest rates of unhealthy behaviors. Half of straight women said they were in excellent or very good health, versus 44% of lesbians and 45% of bi women. Twenty-seven percent said they had engaged in binge drinking within the previous year, compared to 50% of bi women. Ten percent of straight women were smokers, compared with 23% of bi and lesbian women. Lesbians had the highest rate of obesity, 35%, compared with 26% of  bi women and 24% of straight women.
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“Our study shows bisexuals have among the greatest need for regular health care, but are the least likely to get it,” said Joelle Wolstein, a research scientist at the Center and the study’s lead author. “Even if they have a high-quality insurance plan through an employer, health equity is far from a reality for many LGBTQ patients.”

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Health & Wellness

Religious freedom laws may be linked to poorer self-reported health among sexual minorities

Religious freedom laws may be linked to poorer self-reported health among people who identify as lesbian, gay, bisexual or are unsure of their sexual orientation.

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#QueerInFaith

Religious freedom laws may be linked to poorer self-reported health among people who identify as lesbian, gay, bisexual or are unsure of their sexual orientation – a group known as sexual minorities.

This is according to an analysis led by scientists at the University of Pittsburgh Graduate School of Public Health’s Center for LGBT Health Research. The study, published online in the American Journal of Orthopsychiatry, focused on Indiana in the US. It found that after the passage in Indiana of a Religious Freedom Restoration Act (RFRA) in 2015, sexual minorities increasingly reported poor health on a national survey. Such laws are often invoked by courts to support those who want to deny services to members of particular groups due to conflicts with their personal religious beliefs.

In the Philippines, for instance – and to contextualize – the Catholic Bishops’ Conference of the Philippines (CBCP) has been one of the staunchest opponents of passing an anti-discrimination law that will protect the human rights of LGBTQI people.

In 2015, it actually gave a “partial support” to the passage of an anti-discrimination bill (ADB). However, this support is limited by CBCP’s desire for it to still be allowed to discriminate, particularly in: 1) determining who should be admitted to priestly or religious formation, who should be ordained and received into Holy Order, or who should be professed as members of religious communities and orders; and 2) for Catholic schools to be allowed to discriminate on who they can admit or retain.

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The CBCP also stressed its “love the sinner, hate the sin” position by claiming its “disapproval of homosexual acts (that) remains part of the Church’s moral teaching.”

In the aforementioned American study, the researchers – which included John R. Blosnich, Ph.D., M.P.H., Robert W.S. Coulter, Ph.D., M.P.H., Jordan M. Sang, M.P.H., and Christina Mair, Ph.D. – used data from 21 states that participated in the Centers for Disease Control and Prevention’s (CDC) 2015 Behavioral Risk Factor Surveillance System survey. Across the participating states, the team focused on the health of the nearly 5,000 participants who identified as sexual minorities. In particular, the team analyzed the number of “unhealthy days,” which the CDC characterized as the total number of days in the past 30 that people reported that their physical and mental health were not good.

The researchers found that, among residents of the 21 states, only Indiana saw a significant increase in the percent of sexual minority people reporting unhealthy days over the course of 2015. In the first quarter of the year, 24.5% of sexual minorities surveyed reported that their health was poor for 14 or more days each month. In the final quarter of the year, following public discussion and Indiana’s passage of the RFRA, 59.5% of sexual minorities reported poor health in 14 or more days per month. By contrast, heterosexual people in Indiana did not have any increase in unhealthy days across the same period.

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Research shows that sexual minority populations have greater rates of poor mental health, including depression and anxiety, which are attributed to the discrimination, harassment and stigma that they often endure. They also face a higher risk of suicidal thoughts and behaviors.

“The Indiana case suggests that the character of the RFRA law might be an important factor in its broader impacts on public health,” study co-author Erin Cassese, Ph.D. was quoted as saying. “Some RFRAs are stronger than others, and Indiana’s RFRA law ‘has teeth’ in the sense that it can be used in private litigation, including cases where businesses wish to deny services to sexual minorities. It also permits courts to grant compensatory damages against whomever brings the suit – making a court challenge to a service denial a much riskier proposition.

In the end, this research adds to a growing body of research demonstrating that experiences of discrimination are associated with poor health outcomes in a range of minority populations, Cassese added. It also “suggests negative health outcomes might be a consequence of this type of policy, and thus warrant some consideration by policymakers.”

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