#SaludLGBTT Wrap-Up: Working Together as Advocates

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

Corey captures the sun setting over the San Juan Bay – and a great summit.

Now that the hundreds of us who participated in the Salud LGBTT summit in Puerto Rico last weekend have had a chance to return home and recuperate (and, in my case, pour on the aloe vera), I wanted to write a quick wrap-up on my experiences there.

In addition to the two days we spent talking about topics ranging from trans health to e-cigs, many of us spent time networking, developing collaborations, and making lasting friendships. People came from all over the island and the continental U.S. not only to share their experiences but also – and more importantly – to learn from the experiences of others.

Chances are that those of you reading this blog, like the attendees of the conference, come from all different backgrounds and specialties. Some are students, activists, lawyers, healthcare providers, community health workers, and academics. Some are focused on tobacco control, others on LGBT rights, and still others on healthcare disparities generally. And we each have different intersectionalities with respect to our own orientations, gender identities, races, ethnicities, abilities, and social groups. In short, we each bring different things to the table, both personally and professionally.

Over the weekend, I had a realization that there is none among us who can “do it all” with respect to LGBT health. We can’t all prioritize everything or be experts on every topic. One prominent activist told me that she sometimes feels pressure to prioritize one sub-group within the LGBT community over another. But rather than despair at this truth, or just give in and pick favorites, she and I focused our discussion on how to create collaborations so that we’re all working together towards a common goal.  By recognizing and using the expertise of others, we can focus on doing novel work ourselves.

So that was my lesson from the Salud LGBTT summit: to not reinvent the wheel trying to change the world alone, but to join forces with others to keep our wheels moving forward together. That means creating more opportunities like this amazing summit to gather and not just speak, but also listen.

Congratulations to Juan Carlos Vega and the entire board of Salud LGBTT for a successful and inspiring weekend! I look forward to seeing the attendees – and hopefully many new faces – next year.

To read more coverage of the Salud LGBTT summit, click here.

#SaludLGBTT Summit: Spotlight on Trans Health

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

A transgender health panel at the summit.

There is a human right to have competent health care that preserves the dignity of all people, said Ericka Florenciani, launching the Salud LGBTT summit’s panel on trans healthcare. While trans issues were woven throughout the summit, this panel was one of many efforts to ensure that the issue of trans health would be front and center – a necessity given the difficulty the trans communities face getting care in Puerto Rico.

One of the speakers, Zil Goldstein of the Persist Health Project and Beth Israel Medical Center, noted that many trans people attempt to leave Puerto Rico to get transition-related care. Improving trans care here “has to start with hormone treatment,” she said. In New York, Zil sees sixteen to eighteen patients a day to provide hormone treatment; here in Puerto Rico, advocates say it is nearly (if not entirely) impossible to access.

But even in New York, the trans communities face many barriers to receiving quality care. “Anytime a trans person accesses healthcare, we’re dealing with transphobia,” Zil noted. This explains why, for example, 30% of trans youth in the U.S. put off receiving medical care out of fear discrimination, said Susan Mash of the Trans Youth Equality Foundation.

The problem is certainly national. Lambda Legal attorney Dru Levasseur noted that in their 2011 report on LGBT health, When Health Care Isn’t Caring, it was the trans population that faced the most obstacles in the field of healthcare. And the roots go deeper than health, starting with the socioeconomic position of trans individuals in our society; according to the study, seven percent of trans individuals reported that they had no income at all, which makes even basic health care an impossibility.

Speaking to doctors, Dru said, “You don’t have to be a specialist,” but you do need to take the time to educate yourself on the basics of trans care so that you are not turning people away. Noting that Lambda can connect them to resources, “there really is no excuse,” he added.

Dr. Carmen Milagros Vélez of the Universidad de Puerto Rico has been working on improving services for trans people in the community health clinics across Puerto Rico. Often, medical personnel think that LGBTT people want special treatment, and do not want to do anything different than they do for their other patients. But given the unique health needs of the community, and the disparities it faces, LGBTT people do need specially-tailored care – although this is about basic equality, not about “special” treatment.

