Transgender Day of Remembrance, November 20

In the hopes that this memorial will one day become unnecessary, we mark Transgender Day of Remembrance (November 20) with attention to health issues.

The 2011 Institute of Medicine report The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding provided alarming but not entirely surprising information about health disparities among sexual minority people, including transgender people.

Among its more salient findings:

  • Some research suggests that young transgender women are at significant risk for homelessness.
  • Research based on smaller convenience samples suggests that elevated rates of suicidal ideation and attempts as well as depression exist among transgender adults; however, little research has examined the prevalence of mood and anxiety disorders in this population.
  • Limited research among transgender adults indicates that substance use is a concern for this population.
  • Limited research suggests that transgender elders may experience negative health outcomes as a result of long-term hormone use.

These data are significant and persuasive. The human dimensions, however, may be more powerfully represented in the documentary Transgender Tuesdays: A Clinic in the Tenderloin.

Transgender lives are more than statistics.

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Medical-Colleges Group Releases Standards for Treating LGBT Patients

Announced today by the Chronicle of Higher Education:

The Association of American Medical Colleges has released a set of guidelines aimed at helping medical schools better train physicians to treat people who are LGBT, don’t identify with a gender, or are born with differences of sex development. The guidelines, contained in a report, are the first comprehensive set of standards for treating lesbian, gay, bisexual, and transgender patients, according to a news release from the organization.

The AAMC report can be downloaded here:

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November 20th – International Transgender Day of Remembrance

Ceremonies are being held worldwide during the month of November to memorialize those who have been killed as a result of anti-transgender hatred or prejudice.  The Transgender Day of Remembrance web site provides a list of events that will be occuring throughout the month, many on November 20th.  They also publish a list of all who have been killed throughout the previous year; this list consists of deaths that were corroborated by media accounts.

This is a senseless and horrifying tragedy.  Please join us in pausing for a moment of reflection to remember those who have perished, and to focus our energies on all the ways we can work together to end the violence.  Statistics_and_other_info____Transgender_Day_of_Remembrance

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What are you working on?

We’ve been blogging about a number of topics in the past year or so, all very interesting, but not terribly interactive. I’d like to start a discussion of the types of research on LGBTQ issues that our followers are up to. We’ve heard that nursing journal editors are eager to publish LGBTQ-themed articles, so we need to be submitting quality work to them to educate our colleagues. So here are some questions to chew on:

  • What are you interested in?
    What challenges are you having to doing your project?
    Have you experienced any resistance from faculty colleagues or professors?
    What methodological challenges are you experiencing in developing instruments, recruiting, analyzing data?
    Do you need a co-author to help you get over the hump?
    Are you wondering where to publish?
    And anything else that keeps you awake at night…

So weigh in and let’s talk!  If you have not already joined the GLMA Nursing Section’s Research Group, that is another forum for discussing research and finding collaborators.

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Understanding Queer!

Even though the term “queer” has been used for many many decades as a pejorative term, and now has been re-claimed as a term of pride to deliberately dismantle its negative implications, there still are many  folks that I encounter who are puzzled, mystified, and perhaps even revolted by the term.  LGBT_HealthLink__The_Network_for_Health_Equity___Linking_People_and_InformationI can understand each and every one of these reactions, because over the years I, like practically everyone else who uses the English language, have had the full range of reaction!

One of the earliest encounters I had with the term after I realized my own lesbian identity was with my young son.  He had been part of my lesbian social network throughout most of his childhood, but I had failed to “come out” to him explicitly, thinking that when he wanted to talk about it, he would ask.  When he confronted me and I told him I was waiting for him to ask he said “Mom, you do not just ask your mom if she is queer!”

This was in 1980, when our now rich vocabulary was just beginning to emerge, and so started my personal quest to figure out what was meant by a host of terms, including queer.  This was also just about the time of the height of the feminist movement in the U.S., and only about a decade after the Stonewall riots in New York City that launched the modern gay rights movement.  It was not long before Women’s Studies in colleges and universities were shifting from “women’s studies” to “gender studies” and even lo and behold – “queer studies.” Today, queer is here – full tilt!  The poster above is just one of hundreds of examples – it is advertising the 6th annual Genderevolution conference in Salt Lake City on November 15th, sponsored by the Utah Pride Center, the aims of which “are to deconstruct gender mythology, explore the implications of socially constructed gender norms, and integrate our many intersecting identities.” (See Utah Pride Center)

Many LGBTQI folks now prefer the term “Queer” to the alphabet soup that always excludes someone, and it is generally the preferred term of gender identity for young people who view gender identity as a restrictive and harmful social construction that should not be inextricably linked to sexual identity.  The term is problematic for some feminists and others who are concerned about and sensitive to the huge gender inequities and gaps that privilege male persons and masculine values and behaviors, and disadvantage women and women’s traditional values and roles.   From this perspective, the power of language to render women invisible remains a fundamental challenge at a time when huge gender inequities remain the norm. From a queer perspective, the path to destroying these inequities is to dismantle gender altogether.

