Open Enrollment for HealthCare.gov starts on November 15th!

Health_Insurance_Marketplace__Enroll_for_2015_Healthcare_Coverage___HealthCare_govWith the US mid-term elections, Ebola, and act-alone terror attacks, there is not much oxygen left in the current news cycles for information about the Affordable Care Act Open Enrollment period that starts on November 15th, and lasts through February 15, 2015!  For many many Americans, this is huge news, yet many of us are totally oblivious to what this means.  So we want to make sure that everyone who follows LavenderHealth.org knows the facts, because health care for LGBTQ individuals and families is one of the most important things we can do to improve well-being for our communities.

Right now, you can explore the options that will be available, and you can sign up for news and updates from HealthCare.gov here.  If you recently got married, you do not have to even wait until November 15th to get started!  Your “change of status” qualifies you to apply now! There are many concerns, including marital status, that are are specific for all LGBTQ people and families, and there are two online resources to help!

Where to Start, What to Ask: A Guide for LGBT People Choosing Health Care Plans is published by “Strong Families” and a host of LGBT partner groups. This guide provides information to help :

  • Evaluate your healthcare needs,
  • Navigate new insurance options and
  • Choose the best plan based on needs of LGBT families.

Out2Enroll is another resource specifically for LGBT individuals and families, offering guidance and assistance to get medical insurance coverage.

So if you do not have healthcare coverage, reach out to get the information you need and hopefully the coverage you need.  If you do have coverage, pass this information along to everyone you can reach in your local communities.  We all have friends and acquaintances who need this information and the least we can do is pass it along!

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Coming Out to Our Patients: Dilemmas of Bedside Nursing

I’m out. I’m out to most everyone; even some of my closest colleagues are aware. But, just when I think I have finally conquered my own discomfort with my coming-out process and embraced myself, my patient asks me: “Are you married?”

Besides the fact that the respiratory therapist, who knows that I’m gay, is giggling under his breath, I remain externally un-phased. Yet, so many thoughts run through my mind, including how to answer the very simple question: “Am I married?”
Does he think I’m heterosexual? Is he talking about Gay Marriage? Do I finally “look” gay? Am I giving off vibes that cause him to question my sexuality? Why do people ask me this question? What if I just got out of a terrible divorce—do they really want to open that can of worms? This is the intensive care unit. Do people ask their doctors this question? I mean, he’s hemo-dynamically unstable, technically, so my answer could potentially cause a code. 

I reply, “well, I was ALMOST married…once.” He replies, “Well, that boy was a fool.”
So, he DOES think I’m heterosexual. Now I wish I’d come out.

In the grand scheme of things, my sexuality in the workplace doesn’t matter. Nor is it really anyone’s business. But the more I’ve thought about it, I admit that I dread having that conversation with my physician colleagues, nursing team, or patients. As a newly graduated nurse practitioner, I worry that if I “turn out to be gay”, it will affect my ability to get the job I want. And, yet I’m lying about myself…. Why should I feel concerned that in disclosing my sexuality to a patient, I could create an uncomfortable nurse-patient relationship and sabotage the day?

How many bedside nurses encounter my issue? I am very curious to find out how nurses respond to this category of questioning and why, and explore the results of their disclosure or non-disclosure. What are nurses’ fears surrounding this dilemma? My suspicion is that nurses may fear the repercussions of a hospital/nursing culture which has unintentionally exempted patients from adhering to expected behaviors; thereby creating a hostile work environment.

Despite the progressive leaps nursing has made, nurses are still a very stereotyped profession in all kinds of ways. Patients have wild imaginations and forget boundaries while hospitalized. We are sexualized, idolized and stripped of credibility at the same time. We are a mystery profession to many patients who are led astray by television and prime time news. We wear white hats and mini skirts and heels and are armed with syringes and needles the size of a shot gun. We can be someone’s greatest fantasy and someone’s worst nightmare. But we aren’t gay—the male nurses are gay— not the women.

