Many Transgender People Are Completely Avoiding Doctors

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It can be difficult for many individuals to have discussions about their sexual history with a physician. It’s not uncommon for people to consider it uncomfortable. But, for many transgender people, the conversation never happens because they do not seek out health care, according to Adrian Juarez, PhD, a public health nurse and assistant professor in the University at Buffalo School of Nursing.

A preliminary study (“Examining the Role of Social Networks on Venue-Based HIV Testing Access and Decision Making in an Urban, Transgendered Population”) that examined health-based decision making and access to HIV testing in urban, transgender populations, showed that many transgender individuals withheld from pursuing necessary care due to social stigma and lack of affordability.

“There is evidence that health care providers do tend to be judgmental, and it’s unwelcoming,” says Juarez.  Of course, people are not going to visit health care providers if they fear that they’re going to face discrimination and stigma.

The results of the study are especially cause for concern because, according to a 2009 report from the National Institutes of Health (NIH), about one third of transgender people in the U.S. are HIV positive. And, transgender women of color are even more at risk of HIV infection. According to the NIH study, more than 56 percent of black transgender women are HIV positive.

Among other reasons, an inability to afford medical care is keeping transgender patients away from doctors. Transgender people are more than twice as likely to be homeless and four times more likely to experience extreme poverty (compared to the general population)…having a household income of less than $10,000 per year. This data comes from a 2011 report from the National Center for Transgender Equality. It’s not as if it’s easy for transgender people to get work, either. According to the National Center for Transgender Equality, out of more than 6,000 transgender people surveyed in the nation, 90 percent said they were subject to mistreatment, harassment, and discrimination at work.

If a transgender person does happen to visit a healthcare provider, some doctors are not informed on how to properly treat the  patients. Juarez says, “It puzzles me how doctors will still refer to trans individuals by their biological name. That’s their identity.”

The line between identifying and biological gender can be blurry in healthcare settings. For example, transgender men still need Pap smears and transgender women need prostate screenings, but some health care providers might not offer these tests in order to keep from making suggestions that go against the patient’s identified gender. There is an urgent need to address stigmatization and provide health care professionals education on how to appropriately and compassionately treat transgender patients.

7 Ways To Improve Healthcare For The Transgender Patient

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Many healthcare workers lack the training to deal with the unique issues the transgender community faces. While others disapprove of the lifestyle of the LGBT community for one reason or another. This can compromise the patients’ care.

That’s according to a study in LGBT Health that discusses the issues the transgender patient faces and measures that can be taken by providers to improve care.

The transgender population struggles with social stigmas and rejection, and this experience has compounded in some medical settings, according to the study. The lack of cultural competency and knowledgeable physicians interferes with the patients’ ability to receive compassionate, knowledgeable and nonjudgmental healthcare.  Awkward doctor-patient interactions occur because many physicians lack training in transgender healthcare issues, such as how to approach the gender identity of the patient.

This is a problem because more than 7,000 transgender patients postpone medical care due to the discrimination they face, according to the National Transgender Discrimination Survey.  This group is at an increased risk for HIV infection and its related illnesses like depression, anxiety, suicide and substance abuse.

Healthcare facilities and workers at these organizations can take steps to improving transgender care by conducting an education campaign.

Here are some ideas on how to start:

  1. Schedule a series of lectures from healthcare workers with specific training in transgender healthcare.
  2. Hold consumer panels with transgender individuals.
  3. Conduct cultural-sensitivity trainings.
  4. Make resources about transgender healthcare available to workers whether online or via printed materials.
  5. Post LGBT-friendly signs and welcome information at the facility and on the organization’s websites.
  6. Signal in your publications that your physicians are comfortable with transgender patients and knowledgeable about their unique care.
  7. Review office documents and update them accordingly to respectfully address the complex issue of gender identity, such as providing gender-neutral or transgender-inclusive terminology.

The cultural sensitivity provided at your healthcare facility can minimize barriers so transgender patients receive the care that they need. The study believes it will help prevent further health complications, build rapport within the transgender community and diminish healthcare delays.

 

Dr. M. Mirza, LGBT Health Wellness – 2014

Cervical Cancer Risk for Lesbians

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The risk factors for developing cervical cancer are the same for all women regardless of gender identity and sexual orientation (LGBT Health Education .org). That said, bisexual women and lesbians are ten times less likely to get tested for cervical cancer.

Regular screenings, however, have been shown to be the best way to catch it early when treatment options and outcomes are the best. Lesbians are less likely to get preventative healthcare out of all women and lesbians and bisexuals are less likely to have health insurance that heterosexual women. Originally, cervical cancer was the most deadly form of cancer for women. Today, with early screening, it is one of the most preventable.

Since we know now that bisexual and lesbian women are the least likely to be screened, an outreach program is underway to get cervical cancer under control, and these two groups have been designated as priority populations. In addition, black women suffer the highest mortality rates from cervical cancer, while the highest age-adjusted rates are suffered by Hispanic women.  Survival rate from cervical cancer within the first five years of being diagnosed is 67.9%, but if it is found early on, the survival rate is 90.7%. That’s why it’s so important to reach out to these populations and motivate them to get regular screenings.