And the need for that equality is urgent: in Dr. Milagros Vélez’s research, 35% of clinic respondents said they were not prepared to work with trans clients. The advocates at the summit agree that that needs to change.

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!

#SaludLGBTT Summit: Spotlight on Bi Health

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

The “Bi Umbrella,” as shared by presenters.

Earlier this week, before coming to Puerto Rico, I gave a presentation on diversity within the LGBT community – and how we can protect and strengthen that diversity instead of trying to homogenize the community or focus on assimilating into non-queer social structures. One issue that’s being highlighted here at the Salud LGBTT conference in San Juan is bi health, which is an important topic given that bi people are often forgotten within the LGBTT community.

First, let’s start with terminology. Caleb Esteban, M.S., one of the presenters on this subject, states that (in my opinion, not unlike the trans community) there are many terms that bisexual people choose to identify as. Many prefer “bi” to “bisexual,” fearing that the latter overly sexualizes them – so that is the term that I will use in this post. Some prefer terms like heteroflexible or homoflexible. The ability to identify as one feels, and to have others respect and reflect back that identity, is one that we should all be able to relate to.

Bisexuals, he explains, find that they are met with judgment and a lack of knowledge when seeking medical care. People think that bisexuals are transitioning to homosexuality, are sexually and/or emotionally immature, and not people with a unique and complex orientation of their own.

And this mentality is not limited to heterosexual, cisgender people, according to the second presenter, Miguel Vázquez Rivera, PsyD. Rather, bisexuals face “double discrimination” – they are discriminated against not only by heteronormative society but also by others within the LGBT community.

One concern with bi women is that they believe sex with other women is not risky, which is not the case. The medical community does not know enough about these issues, especially with respect to the bi community, to effectively communicate preventative health strategies for bi women or to properly manage their care with the right types of screening and monitoring.

He explains that the bisexual community, compared to gays and lesbians, have higher rates of depression, anxiety, suicide, use of alcohol and drugs, and experiences of violence. This partially results from the lack of knowledge by healthcare providers, and is exacerbated by this problem.

Bi people are also more likely to identify as polyamorous. 33% are in polyamorous relationships, and 54% see this as the ideal for them, Dr. Vázquez Rivera says. This has an impact on all areas of their health and requires an extra level of competence and understanding by providers and those working in the public health field. This understanding is often hard to find, and this dual status as a sexual minority (both bi and poly) compounds discrimination and incompetent provision of care.

Elle Auguston, one of the Georgetown Law students who has been helping me research LGBT health policy this year, found research from a 2010 study in Washington State establishing that bi women, compared to Lesbian women, have higher rates of poverty and lower rates of insurance coverage. So not only do bi people have unique healthcare needs that providers do a poor job meeting, but they have a harder time receiving care at all.

So, according to Dr. Vázquez Rivera, the path forward is a combination of training medical professionals, ending biphobia (perhaps starting within the LGBT community), and ensure that data collection and programming recognize the distinctiveness of the bi community. Sounds to me like a good way to tackle disparities!

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!

Health and Human Services Attorney: New Regulations Won’t Cover LGB Discrimination

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

Speaking at the Salud LGBTT summit, Fernando Morales – an attorney with the Department of Health and Human Service’s Office of Civil Rights (OCR) – said that new regulations will be coming this fall will not protect lesbian, gay, and bisexual people who face discrimination in healthcare on the basis of their same-sex attraction or orientation.

The Affordable Care Act’s Section 1557, for the first time in history, bans discrimination in healthcare on the basis of sex. Advocates have argued that if this is to be fairly applied, it should include LGBT people. Discriminating against someone because they’re attracted to members of the same sex, or don’t fit the stereotypes of what a man or woman should be because of their same-sex orientation, seems clear to many LGBT advocates to be sex discrimination.