How do I overcome this dilemma which stems from the fear that patients falsely link my accountability and expertise to my sexuality? The answer seems simple, but it isn’t. For someone as active in social justice as I am, I feel ashamed to even experience this, and vulnerable to be sharing it. But, even strong individuals have insecurities. To my patients: I’ve been dishonest, and I apologize, but be prepared for the possibility that I may shock you, because I can’t hide any longer how proud I am to know myself and how genuinely I love…

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From Music Festivals to College Campuses: Trans* and Women’s Communities

imagesCo-authored by Elizabeth McConnell

Some of you may have read the article “When Women Become Men at Wellesley,” authored by Ruth Padawer, in last week’s New York Times Magazine. Padawer skillfully and thoughtfully brings to light the challenges related to transgender students at Wellesley College and other women’s colleges like it. This issue has also been discussed in online queer women’s blog communities like Autostraddle.

When Women Become Men at Wellesley” brings up questions like the following: What is the purpose of a women’s college? Who belongs there? Should trans men, trans women, and other gender-nonconforming students be accepted into a women’s college? When a person transitions during their time at a women’s college, should they then be asked to leave? What are the complications between diversity and inclusion on the one hand and, on the other, the desire to have a “safe space” for women-born, women-identified women, or cisgender women, to be where they see other women-born, women-identified women as leaders, where there is no competition from men for these positions, where women are free from the patriarchy of our society?

We related to Padawer’s article because of our own work on trans inclusion. We are currently writing up results from a study that we undertook at Michfest (Michigan Womyn’s Music Festival). Michfest, which began in 1976, is an annual gathering in the woods of Michigan with camping, music, and workshops. The festival states its intention is for only women-born, women-identified women to attend.

We interviewed and surveyed Michfest attendees about their attitudes toward including trans women at the festival. We were interested in the dialogue and tensions around this issue, which has been actively debated in several recent online communities — Bitch Magazine, Autostraddle, and The Huffington Post, to name a few.

Similar to students at women’s colleges, the women we interviewed identified certain parts of the culture at Michfest that were important and valuable to them. They spoke about having the freedom to be themselves as strong women and to violate traditional gender roles, experiencing healing through being in a safe climate away from patriarchy, and undergoing a process of renewal and recharging that gave them the strength to deal with the world outside the festival.

Women at the festival who did not support including trans women at the festival placed a high value on the importance of separate space for women-born, women-identified women apart from trans women. Many of them expressed the belief that trans women’s experiences of womanhood are just different, especially around girlhood, and thought that trans women would benefit from having their own space to organize. Some women also worried that the presence of male anatomy (penises) at the festival would trigger trauma survivors who felt safe in a community of cisgender women. Some women also viewed the effort of trans women to be included in the festival as a form of male privilege and stressed the importance of creating boundaries so that the festival didn’t end up becoming open to anyone who wanted to attend.

Women at the festival who supported trans inclusion believed that women’s spaces should include trans women. Many connected this position to a belief that feminism should address all oppressions, and that trans women are directly oppressed by patriarchy. Some women also expressed a need to move beyond the gender binary and to stop seeing trans women as men. Some said Michfest needed to change with the times in order to increase attendance among younger feminists, or to extend its benefits to trans women.

As these examples illustrate, there are a number of complicated perspectives and positions on trans inclusion in women’s spaces, and these dialogues illustrate some of the complexities of combating patriarchy.

We are in a time of broad social change — marriage equity has become a reality in 32 states plus the District of Columbia — and more change may be right around the corner.

Instead of excluding those who are different, we must forge bridges and new partnerships and work to make feminist institutions more trans-inclusive. In this way, we can work to address the interconnections between systems of oppression, rather than targeting them in isolation.

Trans* exclusion in women’s communities will continue to divide and isolate us. Trans* inclusion has the power to unite us and create transformative change.

Elizabeth McConnell is a doctoral student in the department of psychology at DePaul University and an intern at Impact: The LGBT Health and Development Program at Northwestern University.

This blog was originally posted on Huffington Post on October 23, 2014.

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Bad Blood?

What if you could potentially save nearly two million people with a simple regulatory policy change?

That question, according to a recent study by Ayako Miyashita and  Gary J. Gates for the UCLA School of Law’s Williams Institute, is not rhetorical. Ending the Food and Drug Administration’s (FDA) longstanding ban on blood donations by men who have sex with men (MSM) could result in an estimated 360,600 men donating an additional 615,300 pints of blood each year, an increase of 2 to 4 percent.