You could probably get as many perspectives and definitions of the term “Queer” as there are people to ask, but here are common understandings of what it can mean:

  • In the context of the acronym LGBTQ, the “Q” stands for queer, questioning, or both, and is meant to cover any person who prefers Queer as their personal identity, regardless of what that means exactly to them.  Queer is not necessarily connected to one’s sexual identity.
  • From a political perspective, it generally refers to an identity that does not conform to gender binaries and that values a chosen expression of Self that is not restricted by traditional gender norms based on sex of behavior, dress, or social comportment.
  • From a philosophic perspective, “queer” points to the belief that gender is socially constructed, and that the gender norms that have dictated human behavior based on sex can be changed. From this perspective, each person, regardless of biological or assigned sex, should behave and live their lives as an authentic human being and not be restricted by gender norms that govern behavior, dress, interests, occupations or other expressions of Self.

When we take a closer look at the implications of the political and philosophic values that “queer” represents, it becomes apparent that this is a social phenomenon that has the potential to actually change the world!  Even though the Queer movement has grown and flourished within and from the LGBT movement, it is not simply a phenomenon of the LGBT communities.   “Queer” embraces all realms of life where gender has played as significant role – which in fact encompasses all of life.

So here’s to Queer!  Please add your comments and questions below .. we would be delighted to have a conversation with you!

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The LGBT Checkbox on Medical Forms

The Washington PosCheckmarkt recently published a piece on its advice column about the importance of including check boxes on medical forms to identify LGBT people. The advice column included quotes from Hector Vargas, executive director of GLMA, and Liz Margolies, founder and director of the National LGBT Cancer Network. Both strongly support including questions on medical forms to identify LGBT people.

Anyone versed in LGBT health know that chronic stigma has resulted in numerous health disparities. Research has shown numerous negative health outcomes among LGBT populations, such as mood and anxiety disorders, obesity, HIV/AIDS, and lower utilization of healthcare services. In fact, the Institute of Medicine (IOM) published a report in 2011 recommending the collection of sexual orientation and gender identity (SOGI) in medical records. Collecting SOGI information could assist in identifying and addressing LGBT health and healthcare disparities.

Since the release of the IOM report in 2011, there has been overwhelming support for the routine collection of SOGI data in medical records. Drs. Cahill and Makadon’s recent publication did a remarkable job of arguing for the inclusion of SOGI questions on medical forms. They argued that SOGI questions are the key to ending LGBT health disparities. Many others have also published research or commentary publications that argue or show the importance of SOGI questions.

I am also a supporter of including SOGI questions on medical forms. Sexual orientation and gender identity are blind spots to healthcare professionals. Most medical, nursing, and health education programs emphasize treating the individual. If health professionals are not taking sexual orientation and gender identity into account when caring for people, how can they claim that they are individualizing care?

With all of that said, there are numerous challenges to including SOGI questions on medical forms. First, although numerous organizations have published “Best Practice” guidelines on proper wording and placement of SOGI questions, there is not much evidence to show how these questions will be perceived or understood by the public. Second, for SOGI data to be meaningful, patients need to be willing to disclose their SOGI. Numerous studies have found that disclosure of SOGI is dependent on the patient-provider relationship, the perceived risk in disclosing, and internal attributes of the patient. How will this translate when SOGI questions appear on a medical form? Last, will health professionals and providers know how to use this data in meaningful ways? I think the last challenge is most important. If SOGI questions become mandated, LGBT people should feel safe in disclosing and be assured that they would not encounter discrimination as a result.

With careful thought, I think all of these challenges can be negotiated and overcome. SOGI questions will not happen overnight, but we are headed in the right direction.

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Open Enrollment for 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 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 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!

Posted in Affordable Care Act, LGBT Health, LGBTQ rights | Tagged , | 1 Comment

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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