#BWLGBTI Day 3 Part 2: Community-based research is still important

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Dwayne Steward

LGBTQ Health Advocate
Columbus Public Health

 

 

We’ve come to the end of the LGBTI Health Research Conference at Baldwin Wallace University. This has been a very life-changing experience, for which I am truly grateful. Being in the room with so many experts that have and are currently making groundbreaking changes in the country, and around the world, regarding the inclusion of LGBTI communities in health research has been phenomenal. I can’t thank the Network for LGBT Health Equity enough for this amazing opportunity.

Jacob Nash

Jacob Nash

The conference began it’s last half with two lively panel discussions. The first was “Community Perspectives Regarding LGBTI Health” featuring Jacob Nash (transgender activist and director of Margie’s Hope), Alana Jochum (Equality Ohio’s Northeast Ohio Regional Coordinator) and Maya Simek (program director for The LGBT Community Center of Greater Cleveland). Jochum made some very interesting points regarding how LGBTI health research has made historic advances in LGBTI rights possible. She referenced several court cases that have used the statistics compiled by researchers, several in the room, in major courtroom arguments for marriage equality. Her examples helped further illustrate the need for the work of those attending the conference. Nash and Simek put out calls to researchers for more specified research studies on marginalized populations and offered insights on the health issues they’re seeing among marginalized populations. They both reiterated the need for more collaboration between activists and health researchers.

The conference officially ended with “LGBTI Health and Human Rights in International Settings” with a very dynamic panel of LGBTI health community organizers from Latin America and India.

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“LGBTI Health and Human Rights in International Settings” Panel

Wendy Castillo, a community organizer from El Salvador who has done work providing safe spaces for lesbian and transgender women, spoke at length about the tragic murders that continue take the lives of transgender women regularly in El Salvodor and the struggles organizations there face with trying to keep transgender women safe. Daniel Armando Calderon and Alejandro Rodriguez, both community organizers around issues facing the MSM community in Columbia, discussed how they try to decrease barriers for “heterosexual MSM’ and other special populations needing HIV care and other health services.

Vivek Anand, of Humsafar Trust, closed out the conference with more detail regarding his efforts regarding the recent re-criminalization of homosexuality in India. His organization has courageously come to the forefront of attacking this law that was passed by the country’s Supreme Court after massive efforts from religious leaders. I thinks it quite admirable that the work he’s doing is heralding and sometimes dangerous, but he faces it head on with an upbeat attitude. He ended his presentation with a video of Gaysi‘s (an LGBT advocacy organization in Mumbai) #notgoingback campaign, one of the efforts to build awareness and garner support for repealing the law. The upbeat video, featuring Pharrell Williams’ massive hit song “Happy,” is a perfect representation of Anand’s bubbly activist spirit.

And thus we end our time together my friends. Please always remember the words of Dr. Martin Luther King that I used to start this blog series, “Our lives begin to end the day we become silent about things that matter.” Let’s never end this very important conversation!

#BWLBGTI Day 2 Post-Lunch: Revisiting sexual health

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Dwayne Steward 
LGBTQ Health Advocate
Columbus Public Health

After lunch at day 2 of the LGBTI Health Research Conference at Baldwin Wallace is all about sexual health. Historically this would have been the bulk of such a conference as this. As most of us know, pathology-focused research on homosexuality and gender diversity, along with the stigma associated with the HIV/AIDS epidemic forced LGBTI healthcare into a sexual health box for many years. It’s interesting to see that the pendulum is swinging back the other way in some ways as we as LGBTI healthcare workers/researchers are now having to convince certain communities that sexual health is still an important factor of the LGBTI health experience.

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Dr. Anthony Silvestre, professor of Infectious Disease and Microbiology at the Graduate School of Public Health at the University of Pittsburgh, opened with a lunch-time keynote on the history of sexual health research, reminding us how far we’ve come regarding the study of sex and sexuality in this country. He than joined Dr. Brian Dodge, Indiana University-Bloomington School of Public Health, for the “LGBTI Health Training” seminar track, which included a lively discussion on the changing landscape of HIV and intersectionality in public health research.