Courts have grown more accepting of including transgender people in these protections, but have been reluctant to use sex discrimination laws to protect LGB people. (In fact, watch Terveer v. Billington, a federal case progressing now that this week seemed to be cutting our way.  Mr. Morales wasn’t familiar with the development of that case, so he could not comment on the question of its applicability.) However, OCR is not bound by this caselaw and has it within its authority to protect LGB people fairly.

However, Mr. Morales said today that OCR will not say that discriminating against someone because of their same-sex attraction is covered by the law. “Unfortunately, no, not at this time,” he said. “That is not covered under 1557.” I repeated Mr. Morales’s position back to him to make sure I had understood it correctly, and he affirmed that I was correct.

This seems to be breaking news, and heartbreaking news, for the LGBT community. If there is a silver lining, Mr. Morales said that gender identity-related discrimination will be included in the regulations. However, even there, how good of news this remains to be seen. Some in the department “want to go farther than others,” Mr. Morales said.

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for more live coverage of the summit.

#SaludLGBTT Summit: E-Cigs are a New Face for an Old Addiction

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

 

“Que es?” Dr. Jeannette Noltenius asks the crowd as she “lights up” an electronic cigarette on stage. Despite its flashy look and hidden interior, it’s nothing more than another mechanism for delivering nicotine, she says.

Dr. Noltenius is here to finish up the plenary sessions at the first day of the Salud LGBTT summit. Her presentation focused on the timely issue of electronic cigarettes, or e-cigs, which I have been told have been growing very popular across Puerto Rico in the past few years.

In a regular package of cigarettes, there are 21 grams of nicotine. In one electronic cigarette, there can be as many as 26 grams – so in a few minutes, you could get a pack’s worth of the addictive chemical.

And these companies aren’t stopping with regular e-cigs. They’ve also developed a liquid version of the product that can be smoked inside an e-cig but also inhaled, mixed with drugs like Cialis, or consumed in any other number of ways. Furthermore, niche products like e-Hookah seek to draw in as many consumers as possible.

Dr. Noltenius explains that 95% of ads for e-cigs have featured the concept that they are healthier than cigarettes. Other marketing strategies include promoting that it reduces second-hand smoke and can be smoked anywhere, even indoors. But these claims ignore the addictive properties and unhealthy chemicals that define these products, as well as incidents of poisoning and even a few instances of explosions, one of which lit a three-year-old child on fire.

Distributors have been marketing heavily and handing out free products on the streets as a way of getting people hooked. By and large, they are unregulated in how they can advertise, unlike traditional cigarettes are today; the FDA hasn’t yet exercised its power to regulate them. They are targeting the LGBTT community with club promotions and sexy ads the same way cigarettes were pushed upon our community. And Dr. Noltenius cautions that they will be trying to “buy” the LGBTT community with offers of funding for issues like HIV prevention that allow them to infiltrate our social spheres. You will end up repaying them, she warns, in the long run.

Tobacco companies might have been threatened by the rise of e-cigs, but they solved that problem by buying them out. Today, most of the e-cigs are owned by the same corporations that have caused millions of smoking-relating death. Now they are marketing e-cigs as a safer alternative to their own more traditional products.

E-cig makers are seeking to re-normalize smoking, Dr. Noltenius says, with the tobacco companies now projecting that consumption of e-cigs will exceed that of traditional cigarettes in just ten years. If that’s the case, this issue will only become more important for us to tackle as a community.

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!

#SaludLGBTT Summit: Intersections of Violence and Health

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

 

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

Corey, live-tweeting and blogging the summit

 

My first official meeting here in San Juan, before the start of the Salud LGBTT summit at which I’ll be presenting, was with local attorney Thomas Bryan. Thomas founded Fundacion Gaviota several years ago after his activism following the death of a transgender victim of a hate crime led him to be interested in preventing future hate crimes and in ensuring the prosecution of those who commit them.

I’ve recently become a volunteer advocate with GLOV, an organization that does similar work in the DC area. Because much of my professional life focuses on LGBT health policy, I’ve lately been wondering: what are the intersections between violence and health outcomes?