Smoking, immunosuppression often related to HIV, and human papilloma virus (HPV) infection are major risk factors for cervical cancer. Many in the LGBT community such as lesbian women, bisexual women and transgender men who still have a cervix have higher chances of having or developing these other conditions, and so have an increased risk of developing cervical cancer.  What makes matters worse, since they are much less likely to be insured, they are less likely to seek out preventative care.

Obesity is another risk factor which is also higher among lesbians. Not as much data is available on bisexual women, though some studies show that they may have lower insurance rates and higher smoking rates, making them also more susceptible. One study found that 2.2% of bisexual women develop cervical cancer as opposed to 1.3% of heterosexual women. Hispanic and black bisexual and lesbian women should be particularly targeted for an outreach program.

Although we are seeing more and more types of studies being done concerning LGBT health, more still has to be done. We see that race and age data is often collected while sexual orientation data often slips through the cracks of the healthcare system. There has been a pivot recently. LGBT health is becoming more of a priority in communities across the country and certainly on the national front.  We should see this data being collected more and issues such as this coming to the forefront, as well as policies and procedures to better address the health disparities suffered by the LGBT community.

Cervical Cancer Risk for Lesbians and WSW
Dr. M. Mirza, LGBT Health Wellness – 2015

Transgender Activists & Radical Feminists Battle On Social Media

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There’s something trending on Twitter but also offline. Both transgender activists, and feminists who do not view trans women as women are debating online and on college campuses.

#TERFs (trans exclusionary radical feminists is a hashtag being used and is a pejorative term used on Twitter to describe anti-trans feminists. Anti-sex work, anti-porn, anti-trans feminists seem to be reappearing from the 1970’s. Many wonder why.

An open letter published in the Guardian of London and the Observer that claimed those who expressed opinions regarded as “transphobic” were being censored on England’s college campuses triggered a significant debate on social media. The letter posted revealed a strong hostility that many wouldn’t be aware of unless they were in specific activist or academic circles, that is occurring between transgender activists and a certain group of feminists who do not believe transgender women are ‘real’ women. Beliefs they hold include, transgender women should not be let into feminist events or female bathrooms. Some of these women are even doxing transgender teens, which means they are revealing their identities to the public online.

These radical feminists have been nicknamed “the Westboro Baptist Church of feminism”, referring to the church known for its hate speech that pickets at funerals of LGBTQ people. Urban Dictionary has a definition listed, which describes them as “group of feminists that claims that trans women aren’t really women, as biological determinism is only a fallacy when it used against them, not when they use it against others.”

One of the loudest anti-trans feminists is Germaine Greer, a 1970’s feminist who wrote the book “The Female Eunuch”.  Greer, now 76, has said that transgender women are a “ghastly parody”, that they are men with “delusions” who use their male privilege to sneak their way into the feminist movement. She believes that transgender women don’t know what it is to “have a big, hairy, smelly vagina”.

Some people regard this as transphobic hate speech and connected to essentialist ideas regarding sex that have been challenged since around the 1990’s, when debate was shifted from sex to gender and its social construction.

It seems that that, according to the “TERFs”, one must be a woman who has suffered sexism in order to be a feminist. Thankfully, present day feminists tend to believe this is an outdated and narrow-minded approach. More and more people are understanding the importance of inclusion, and not rigid definitions about what it means to be a man or a woman. Hopefully this will only continue.

Dr. M. Mirza, lgbt health wellness .com – 2015

What Gay Men Think About Masculinity

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Masculinity is a big deal in gay culture. Not only is it a force that crushes many “effeminate” gay men with unnecessary ideals, but it also impels gay men to avoid and disdain other gay men that do not meet their own standards. Studies have shown that the gay male image of masculinity is based strongly on ideals like a muscular and large frame, emotional restriction, and sometimes sexual adventurism. These ideals draw obviously from mainstream societal standards for men, and their impact on gay men probably make a large contribution to the higher incidence of psychological distress and HIV/AIDs in young gay men who are particularly vulnerable to societal pressure.

It’s not just chance encounters that are tarnished by masculine ideals. Research has shown that personal ads placed by gay men seeking other men tend to list masculine ideals like muted emotions and muscularity. Self-descriptions by single gay men will emphasize classically masculine personality traits while neglecting more feminine ones.

If these divisions in the gay community exist as reported, why is it that gay men don’t take the reins back from mainstream culture and stop adding to their own adversity?

Well for one, gay men are already an extremely varied group in terms of how they express gender, and the stress that mainstream culture puts on masculinity in general is unrealistic — but valuing masculinity isn’t inherently harming gay men, per se… at least not enough for anyone to prove it.

Surprisingly, many gay men in social studies done on gay masculinity report being protective of masculine ideals, such as competitiveness and masculine interests, because of their potential to advance one’s success in the workplace.

Positive consequences of conforming to masculine ideals keep gay men seeking men with similar ideals. Personal care that involves fitness rather than fashion, an interest in traditionally male entertainment, and financial security are all factors that singles looking for same-sex partners may have in mind while creating personal ads.