There was definitely a lot of talk about training program models in Indiana and Pennsylvania, but through the lens of sexual health research. Dr. Silvestre spoke on University of Pittsburgh’s LGBT health certificate program along with several other LGBT-focused specialized programs the university offers, including a post-doctorate program that specialized in MSM (men who have sex with men) healthcare.

Dr. Dodge made several interesting conjectures about the study of sexual health saying, much of the conversation regarding sexual health has been risk based. “We need to be including more about the actual pleasure of sex and begin taking a more sex-positive approach. It is okay for gay sex to be enjoyable,” he said. He went on to say that programs should take a more competency-based approach to better prepare students for their post-college endeavors.

My fellow Network for LGBTQ Health Equity scholarship recipients Heru Kheti (middle) and E.Shor (right).

My fellow Network for LGBTQ Health Equity scholarship recipients Heru Kheti (middle) and E.Shor (right).

Dr. Francisco Sy, director of the Office of Community-Based Participatory Research and Collaboration at the NIH/National Institute of Minority Health and Health Disparities (NIMHD), took a moment to educate the audience on the NIH grant process and how to best navigate their grant application process. But the day’s real winner was Dr. Erin Wilson’s presentation, “HIV Among Trans-Female Youth: What We Now Know and Directions for Research and Prevention.” Dr. Wilson, who is a former NIMHD Loan Repayment Program (LRP) recipient and research scientist currently with the AIDS Office at the San Francisco Department of Public Health, quickly (due to time constraints) spoke on her ground-breaking NIH-funded research on the social determinants of health that led to high HIV-infection rates for transgender female youth in Los Angeles.

The statistics Dr. Wilson reported were pretty staggering. She prefaced much of her presentation by saying her studies were very specific to L.A. and she had no research to show that this was reflective of the national transgender female population. She reported finding that transgender females in L.A. were 34 times more likely to contact HIV than the general population and at the time of her study nearly 70 percent of transgender female youth in L.A. participated in sex work. As a result of her work The SHINE Study was created, the first longitudinal study of trans*female youth that still continues today. Though nearly 40 percent of transgender females in L.A. are living with HIV only 5 percent are youth. “We have a great opportunity to get ahead of this disparity and create some real change,” she said.

That’s all for today my friends. Check back tomorrow for a full report on Day 3 of the Baldwin Wallace University LGBTI Health Research Conference (#BWLGBTI)!

President’s Budget Highlights LGBT 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.

 

 

Even most casual observers know that the President’s budget proposal, released yesterday, is unlikely to become law (so much so that Senate Democrats won’t even vote on it this year).  But budgets are really just outlines, anyway – even a passed budget needs separate laws to dole out the promised money – and in this way, it’s the symbolism of budget proposals that’s most important.

So it should be comforting to those of us who care about LGBT issues to see that the White House released a fact sheet dedicated to explaining how the President’s budget helps our community.  What’s more, LGBT health (and other aspects of LGBT life that impact health) were front and center in the report.

The fact sheet has a whole section on disparities, noting that it “supports community effort to focus on prevention, including using evidence-based interventions to address tobacco control, obesity prevention, and better nutrition and physical activity.”  It also supports expanding health care services, which will hypothetically benefit all groups with health disparities, and increase data collection.  The budget also maintains funding for the Affordable Care Act and, as touted by AIDS.gov, expands access to care and housing assistance for people living with HIV.  These points cover quite a few of the health disparities that I recently outlined as plaguing the LGBT community.

What’s more, the budget addresses several types of violence that have a disproportionate effect on the LGBT community – in terms of both the physical harm that befalls individuals, and the greater social and emotional harm that afflicts LGBT people who live in a culture of violence.  (Recent research, noted on the Network’s new HuffPo LGBT Wellness page, has confirmed that just living in a community that is homophobic can take years off an LGBT person’s life, so this latter point shouldn’t be ignored.)  What are these types of violence?  Well, there’s domestic violence, which the budget addresses by funding the Violence Against Women Act (VAWA), a law that Republicans in Congress have attempted to keep exclusive of the LGBT community despite the high rate of domestic violence we face.  Closely related is the problem of hate crimes, which the budget addresses by providing funding for the Justice Department to prosecute offenders.