The FDA notes that its ban on blood from MSM donors emerged from policies early in the HIV/AIDS epidemic, though the current policy was formulated in 1992. This ban includes any man who has had sex with a man since 1977, which embraces Baby Boomers, Gen Xers, and the Millennial Generation. However, the FDA also acknowledges that:

The Health and Human Service’s Advisory Committee on Blood Safety and Availability (ACBSA) met to discuss the FDA MSM deferral policy on June 10-11, 2010. . . . The committee found the current donor deferral policies to be suboptimal in permitting some potentially high risk donations while preventing some potentially low risk donations [emphasis ours], but voted in favor of retaining the existing policy, and identified areas requiring further research.

Potential responsible MSM donors are faced with the ethical dilemma: Lie about prior sexual practices when donating blood or abstain from blood donor drives. That we use the term MSM to classify this population suggests some of the ambiguities and complexities of sexual identity, which further complicates the issue. In epidemiology, behavior (MSM) trumps socially constructed identity (gay or bisexual men). Further complicating matters is the question, What is sex?, which in the case of some sexual practices, as I pointed out here last spring, is not a settled matter.

Moreover, Miyashita and Gates note that:

In recent years, both the United Kingdom and Canada have made changes to their laws shifting from an indefinite deferral of MSM to a twelve-month and five-year deferral, respectively. In Mexico, new regulations have established criteria for blood donation based on risk factors for transmission of blood-borne diseases.

Blood has both a physiological dimension and a cultural dimension. As a physiological phenomenon it may be studied empirically, with an evidence based developed for sound policy. As a cultural phenomenon, blood exercises an imaginative power that is diffuse and pervasive.

 

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Columbia University School of Nursing Awarded Grant to Expand LGBTQ Elder Care in NYC!

This amazing grant was announced late in September, 2014Elder LGBT Interprofessional Care Program (E-LINC) is an interdisciplinary project headed by jkwongJeffrey Kwong, DNP, ANP-BC.  The main purpose of the project is to eliminate health disparities for LGBT elders living in New York City.  There are several key features of this project that are particularly notable!

  • The project is a partnership between the Columbia School of Nursing and SAGE: Services & Advocacy for LGBT Elders .
  • It draws on the expertise of interprofessional practice teams to provide the best culturally competent care possible.
  • The program provides personalized health and wellness plan based on initial assessments to identify physical and mental health risks.
  • The program is also designed to educate the next generation of health care providers as culturally competent to work with all LGBT individuals and commmunities.

Congratulations to Dr. Kwong, and to the team of providers and researchers who have made this project possible!

Posted in LGBT Elders, LGBT Health, LGBT Services | Tagged , , | 1 Comment

Wake Me Up Before You Go Go

Don’t you just love it when you read something that jolts you to attention; that makes you consider another perspective? I had that experience a few weeks ago when I read an article in the Hastings Center Report special issue on LGBT health, called “Repaving the road of good intentions: LGBT health and the queer bioethical lens.” The authors, Lance Wahlert and Autumn Fiester, really highlighted for me a distinction that I have somehow forgotten in the past few years; the difference between an LGBT health agenda and a queer health agenda. They reminded me that LGBT health research can unintentionally reinforce the marginalizing of some sexual minority patients and reinforce a heteronormative spin on cultural norms related to sexuality, gender identity, and the family. Their article begins with reference to a 1998 article by James Lindemann Nelson called “The silence of the bioethicists” that lamented the lack of attention to trans* health issues. He followed this in 2012 with an article called “Still quiet after all these years.” I wish I had known of this article when we were writing about nursings’ silence on LGBT issues! Wahlert and Fiester go on to suggest that the IOM report on LGBT health has an effect of reinforcing heterosexism and silencing those with the most marginalized identities. One example they use is the recommendation for electronic health records to include sexual orientation and gender identity questions. The authors’ analysis of this is:

“This seemingly innocuous recommendation…is profoundly loaded for LGBT patients, yet there is only a perfunctory nod toward the ‘hesitancy on the part of patients to disclose this information.’” The authors suggest that the recommendation is “not a serious examination of the root causes or legitimate concerns underlying LGBT persons’ reasonable and anticipated hesitancy about such disclosure. In fact, in treating this information as if it were purely (and neutrally) demographic, the IOM report naively (or obtusely) fails to recognize its complicity in reinforcing stigma. It sanctions probes for disclosure about desires, relationships, sexualities, and gender presentations of those who are non-normative and often societally disdained.”

