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HIV Transmission -> What We Know & Why States Are Getting It Wrong

HIV

andrew shaughnessy

By: Andrew Shaughnessy, Manager of Public Policy
PROMO Missouri
@AndrewShag

AIDS.gov states that certain body fluids from an HIV-positive person can transmit HIV.

The body fluids mentioned are: Blood, Semen (cum), Pre-seminal fluid (pre-cum), Recital fluids, Vaginal fluids, & Breast milk.

Nowhere on this list does it mention saliva. Missouri laws, similar to several States, criminalizes behaviors that the CDC regards as posing either no risk or negligible risk for HIV transmission, this includes saliva. The Justice Department goes so far as to detail the best practices States should incorporate to make HIV-related laws align with science.

However, earlier this week, Missouri Legislator Travis Fitzwater (R -49) introduced Missouri House Bill 1181, which would have made it a crime for an individual knowingly infected with HIV to intentionally project saliva at another person.

HB 1181


Missouri is no stranger to strict laws (MO Rev. Sec. 565.085) that criminalize certain behaviors that have been proven by science to not transmit HIV. Several States still reference criminal statutes that fall under this category, which is why States should start modernizing their HIV criminal laws: now. Enacted through the fear of the 80s – early 90s, Missouri, like many States, continues to get it wrong it when it comes to effective HIV/AIDS policy. States enacted these laws with the intention of reducing HIV transmission, however research shows that these fear-based laws have the opposite effect and help HIV proliferate.

Missouri House Bill 1181 was scheduled for a hearing on Tuesday April 7th, but at the last moment was taken off of the docket. This hopefully signals a step in the right direction — but we still have a long journey ahead. Advocates in Missouri and nationwide should continue to monitor any legislation that seeks to further criminalize people who live with HIV.

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Missouri Case Study 12 – Sparking Interest from Rural Missouri Hospitals on LGBT Health

andrew shaughnessyBy: Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@AndrewShag

Upon concluding the review process for our Mid-Missouri and Southeast Missouri hospitals, health advocates were faced with the challenge of sparking interest among rural hospital officials on a review of their LGBT welcoming policies. Knowing the formula for sparking interest among urban hospitals, we knew that rural outreach would be considerably different. Putting on our strategy caps, advocates came up with a road map to engage these hospitals.

One issue that we felt needed to be overcome was the assumption that LGBT health is not an issue in rural Missouri – quite the contrary. We know that LGBT folks exist and live in every county in Missouri and across the Nation and we know that they utilize health and social service facilities – just like any citizen. But, disproportionately sexual minorities experience poorer health outcomes than our heterosexual peers according to the Missouri Foundation for Health.  Often times this is because of the invisibility LGBT rural folks feel within health and social service policies – it was our task to break our invisibility.

With this, advocates set out by utilizing the community, and the tools we learned from our outreach with urban hospitals. Through a series of strategic mailers that included a report of the hospitals LGBT welcoming policies as well as copies of local news articles that focused on LGBT health, advocates began to engage these officials.

In our outreach to rural hospital officials, advocates developed four points:

1. Create a sense of urgency – by highlighting local news articles that focus on LGBT health we were able to break our invisibility and create a sense of urgency. In developing these pieces, we also helped to start a community dialogue on LGBT health and the issues associated, including the lack of regional LGBT welcoming policies.

2. Highlight successes to create credibility– knowing this was the first time that these hospital officials would have likely been engaged by LGBT advocates, we wanted to create credibility from the begin by highlighting our past successes with urban hospitals.

3. Report along with methodology – to let officials know how we came to our conclusion on their LGBT welcoming policies, further establishing credibility.

4. Clear ask from the officials.

To review the packet of information sent to rural hospitals, please click here.

In the next case study, we will outline the work of the LGBT health advocates in outreaching to these officials along with lessons learned in moving forward with rural outreach on LGBT health.