Then there are a few more social types of violence that nonetheless can have a major impact on LGBT health.  Civil rights violations and homelessness are both problems that are targeted by the budget, and are also problems that – if left unaddressed – greatly diminish the chances of LGBT people having good health.  We might not think of homelessness as a health or violence issue, but as someone who works with homeless individuals, I have personally found that it is extremely difficult for someone to stay on their medication and keep doctors’ appointments when they have nowhere to live.   And that’s to say nothing about the psychological and nutritional toll, as well as the risk of disease, exposure, and harassment one faces by having to sleep outside.  Kicking someone out of their house is a form of social and economic violence, and as many as 40% of homeless youths identify as LGBT.

Let’s face it, this budget won’t become law.  But it does show that the administration does a pretty good job of “getting it” when it comes to systemic problems that plague the LGBT community.  That’s not to say there isn’t more that we can do as a society to improve LGBT health outcomes, but it’s a good start.  And it serves as a reminder that we have to think broadly about LGBT health and dig into underlying social problems (as well as get some government funding) if we want to end disparities.

Upcoming Conference! Unity through Diversity: A national LGBT people of color health summit

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Upcoming conference calls for proposals 
Unity Through Diversity: A National People of Color Health Summit
February 20-23rd, 2014 | Albany, NY 

 

The Unity Through Diversity: A National LGBT People of Color Health Conference, being held in Albany NY, february 20-23rd is seeking workshop proposals!

This year’s focus is on “The Power of Unity”;

This year, the LGBT movement has taken enormous strides in the struggle for marriage equality. For LGBT POC, however, our struggle is far from over. In this same year we have also lost family and community members to violence against transgender people, HIV/AIDS, suicide, bullying, ableism, and homelessness. Additionally, the disproportionate incarceration rates among people of color – particularly among African Americans – and the racial profiling so prevalent in our society continues to put the safety of young African Americans at risk. Our struggle is not over.

There are only a few days left to submit your proposal, so hurry up and get those in by Nov. 15th! For information on proposals, click HERE.

Additionally, there are scholarship (and sponsorship) opportunities- so spread the word!

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A Year In Review: Spotlight on North Dakota Department of Health Tobacco Prevention and Control Program

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Gustavo Torrez
Program Manager
The Network for LGBT Health Equity
 
 
 

When I started working with the Network almost 4 years ago the first state I had the pleasure to visit was North Dakota. During my visit I conducted two LGBT Cultural Competency training one for their grantees, and another at their Annual Statewide Alcohol and Substance Abuse Summit. At that time they were thinking about strategies to include LGBT communities in their tobacco control work and have not looked back since. I had the privilege of going back and spoke at the 3rd annual statewide GLBTQA conference held at the University of North Dakota this past

Left to Right: Neil Charvat, Gustavo Torrez, Rep. Kayie Overson, Rep Josh Boschee, and Krista Headland

Left to Right: Neil Charvat, Gustavo Torrez, Rep. Kayie Overson, Rep Josh Boschee, and Krista Headland

April, and was overjoyed at the progress they have made over the past couple years in terms of community support for LGBT tobacco control efforts. At times we can see progress through emails and updates here and there, but to actually see the level of community support for LGBT Tobacco Control efforts was absolutely amazing. From local LGBT groups to State Representatives its was truly refreshing especially for a state like North Dakota.  Over the past couple of years work in North Dakota has not stopped, in fact the work has grown to include more and more folks in the community committed to LGBT Tobacco Control efforts in the state. Neil Charvat, Community Health Specialist with the Chronic Disease Program at the North Dakota Department of Health has truly made some huge strides in the state. Neil has been charged with the talk of LGBT inclusion efforts and has forged many partnerships which have truly shaped the direction of their efforts. Most recently, a great article was published North Dakota puts $2,500 in anti-smoking funds toward Fargo pride festival, highlighting some of these efforts.