In other words, health care providers are urged to press their patients for personal information, without corresponding education to teach health care providers about why disclosure might be dangerous for some of their patients, and without preparing them for how to respond to non-normative answers to their questions. On the part of the patient, a perception of being coerced into disclosing to a health care provider for whom they may lack knowledge of attitudes about LGBTQ issues, may lead to feelings of shame, guilt, and fear (and avoidance of health care).

Wahlert and Kriester note “you miss the stakes involved in asking such questions only if you are safely enveloped in the normative fold.” They admonish LGBT health researchers who have been at least somewhat embraced by health research disciplines as “legitmate,” to consider whether their needs for data is elevated above the potential harm to already marginalized LGBTQ patients. I’m not sure where my reflections on this piece will take me. I’ve made this plea for data collection on sexual and gender identities many times myself, and I’m a tenured professor in the “normative fold” of the academy. Have I forsaken my less fortunate LGBTQ family members in my quest for understanding health disparities? So, thank you Lance Wahlert and Autumn Fiester for the much needed wake-up call!

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Victory in California!

lgbt_rainbow_justice_scaleIf you have not heard, California Governor Jerry Brown signed into law a bill that includes specific recommendations for the inclusion of LGBTI health in continuing medical education (CME). The law amends the current cultural competence law to include information pertinent to the appropriate treatment of, and provision of care to, the LGBTI communities. If you want to read the law, click here. The law is actually quite short and very easy to read and understand.

If you have been a follower of our blog, you know that we have discussed (or at least mentioned) the need for all healthcare professionals to have cultural competency training specific to LGBT care (see these past blogs: here, here, and here). Thus, it was a nice surprise to see that this law was passed in California!

There is no doubt that physicians are integral to patient care. Patients often view them as an “authority” figure. A discriminatory experience with a physician can have dire consequences. The LGBT patient who experienced the discrimination may defer or delay seeing other healthcare providers, leading to negative health outcomes. Thus, I do not want to minimize the victory in California and the implications to appropriate care for LGBT people.

However, with this victory in hand, we must continue advocating for other professions to do the same. Nursing represents the largest healthcare profession in the United States. Nurses are often the first and last healthcare professional a patient sees. Also, the Affordable Care Act resulted in millions of people receiving health insurance and an increase in demand for primary care providers. As a result, the demand for nurse practitioners has increased. The new law in California will have no implications to nurses, including nurse practitioners. This type of mandated cultural competence education needs to be extended to ALL health professions, especially nursing.

GLMA has advocated for and supported the California bill since 2011. Although GLMA cannot be credited as the sole inspiration for this bill, their policy work definitely played a role. This is good news for the newly established GLMA nursing section, Nurses Advancing LGBT Health Equality. I hope that the new nursing leadership team can release similar cultural competency position statements. Other healthcare professionals reading this blog should pressure their professional organizations to do the same.

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I’m Not Gay

All over the news and social media outlets this week are stories of the big photo-hacking iCloud leak of alleged images of celebrities in the nude. Celebrities such as Rihanna, Jennifer Lawrence, Kim Kardashian, Ariana Grande, Kirsten Dunst, Mary Kate Olson, and Liam Payne, among others. Some of these celebrities have confirmed the authenticity of the images (while threatening lawsuits), others have denied them claiming the images were Photoshopped.

The image of Liam Payne, singer in the boyband One Direction, apparently was of him in the nude with a nude man. Payne cries foul and in more than one tweet, exclaimed that he isn’t gay and would not have been in that “weird picture.”

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Granted, Liam Payne is not the first nor will be the last celebrity to be rumored to be gay. A recent Huffington Post post lists 38 recent examples, from Vin Diesel to Tom Cruise.

What troubles me was Payne’s recent response.  He could’ve simply denied that the image was really him.

The LGBTQ movement has made such great strides in recent months and years. It’s time to state clearly and unequivocally that a exclaimed statement such as “I’m not gay!” is homophobic. Let’s not pretend that it isn’t.