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Missouri Case Study 11 – Reviewing LGBT Welcoming Policies in Rural Missouri Hospitals

andrew shaughnessyBy: Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@AndrewShag

At the beginning of February 2015, LGBT advocates in Missouri began reviewing our second list of hospitals on their LGBT welcoming policies. Having successfully accomplished several LGBT policy victories during our first round of outreach, we began to tackle a new beast — rural Missouri.

Choosing 10 hospitals throughout the Mid-Missouri and Southeast Missouri region, we began our review. Reviewing rural hospital policies as an outsider can be difficult. Our researchers, however, presented themselves as regular patients that really only had one connection publicly* with these hospitals — their website. Herein lies several challenges to this research. Difficulties in the regular maintenance of a hospital’s website, problems with the lack of hospital organizational structure to allow for maintenance, and the years of slowly decreasing revenue adding to the lack of structure; could lead to possible inaccuracies from the data collected during the reviewing process. We, however, have not experienced any hospitals who have challenged our review.

How did we begin to review a rural hospital’s website?

  1. Identify hospital’s main website – for most rural hospitals this could be the website that their System had set-up, make sure to check both. If the hospital’s website links to the System network, then make sure to check the System website for their LGBT welcoming policies.
  2. Use search engine to identify key terms used by LGBT patients – this includes searching for terms such as “discrimination”, “sexual orientation”, “gender identity”, “visitation”, “patient rights”.
  3. Document and log policy research – in order to create the individualized reports, while also maintaining for your records whether policies do or do not exist before beginning our outreach.

Upon reviewing each hospital website, we concluded our findings and began to work on outreaching to those hospitals in hopes of sparking their interest in reviewing their policies. Next Missouri case study, find out the strategy used in outreaching to rural hospitals to spark their interest in LGBT welcoming policies.

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Pressure Building to End Trans Exclusions under Obamacare

andrew shaughnessy

By: Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@andrewshag

Before the end of 2014, my organization (http://www.promoonline.org) urged Missourians to consider supporting a complaint that urged the United States Department of Health and Human Services to end exclusions under Obamacare for transgender folks. The complaint highlighted the individual story of a Missourian who experienced the effects of these exclusions, first hand, when he was approved to receive a marketplace plan. Hundreds of Missourians weighed their support to this complaint in hopes of ending basic health coverage exclusions for an already marginalized community.

Pressure continues to build as several organizations under the LGBT State Exchanges Project weigh concerns to Center for Medicare and Medicaid (CMS) about possible transgender exclusions in certain qualified healthcare plans. Among the items in need of review was the clarification of ‘discrimination’ under the Affordable Care Act. The complaint urged CMS to issue guidance with specific examples of benefit design features—such as transgender-specific exclusions—that are discriminatory against protected classes of consumers under the Affordable Care Act. The aim is to make sure CMS leads a thorough investigation into marketplace plans for any forms of exclusions often held by issuers to transgender folks.

It’s telling when the Missouri Foundation for Health found that sexual minorities in Missouri are 1.5 times more likely to be uninsured than the general population, that this population continues to face barriers when it comes to accessing the healthcare they need. It was our conclusion then and now that exclusions still do exist under certain federally qualified Healthcare plans, which continues to violate Section 1557 of the Affordable Care Act. We are waiting for a response from the Department of Health and Human Services on our filed complaint and will keep you informed as we work to end exclusions under Obamacare.

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Ending Exclusions Under Obamacare

Andrew Shaughnessy, Manager of Public Policy for PROMO

By: Andrew Shaughnessy
@andrewshag

For the LGBT community health is a complicated matter. It is further complicated when health insurance companies deny or exclude certain forms of coverage that for some are basic health needs. For LGBT folks seeking gender-affirming health care coverage barriers exist at every turn — until the Affordable Care Act. Or so we thought…

Section 1557 of the Affordable Care Act prohibits discrimination on the ground of race, color, national origin, sex, age, or disability under “any health program or activity, any part of which is receiving Federal financial assistance … or under any program or activity that is administered by an Executive agency or any entity established under [Title I of ACA]….” To ensure equal access to health care, Section 1557 also applies civil rights protections to the newly created Health Insurance Marketplaces established under the Affordable Care Act.