I wanted to take a moment and showcase in depth some of the great work that has taken place over the past year, and thank Neil for his commitment to inclusion efforts in North Dakota. I am so proud of the work that he has not only accomplished, but how the Department has truly institutionalized LGBT tobacco Control efforts in North Dakota. Please read his article below as he article below –  Engaging Disparate Populations: North Dakota LGBT Communities.

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Neil Charvat
North Dakota Department of Health
Tobacco Prevention and Control Program
Fiscal Year July 1, 2012 – June 30, 2013

Engaging Disparate Populations: North Dakota LGBT Communities

The Tobacco Prevention and Control Program (TPCP) in the North Dakota Department of Health (NDDoH) work to engage populations disparately effected by tobacco use on a statewide level. One of the populations identified by the Centers for Disease Control (CDC) as having high tobacco use rates and being targeted by the tobacco industry is the Lesbian, Gay, Bisexual and Transgender (LGBT) community.

Efforts to engage North Dakota’s LGBT communities in tobacco control efforts have been made since 2008, varying degrees of success. The main obstacle has been identifying LGBT groups in North Dakota. The NDDoH TPCP was fortunate to become involved in Fargo-Moorhead Pridefest for the first time in 2011. FM Pridefest is the largest LGBT event held in North Dakota. This initial effort was to provide NDQuits information and materials to event attendees. In 2012 the ND DoH was again invited to be a part of FM Pridefest. In July, NDQuits marketing tools were utilized at the FM Pridefest 5K Run-Walk, and that event was tobacco-free. NDQuits material and information were promoted at the FM Pride in the Park in August. ND DoH staff attended the event. The staff was able to promote cessation efforts as well as provide information about tobacco issues that directly affected the LGBT community in North Dakota.

NDDoH TPCP staff had the opportunity to meet with Julia Geigle at the University of North Dakota. Julia is a graduate student at UND working on LGBT health issues. The meeting was to discuss the issue of tobacco use in the LGBT community, and the health impacts that resulted from that use. Information on engaging the LGBT community and promoting NDQuits cessation services were provided to Julia. As a result of this meeting, Julia invited the TPCP staff to participate in a UND LGBT conference in April, 2013. NDDoH was able to involve Gustavo Torrez from the Fenway Institute in the UND Conference. Gustavo travelled to the conference to present on LGBT tobacco and health issues. Gustavo was also able to engage North Dakota legislators in attendance by providing information on LGBT health issues. The conference was well attended by the UND LGBT campus community. As a result of the success of this event, there are plans to incorporate more events like this into the newly created ND Campus Tobacco Prevention Project. This project will involve most college campuses in North Dakota.

The NDDoH TPCP will continue to engage the LGBT in future tobacco prevention work for the next fiscal year.

Network Funding Ending? Yes, But You Can Help It Continue.

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Scout, Ph.D.
Director, The Fenway Institute’s Network for LGBT Health Equity

Yes it’s true, the 5 year CDC Office of Smoking and Health coooperative agreement we’ve been funded from will be ending in a few more weeks. But before anyone gets upset — remember we were a Network of people working together before there was paid staff, and in the event we no longer had that luxury, we’d simply move back to our old model. (staff schmaff!) But we hope we don’t even need to go there, because there’s another five year award for networks we’re applying for now!

The Network’s first priority now is getting refunded and you can help! Do you think the Network is valuable? Then please write a letter of support for this next proposal.  The staff will be happy to send you a sample, just email LGBThealthequity@gmail.com and ask.

This new award has some substantive changes — primary among them that the new networks will be for tobacco AND CANCER health disparities. Plus, built into that model are cancer prevention strategies, particularly eating well and exercising more. (*scratches head* Now who do we know who understands those cancer disparities?) The networks also seem to have a new emphasis on changing community based practices, that’ll be an interesting area of work. Plus there will be more disparity networks than before, up to ten, at least one new one for mental health (smart!) and possible a geographical one, and our old favorite -a wildcard network.

