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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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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.

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.

 

LGBT Policy · Show Me MO

Missouri Case Study 4: Nudging Missouri Hospitals on LGBT Welcoming Policies

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

Building off of the work of Tracy McCreery, former Manager of Public Policy for PROMO, my name is Andrew Shaughnessy, current Manager of Public Policy. In the last installment of our Missouri Case study, Tracy observed firsthand the difficulty in getting Missouri-based hospitals, which clearly have LGBT friendly policies, to stand up as leaders in filling out the Human Rights Campaign’s Healthcare Equality Index (HEI). Don’t worry – this still remains the case for some hospitals – but we are seeing a positive shift from many of our targeted hospitals.

Going into this year, our work centered around hospital outreach and education around LGBT welcoming policies. We were interested to see how Senior-level Hospital Executives would react to our outreach efforts for the HEI and its welcoming policy requirements. Given the prior environmental circumstances we faced, we were pleasantly surprised by the reaction we have received thus far. From what we have heard back from our first round of outreach, we know that our work is affecting positive policy change for LGBT Missourians.

Several targeted hospitals, including two network wide hospitals, which will include 14 new hospitals to our original list, have committed to improving their LGBT welcoming policies. Out of the targeted 20 hospitals that PROMO had originally reached out to regarding HEI requirements, we have made contact with, and provide technical policy assistance to six. Three Senior-level Hospital Executives disclosed to us that our outreach efforts had ‘inspired’ them to take action and update their policies.

Now whether they chose to be recognized as ‘2014 Leaders’ will be the next challenge we face, however I can sleep easier knowing that this effort is working. Sometimes all hospitals simply need is a nudge from local LGBT organizations to start the process. Andrew Shaughnessy Manager of Public Policy, PROMO

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Missouri Case Study 3: The Hospital That Wants To Stay In the Closet

Tracey PROMOTracy McCreery
Manager of Public Policy, PROMO
The Closeted Hospital Lobby
The Closeted Hospital Lobby

A targeted hospital, when we researched online, was discovered to have what appeared to be a perfect score on the Human Rights Campaign (HRC) Healthcare Equality Index (HEI). How exciting, right? Now I just needed to find someone inside to complete the survey. I didn’t know anyone on the management team, but from my days in the legislature I’d met and worked with the hospital’s lobbyist. He had some checking to do and what he reported to me was a bit shocking but maybe not really surprising, this is Missouri after all. This hospital did not want anyone to know about their policies and so were not going to complete the survey.  No explanation was given so I can only speculate. Are they worried about anti-LGBT protesters outside their hospital? Obviously, executives at the highest level think it is important to have policies that are friendly to both LGBT patients and employees. But until those policies are promoted to patients they won’t really create any change. Our job in the next year will be to convince them that the public supports workplace fairness and an LGBT patient’s right to health care free from discrimination.

People need to know this information, so why am I being mysterious?  Because I prefer the carrot (versus the stick) approach.  I will be working with this hospital to encourage them to complete the 2014 HRC HEI.  I’m hopeful they will do it willingly this year.  Why?  Because if they don’t, HRC is going to include this hospital in the HEI 2014 anyway.  HRC staff will evaluate them vis-a-vis the Core Four criteria for LGBT patient-centered care even if they choose not to actively participate.

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Missouri Case Study 2: The Nurse Who Changed A Whole Hospital System

Icon_2011 Headshot
Sherrill Wayland
ED, SAGE of Metro St. Louis
Cochran VA
John Cochran VA Medical Center

In 2011, when “Don’t Ask, Don’t Tell’ was repealed, the Veterans Health Administration (VA) looked at ways to optimize healthcare for LGBT veterans. The VA medical centers were encouraged to participate in the HEI.  In the past, SAGE has consulted with local Veterans receiving care at the VA and helped them navigate the system. We reached out to VA and invited them to be a part of our LGBT Health Access Roundtable.

Sometimes all it takes is one person to champion a cause.  The nurse in charge of the VA LGBT Diversity Council learned of the trainings being conducted by SAGE and invited us to join the VA LGBT Diversity Council.  This Council interacts with all levels of the VA to help ensure that the local VA is meeting all requirements set forth at the federal level to ensure LGBT health access.

A critical change was recognizing that LGBT patients may have concerns related to fair treatment and access. The VA created an LGBT liaison who is available to help LGBT patients navigate the system and request a new doctor if they are not comfortable with the care being received. Over the past year, the work at the VA in St. Louis has grown to include a robust offering of LGBT Health Cultural Competency Trainings provided by VA employees and SAGE. We are currently in the process of developing a schedule of trainings for SAGE to present on a monthly basis.

SAGE recognized the VA with the first SAGE excellence in community care award at our 5th Anniversary celebration.  SAGE presented them with a plaque and asked all Veterans in the audience to step forward so the VA could see those impacted by LGBT care.

2014 is shaping up to be another good year for the VA.  They’re making plans to attend their 2nd Pride Festival, continuing to identify things they can do  to be more LGBT inclusive, and are offering ongoing LGBT health trainings.