End

Upon researching a complaint raised to us by a Missourian, who qualified and enrolled in a federal marketplace plan, we concluded that exclusions still exist under ACA plans that inhibit transgender patients from getting the basic care they need. Under certain Federal marketplace health insurance plans exclusions have been put in place that state “sex change services and supplies for a sex change and/or reversal of a sex change.”

A real life example of how this affects transgender patients was raised to me, “I had a large cyst on my ovary that had to be removed a several years ago. I hadn’t started transitioning, so my insurance company didn’t blink when I claimed the surgery to remove it. Fast forward to now. If I had the same problem and walked into the doctor’s office with a beard and “male” on my documents, the insurance company can (and would absolutely) deny my claim.”

The State of Missouri’s, along with several states’ ACA exchange, is administered by the federal government and is governed by this rule, however this exclusion is a clear violation of Section 1557. Transgender patients who rely on marketplace coverage for health insurance are forced to censor their own health management for fear that marketplace plans will deem any healthcare on a transgender body excluded from the plan.

I along with the support of hundreds of Missourians requested that the Department of Health and Human Services investigate these claims and make efforts to remedy any claims of sex discrimination in health insurance plans under the Affordable Care Act.

If you are or know someone who is affected, please consider making a request to the Department of Health and Human Services to investigate these claims.

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Welcoming Spaces for LGBT Folks Seeking Marketplace Insurance

Andrew Shaughnessy, Manager of Public Policy for PROMO

Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@
andrewshag

Gaining access to affordable health insurance has never been easier. Thanks to Healthcare.gov, LGBT folks are able to research and choose a marketplace plan that fits their individual or family needs and purchase the plan – all free from discrimination.  This is an amazing step forward for the LGBT community, and a life-saving one for many.

The failure of many state legislatures, including my own in Missouri, to protect LGBT individuals from discrimination has negatively impacted their health.  Specifically in Missouri, research shows that LGBT Missourians are twice as likely to forgo care both preventative and in cases of emergency compared to our heterosexual peers according to the Missouri Foundation for Health.

The insurance marketplace (Healthcare.gov) has been set-up to include nondiscrimination protections based on sexual orientation and gender identity. This means that lesbian, gay, bisexual, and transgender folks can peruse marketplace plans and be their authentic self, free from the fear of discrimination.

During the 2014 enrollment period, PROMO launched its LGBT Welcoming Spaces program for navigators and CACs, who help community members navigate the healthcare marketplace. The program focuses on education for navigators, assistors, and CACs on LGBT health and ways to help them visibly make their organizations LGBT welcoming.

LGBTHealthLogoMO-1 copy

In Missouri, welcoming spaces can be identified by searching for the above ‘Welcoming Space’ image. Seeing this symbol indicates that their organization has completed the necessary requirements to be LGBT Welcoming.  Visible signs of being LGBT friendly, including the adoption of the welcoming spaces images, are tools that we’ve provided to health and social service organizations to utilize.

Living in a state that does not protect against discrimination, it is imperative that we continue to create spaces in our health and social service organizations that are welcoming to all.

LGBT Policy · Show Me MO · Technical Assistance · Updates

Missouri Case Study 10 – Making LGBT Health Matter in Missouri Hospitals

Andrew Shaughnessy, Manager of Public Policy for PROMO

Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@andrewshag

This year has proven to be a monumental year for LGBT Missourians. Those monumental steps have been the recognition of out-of-state marriages by the State of Missouri, and the leadership of nearly 47 Missouri hospitals, who have included 105 new LGBT welcoming policies to their core values. As an LGBT Missourian it certainly gives me relief to know that I can access health care facilities and be me: my authentic self.