Old friends know we’ve actually had to compete under the wildcard category for the last two rounds of funding, which made our chances of winning it much slimmer. So odd, while there was a set-aside LGBT tobacco network for the first funding round (during the Clinton administration), it was removed for the next two (during the Bush administration), it beats me how that happened. Anyhow, nicely now science has led the day again and CDC is hoping one of the networks will specifically serve LGBT people. But there’s no guarantees!

There will also be a small funding gap between the two awards. Our current one will likely end somewhere in July, the new one, IF we get it, is expected to start in September. We might play a bit in August… but we’ve also got some backup plans so staff doesn’t wander off.

So, there’s some real changes afoot for the Network for LGBT Health Equity and it’ll be a bumpy Summer. But the staff and the Steering Committee are  optimistic there’ll be a stronger and broader Network come Fall!

LESBIANS AND BISEXUAL WOMEN LAG BEHIND IN RECEIVING ADEQUATE CERVICAL CANCER SCREENINGS

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Sarah Peitzmeier, MSPH
Clinical data specialist 
Fenway Institute

 

 

LESBIANS AND BISEXUAL WOMEN LAG BEHIND HETEROSEXUAL WOMEN IN RECEIVING ADEQUATE CERVICAL CANCER SCREENING, DESPITE BEING EQUALLY AT RISK FOR CERVICAL CANCER 

Lesbians and bisexual women are as likely as heterosexual women to develop cervical cancer, but are up to 10 times less likely to be regularly screened for it, putting them at greater risk of the potentially deadly disease, according to a policy brief released by The Fenway Institute. This disparity is due to a misconception that sexual minority women are not at risk for cervical cancer as well as their broader marginalization in the health care system.

Yearly, over 12,000 American women are diagnosed with cervical cancer and over 4,000 die from the disease. The majority of cervical cancers in the US occur among women who have never been screened or who were not screened within the past five or more years. This is bad news for lesbians and bisexual women, who are less likely to undergo routine screening for cervical cancer. The vast majority of cervical cancers are caused by a human papilloma virus (HPV) infection, and many sexual minority women – and their healthcare providers – are under the misperception that HPV cannot be passed between women during sex. In fact, because HPV passes through skin-to-skin genital, as well as potentially through oral-vaginal and digital-vaginal contact, even women who exclusively have sex with women are at risk for contracting the virus, and by extension, cervical cancer. Multiple studies have shown that lesbians and bisexual women are just as likely as heterosexual women to have HPV and cervical abnormalities that could potentially lead to cancer if unchecked.

Current guidelines recommend that screening start for all women at age 21, regardless of HPV vaccination or age of sexual debut, and continue every three years until age 29; the screening interval may be lengthened to every five years for women ages 30-65 if HPV co-testing is done in addition to the Pap test.  Women with a history of a prior abnormal Pap test or who are immune compromised (e.g. by HIV) should be screened yearly.

The brief concludes with a set of policy recommendations, including:

  • –Promote routine cervical cancer screening for lesbians and bisexual women through patient in-reach and community outreach with sexual minority-specific messaging, wording, and peer education;
  • –Increase training for clinicians in the reproductive health needs of sexual minority populations, including the need for regular cervical cancer screening among women who have sex with women;
  • –Promote HPV vaccination as a primary prevention strategy among lesbians and bisexual women;
  • –Include transgender men (individuals born with female reproductive organs but who identify as male, many of whom still retain a cervix if a total hysterectomy is not performed) in cervical cancer screening programs;
  • –Collect sexual orientation and gender identity data in cancer registries, patient medical records, and health surveys to better understand the burden of cervical cancer and cancer screening practices among this population.

“Lesbian and bisexual women experience a number of health disparities,” said Stephen Boswell, MD, President and CEO of Fenway Health. “The Affordable Care Act’s expansion of health care access and efforts by the federal government to increase clinical competency in LGBT health care offer opportunities to reduce the disparity we see in cervical cancer screening.”

A PDF of the cervical cancer screening policy brief is available online at www.fenwayhealth.org/cervicalcancerfocus.