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Missouri Case Study 1: The Almost-There Hospital

Barnes-Jewish Hospital in St. Louis
Barnes-Jewish Hospital in St. Louis

Tracey PROMOTracy McCreery

Manager of Public Policy, PROMO

Barnes-Jewish Hospital (BJH) was the single Missouri entity that filled out the Human Rights Campaign (HRC) Healthcare Equality Index (HEI) the year before. But according to the HEI, they only had two protections out of 7, yet when we looked online, we could find evidence of 5 protections out of 7. But before we go further, let me explain the seven different HEI components for 2012 (they added one more in 2013).

Healthcare Equality Index from Human Rights Campaign

1a. Patient Bill of Rights and/or nondiscrimination policy includes “sexual orientation”?

1b. Ditto “gender identity”?

1c. [added in 2013] Nondiscrimination is conveyed to patients in at least two accessible ways?

2a  Explicitly inclusive visitation for same-sex couples?

2b. Ditto same-sex parents?

3a. Equal employment opportunity policy includes “sexual orientation”?

3b. Ditto “gender identity”?

4.   Provide cultural competency training?

Luckily BJH has an office on diversity, inclusion and equity- so since the new HEI survey was open, we started calling this office to see who could fill it out, and hopefully add the additional protections we found online in the mix too. The process took longer than we’d thought. We found a liaison in the office who could fill out the HEI survey, but HRC reported that they’d filled out the same responses as the year before (thanks Shane!). It took several meetings and a series of calls, and even then, the HEI deadline almost passed and they still hadn’t entered their updates. To make things even more complicated, we were looking up protections assured by their parent company, BJC HealthCare, which had a great LGBT nondiscrimination policy which initially appeared to apply to all subsidiaries… but after meeting with Barnes-Jewish Hospital — they said it did not apply. (And to make things even more complicated, now the page with the parent corporation protections has been taken down. ← were we imagining it?)

Eventually our persistence paid off and BJH filled out the survey reporting five of the now eight categories as yes. They might have been a different five than we first thought, but the point was now one hospital system in the St. Louis region was firmly establishing itself as a leader among the pack for LGBT protections!

But at the same time PROMO was working with BJH, a private hospital, SAGE was working diligently with the largest public healthcare system in the area, Cochran VA Medical Center. Read more about that journey in our next case study.

Cultural Competency Trainings · LGBT Policy · Pride · Resources · State Work

DO Ask Do Tell: St. Louis Veterans Hospitals initiate LGBT cultural competency training program

Icon_2011 Headshot
 
Sherrill Wayland, MSW
SAGE: Services & Advocacy for LGBT Elders
Metro St. Louis
 
 
 

Five years ago when SAGE Metro St. Louis first started providing outreach and trainings, the Veterans Administration (VA) St. Louis Health Care System was one of the last places we expected to be. Fast forward to 2013 and we find the VA St. Louis Health Care System as one of the leaders in creating LGBT welcoming health care in Missouri.

In 2012, the VA St. Louis Health Care System held the first ever St. Louis Veterans PRIDE Celebration. A standing room only crowd of Veterans and employees packed the room to hear a panel discussion, in which SAGE Metro St. Louis participated. At this meeting, SAGE extended a welcome to the employees to have a representative join the Missouri LGBT Health Roundtable, as a part of the Missouri LGBT Health Access Project. In turn, SAGE was asked to join the VA St. Louis Health Care Systems, LGBT Advisory Council as an ad hoc committee member.

Over the years, SAGE has received calls from LGBT Veterans, fearful that they would not receive care from the VA if their LGBT status was known during the time when “Don’t Ask, Don’t Tell” was in force. We also field calls from LGBT Veterans who feel they have been treated in a discriminatory or unwelcoming fashion. Today, we have a direct linkage to the VA St. Louis Health Care System that allows us to assist LGBT Veterans with gaining welcoming care in an environment that truly honors ALL Veterans.

Over the past year, the work at the VA St. Louis has grown to include a robust offering of LGBT Health Cultural Competency Trainings provided by VA St. Louis employees and SAGE. We are currently in the process of developing a schedule of trainings for SAGE to present on a monthly basis.

With the commitment and dedication of the St. Louis VA staff, LGBT Veterans health care and access is a priority. SAGE Metro St. Louis will honor the St. Louis Veterans Administration on June 1, 2013 with the first annual “SAGE Community Cares” Award for excellence in service to the LGBT community.

The groundwork established in partnership with the VA is invaluable as we begin moving forward with sustainable policy change initiatives that will positively impact our LGBT Veterans. Like many we understand the value in building partnerships to advance our movements, and while addressing the LGBT Veterans is mandated by the federal government, having a strategic partnership established will serve as a cornerstone in advancing LGBT health inclusion efforts at both VA hospitals in St. Louis.

“Our LBGT program includes comprehensive care and ongoing education of staff and health care providers about the unique healthcare concerns of our LGBT Veteran community. We believe all staff who are knowledgeable about the health care concerns of our LGBT Veterans are better able to serve our diverse Veteran population. As the Deputy Director of the VA St. Louis Health Care System,  I am extremely proud of the commitment our providers have shown to our diverse (Veteran) patient and employee population.”      – Marc Magill, Deputy Director