In 2013, only two Missouri Hospitals, Children’s Mercy in Kansas City and the VA in St. Louis, qualified as leaders in the Human Rights Campaign Care Equality Index (HEI). In the coming days the health sector will see the launch of the 2014 HEI, where several of Missouri’s top hospitals have been reviewed on their lesbian, gay, bisexual and transgender (LGBT) welcoming policies.  This year, Missouri will see several hospitals both in rural and urban areas that have been working to ensure their facilities are welcoming to all.

To learn more about the policies of Missouri Hospitals, click here for a map detailing their LGBT welcoming policies.

We have truly made LGBT health matter among Missouri’s top hospitals, but the work of the LGBT health policy project does not stop there. Through the technical assistance of Dr. Scout, Director of LGBT HealthLink, we will continue to work with health and social services organizations in Missouri to ensure that we are creating spaces free from discrimination. Through our collaboration with Sherrill Wayland, Executive Director of SAGE Metro St. Louis, we will be training Missouri’s health and social service professionals to understand the unique needs of LGBT patients.  And we will continue to advocate for the health of LGBT families and our families of choice.

As we begin to look at the legal future for the LGBT community, we must be concerned with the growing disparities we find in LGBT health. Our next frontier is on the borders of health and making sure that we are a strong and healthy community. I’m humbled to be a part of this work. Having experienced discrimination in a health care setting myself, I assure you your voice is not going unheard.

 

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Missouri Case Study 9 – Selling A Policy Review to Hospital Officials

Andrew Shaughnessy, Manager of Public Policy for PROMO

Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@andrewshag

Often times the hardest part of policy work is finding the right person to connect with who can make policy change happen. The tricky part is once you have finally identified your contact, what next? What do I say to get them engaged in a review of their internal policies? In the last installment of the Missouri case study, we revealed tips that would help LGBT health advocates maximize their engagement with hospitals and their targets. In this installment, we will discuss some points to keep in mind when talking with Senior-officials that ultimately got them engaged and interested in reviewing their hospitals welcoming policies.

During our follow-up call routine, we had the opportunity to connect with Senior-level officials from 11 of Missouri’s Top hospitals. Many of them helped us connect with the right person in their hospital, who can address the policy concerns; sometimes we were referred to their parent healthcare organization. Often than not they were curious to seek technical assistance on our review.

It is important that once you have been connected to a Senior official of the hospital to make the most of your outreach with them, without taking too much of their time.

Four things to keep in mind:

  1. Confirm that they have seen and reviewed the outreach letters – most of the time I was asked to give a brief background of our work.
  2. Reiterate the urgency – mention the Healthcare Equality Index and the Joint Commission guidelines for patient-centered care, let them know that you can follow-up with any information.
  3. If still hesitant – make a business case for why LGBT welcoming policies are critical to the hospitals and the patients they serve.
  4. Re-ask our main ‘ask’ again… – have you identified a hospital representative who will be working on these policy updates, if so, can we be connected with them.

We had found that after we had ‘re-asked the ask’ the Senior official was able to either give us a name and contact information of the person who would be our representative, or identity themselves as the main contact. Most of the time, we continued to work with the Senior official until the policy changes had been made. The next installment of the Missouri case study, we will provide a breakdown of the technical assistance process we offered to hospitals, including best tips for success. We have several success stories to offer readers in the next installment: stay tuned!

 

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Missouri Case Study 8 – Maximizing Our Missouri Hospital Outreach

Andrew Shaughnessy, Manager of Public Policy for PROMO
Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri

Building off of the successful strategy in sparking Missouri hospitals into reviewing their LGBT welcoming policies, Missouri LGBT health advocates knew the potential we had to maximize our engagement with area hospitals. In this installment of the Missouri Case study, we will provide health advocates a few tips that helped us to maximize our engagement with our target hospitals.