Of course, the most immediate and direct health implications of violence – be it intimate partner (domestic) violence, police violence, or hate crimes – are the medical needs of the survivor. For survivors of intimate partner violence, the violence, and thus need for medical attention, is often ongoing.

LGBT people who need medical care after experiencing violence may face difficulty in receiving it. Reports have shown that a significant number of LGBT people – especially the trans community – have faced violence or mistreatment by law enforcement or medical authorities, so LGBT survivors of violence may be afraid to call 911 or take themselves to a provider.

There are also mental health harms that are inflicted not only on survivors of violence but also on the community as a whole. These mental health issues, such as anxiety, PTSD, etc., may go untreated for LGBT people who do not think that they can get culturally competent mental health care. Older LGBT people in particular may recall that mental health professionals at one time (and, in some places, still today) considered homosexuality or gender dysphoria to be mental illnesses and contributed to the harm faced by LGBT people.

Finally, the persistence of violence against and within the LGBT community can give people a sense that the system is failing them. This institutional mistrust can cause people to think that interacting with any type of official authority – including getting signed up for a government insurance program, or going to see a medical provider – is not going to be helpful to them.

Bryan told me that last year, a law was passed that modified Puerto Rico’s intimate partner violence laws so as to be inclusive of the LGBT community. When the Violence Against Women Act (VAWA), a federal law, came up for reauthorization recently, advocates overcame opposition from some conservatives to ensure that the LGBT community was not be left out of intimate partner violence funding. And the Shepard Act that passed a few years ago adds hate crimes protections for the LGBT community at the federal level. These are all good steps.

But as Bryan said to me, these laws only work if both LGBT people and the general public know about them, and if they are pursued by police and prosecutors, which has improved recently in Puerto Rico but which advocates say still has a ways to go.

When we think about all of the negative health impacts that come from this type of violence, it’s clear why ending it is a priority for the LGBT community, both in Puerto Rico and across the States.

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!

#SaludLGBTT Summit: Educating Medical Professionals on the LGBTT Community

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

 

 

This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.

 

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Disparities in health are unnecessary, unfair, and should not be a part of our society, says President of the Universidad de Puerto Rico’s Medical Sciences Campus, Dr. Edgar Colón, opening the Salud LGBTT summit in San Juan. Discrimination and disparities can take many forms, and we need to work on eliminating them, he added.

This week’s LGBTT health summit is the first to offer continuing education credits for doctors and nurses. This is critical for training the medical community and exposing them to the unique needs of LGBTT people, says Juan Carlos Vega, president of the summit (and a Network Steering Committee member who is also blogging about the event, and who is pictured above).

Yesterday, I met with Joel Ayala, an attorney at the Civil Rights Commission of Puerto Rico who is focused on LGBTT issues. Joel shared with me that finding culturally competent medical professions here in San Juan can be very difficult for LGBTT people. It is especially difficult to find specialists, he says; for example, transgender people who need gynecologists have a very difficult time and are often unable to receive care.

Furthermore, those providers who work well with LGBT people are often out of financial reach for LGBTT persons, Joel said. According to Puerto Rico’s Medicaid website, 1.7 million Puerto Ricans – out of 3.7 million total people – are on Medicaid or related insurance programs for low-income people; another 700,000 are on Medicare. Many high-end providers who are more educated on LGBTT issues do not accept public insurance programs, which have a low reimbursement rate compared to private plans or what they can make by simply not accepting insurance.

Without knowing about LGBTT behaviors and risk factors, preventative health efforts by providers will not be successful, says Alex Cabrera Serrano, who spoke about the 2012 Behavioral Risk Factor Surveillance System report on Puerto Rico’s LGBT community. While the tobacco use rate for the general population has been declining, and currently rests at around 12% for non-LGBTT people, it has been increasing in the LGBTT community – currently at 23%.

This summit is a vital part of the effort to educate the medical community on LGBTT issues – including the disparities the community faces, the unique health needs we have, and the pitfalls in treating LGBTT people in an insensitive or discriminatory fashion. The professionals who are attending this week’s events deserve credit for taking responsibility to provide all their patients with excellent care.

Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!