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Binary No More: The Transgender Challenge

My first transgender friend I met in 1976 when I was a graduate student at the University of Illinois. Formerly “Donny,” Lydia lived at the periphery of the campus community. For part of that bicentennial summer I dated a friend of hers. On one dramatic night, I talked Lydia out of killing herself when her boyfriend left her for a man.

The ambiguities of her life haunted me. Raised as a boy, but identifying as a woman. Wanting a husband, but living among gay and lesbian people.

Last year at the beginning of the semester, one of my students (with an officially male name) emailed me to let me know that she had begun the transition and wanted to be addressed by a female name. I recognized in myself some unexpected measure of discomfort with this ambiguity. My cisgender privilege and my unacknowledged investment in a gender binary became suddenly apparent.

These same ambiguities prevail in the arena of transgender health. As the Institute of Medicine’s The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (2011) explained, transgender people are underreported in the research literature and underserved by health professionals.

Afraid of discrimination by health care providers, transgender people may be less likely to seek preventive or even acute health care. Precariously employed (transgender status is not protected in labor law) without adequate health insurance, transgender people who want body modification consistent with their gender identity (e.g., hormones or implants) may be more inclined to seek medically risky remedies.

A recent documentary film, Transgender Tuesdays: A Clinic in the Tenderloin (2012), provides an informed and informative first-person account of San Francisco’s Tom Waddell Health Center and the lives of its community. The tagline of the film announces, “They came for the hormones and stayed for the healthcare.” More aptly, the acknowledgements of the film’s website characterizes its participants as “Faces from the across the gender spectrum.”

Binary no more, but a spectrum.

Institute of Medicine. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx

Transgender Tuesdays: A Clinic in the Tenderloin. (2012). http://transgendertuesdaysmovie.com/index.html

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Feeling Optimistic Today!

It’s the eve before leaving for the GLMA conference, and the second annual Nursing Summit. I have been excited for the conference for a number of reasons, including getting away from the early fall semester chaos and the dozens of faculty meetings we seem to need to get us jumpstarted after the summer break. But back to GLMA…the Nursing Summit, the launch of the Nursing Section, the number of nurses who are presenting workshops and posters is phenomenal. It seems like our time has finally arrived. We are more organized than ever before. We have a national organization and physicians and other healthcare professionals are lined up behind us in support. The time is ripe for us to demand to be heard in our own profession.

We seem to endlessly discuss the need for LGBTQ content in the nursing curriculum, but it seems like we never get beyond the discussing phase. My hope is that this will be the year that we develop a comprehensive document with supporting materials that can be handed over to curriculum committees at schools of nursing all over the world. Perhaps a book?

We (well, at least, I do) complain that our nursing professional organizations seem not to recognize us. Well, we have an Expert Panel at AAN and the Nursing Section of GLMA now. Let’s form an official alliance and push for policy change.

Our research shows how little practicing nurses and nurse educators know about LGBTQ health. Some of us have already begun to work on that, with continuing education programs and articles in our specific fields or areas. Some of us join, or run for, the curriculum committee at our schools. Let’s do more of that!

We started an LGBTQ nurse scholars mentoring program last year, but we have been pretty quiet in the past few months. Surely some of us have manuscripts that could use peer review, or ideas that we would like to throw out for discussion, or needs for collaborations to get us moving. Let’s use the resource this year and add to the growing number of articles on LGBT topics in our fields.

We have a growing number of allies in our practice, research, and policy work. How have we received this ally network? What can we do to be inclusive and encouraging of them? What kind of partnerships would help us move the discipline of nursing into near full inclusion and welcoming of LGBTQ nurses, nursing students, staff, and patients? Let’s foster and support our allies in a more formal way.

Finally, in preparing for the Nursing Summit, I was looking for images to jazz up my slides a bit. Do you know what comes up when you “google” for images of lesbian nurses? How can we address the sexualization of nurses in general, and lesbian nurses in particular? How can we blend feminism with our LGBTQ activism/theory to change the gender stereotypes and blatant sexism that still exists in the popular media about nurses?

I hope to see many of you in the next few days, and encourage others to join the Nursing Section of GLMA. Our day has come and we’ll have everything (and if you know what song that comes from, you are in my generation…we need to mentor the generation that will implement these changes!).

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