Before beginning my work in public policy, I spent several years working on individual campaigns as field staff, and for three years as PROMO Missouri’s Senior Field Organizer. Bare with me as I put my organizer cap back on. As an organizer, you learn fairly quickly how to engage, communicate, and work effectively with several different types of community members. You help to educate and provide community members with the tools they need to be champions for a cause. The same rules apply when it comes to policy outreach. Here are a few of my organizing tips that will help you maximize engagement:

Tip # 1 – Follow-Up is Key

After mailing the second letter, we waited roughly two weeks before we attempted to make contact with our targets. We followed up with two phone calls within a two week span to Assistants of the Senior-level officials, making sure to leave voice mails.

Tip # 2 – Build Relationships with Assistants

Why should you follow-up and build relationships with Assistants? For many reasons, but 2 reasons will suffice:

  1. You want to know if the Senior official had received the review letters, correct? Most of their mail would be combed by their Assistant, who would likely be able to confirm this.
  2. Assistants should be seen as the gatekeeper. In order for you to schedule meetings with, and even sometimes talk with your official, you will need to go through their Assistant. The more they get to know you the comfortable they will be giving you access.

Following these simple tips will help you maximize your engagement with hospitals. From the beginning of our first outreach letter to this point took us roughly 60 days to complete. After finishing our follow-ups, we walked away having engaged 70% of our list in some way. 35% had confirmed that they were reviewing their current LGBT policies, and 25% confirmed they were actively trying to change their LGBT policies. In the next installment of the Missouri Case Study, we will discuss the nature of our conversations with Senior officials and tips for communicating effectively with them.

 

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Missouri Case Study 7: Sparking Missouri Hospitals into Reviewing Their LGBT Welcoming Policies – Attempt #2

Andrew Shaughnessy, Manager of Public Policy for PROMO
Andrew Shaughnessy
Manager of Public Policy, PROMO Missouri
@andrewshag

The Missouri Case study is a joint project by PROMO Missouri and SAGE Metro St. Louis that highlights the policy work of the Missouri LGBT Health Policy project. In the last installment of the Missouri Case Study, we provided LGBT health advocates a roadmap of how we began engaging Missouri’s top 20 hospitals. It included examples from our initial outreach letter along with an individualized report that was sent to our targets.

Having mailed the letters and after two long weeks of hearing nothing from hospitals, we went back to the drawing board. For myself, I always remain optimistic about new actions, but we were not naive enough to know that it would take more than just one letter and individualized report to spark these hospitals. When we sat down to discuss the second attempt, we knew we had a great roadmap to build upon from our initial outreach letter. However, in the second attempt we focused our message to include only the important pieces of that roadmap:

  • Continue to create a sense of urgency – A new policy by the Human Rights Campaign’s Healthcare Equality Index makes reporting the LGBT policies of your State’s top 20 hospitals mandatory regardless if they decided to take part in the survey or not. Making this clear to hospitals helped us to create our sense of urgency for a review and gave us a tangible deadline ( HEI deadline is June 30th ).
  • Give them a look at who these policies will affect – think of what will motivate that hospital. Knowing that these hospitals were located in urban areas, and since we were talking to CEO’s and Senior-level executives, we decided to use a business case strategy.
  • Reiterate your main ‘ask’ – our main ask was to identify a representative with whom we could work and engage further on the review process.

The original second outreach letter can be found below. We mailed this letter two weeks after the initial letter along with the same individualized report to hospitals.

Keep in mind that most of these plans were used for Missouri’s top hospitals. Health advocates should review their strategy depending on the hospital that you are outreaching to. After the drop of this letter we finally heard from 3 hospitals. Our first hospital official a Senior Human Resources official had referred me to their umbrella network, who was in charge of policy reviews. The second hospital official a Senior Medical Affairs official wanted to learn more and asked us to provide their hospital with technical assistance. The third CEO personally called me to tell me that our letters had ‘sparked him to action.’ All-in-all, this strategy has proved to be a success in sparking hospitals into reviewing their LGBT welcoming policies. In the next installment, we will fill health advocates in on how we maximized our engagement with hospitals.

Outreach Letter II

Report 1