Most of the emphasis on masculinity in gay culture is a consequence of media pressure and traditions that are taking a long time to break, and not deliberate intra-social homophobia. Moving away from such standards involves abandoning the media image of the successful male, and gay men are no more or less responsible for its idolization than the rest of society.

Dr. M. Mirza, gbt health wellness .com – 2014

Gender Roles in LGBT Relationships

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A Cornerstone of LGBT Identity or an Obstacle to Equality?

A blog post from 2009 on “Sex, Gender and US society” carefully delineated some of the gender roles that are known well to certain circles within the gay community. Words such as “butch”, “bear”, “femme”, or “twink” may not be familiar to LGBT individuals that are not as socially active with other LGBT folks, but they have been used to describe gender roles in lesbian and gay relationships for the majority of modern times. There are a few things that anyone new to this particular subculture should be aware of. For one, gender roles do not refer to cross-dressing, although the individual may express themselves by adopting hyper-masculine or hyper-feminine dress. The use of “drag” or deliberate cross-dressing is actually more common in gender queers, who may not even participate in relationships with individuals that express gender differently. Secondly, these terms sound derogatory because to some degree they are.

As the author Logan writes, many of these terms are used by other members of the LGBT community to marginalize the people that they describe, or as a type of “intra-homophobia”. The adoption of a gender role in a homosexual relationship automatically leads to the assumption that one partner will play a dominant role and the other will be more submissive. Depending on the maturity of the homosexual couple, this formula can work very well for a relationship. Like all human relationships of course, it is not always unhealthy when one individual is more outgoing, motivated, judgmental, self-assured, etc… as long as the other person still has a backbone. The real issue arises from the perspective of an outsider. It is more of a challenge for the partner with the feminine role to garner respect from other people in general. This somewhat subversive form of gay discrimination is quite off-putting, but so far there is no statistical evidence indicating that it contributes in any way to violence against LGBT individuals.

Domestic violence in homosexual relationships is not any more common than it is in heterosexual relationships, in spite of some evidence that crimes that do not involve male-on-female violence are taken less seriously by the media. The social burden that gender roles have on LGBT individuals that assume them is probably well within the individual’s power to handle. Gender roles are a form of self-expression, not entirely unlike cross-dressing is for the gender queer individual but perhaps even more personal. For some LGBT individuals the role they use in relationships may be one that expresses their true personality. Even where this is not the case gender roles in homosexual relationships can be a way of balancing needs and giving the relationship more stability. While it cannot really be told how much gender roles influence the equality of LGBT individuals in society it is not outrageous to question whether feminine stereotypes are an obstacle for LGBTs.

The issues faced in the Medical Field by male nurses and female doctors is an excellent example of why the LGBT community should be mindful of the impact of gender stereotypes. Traditionally these two professions have been stereotypically “male” or “female”, and students that don’t heed the status quo are often accused of being gay or perverse. The problem is more marked in women pursing medical degrees, and the Journal of Women’s Health has recently published a review on the interpersonal impact that gender stereotyping has in modern culture on female medical students. The most immediate way to improve the status of LGBT individuals is to improve intra-personal perspectives and close interpersonal perspectives, and there is no better way to do that than to promote personal development. If you think that a gender role is part of who you are as an LGBT individual then it should be your own quirky, genuine gender role that you express everywhere. “Feminine” personalities and “Masculine” personalities are merely constructs that our culture has forced on us. We do not have to accept them as who we are unless they fit. The social status of all human beings will benefit when we dismiss our use of roles that are designed to debilitate and marginalize individuals, but we need not dispose of the antagonizing qualities that we crafted these roles with. Those are intrinsically human, and when they are intrinsically who we are, that’s okay!

Dr. M. Mirza – lgbt health wellness .com – 2014

Gay Black Men’s Pressure to Conform Leads to Higher HIV Risk

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Familial and cultural pressure to conform to expected masculine behaviors leads gay black men to engage in riskier behavior, therefore increasing their risk of contracting HIV.  This is according to a report out of the John’s Hopkins Children’s Center and published in Science Daily. This community of men feel distress and social isolation, according to the report, which may contribute to their decision to take part in such behaviors. The “compensatory” behavior according to researchers leads to riskier behavior and contributes to the higher infection rate among gay black men.

Gay and bisexual black men attributed to 4,800 new HIV cases in 2010, more than two times that of other male groups, says the CDC. Thirty five young, male participants took part in this study, recently published in the American Journal of Public Health. Openly gay and bisexual men took part in this study, as did young men who have sexual relations with men but don’t self-identify as gay or bi-sexual, also known as MSM. Adolescent medicine expert at the John’s Hopkins Children’s Center and the study’s lead author, Errol Fields, M.D., Ph.D., said of this study, “HIV risk is the sum total of many factors, but social and family stress is a well-known driver of all types of risk-taking behaviors, and our findings clearly support the notion this also holds true when it comes to HIV risk.”

There is a very traditional view of masculinity with strong anti-gay sentiment in the community where the participants grew up. These participants needed to prove their masculinity, hide homosexuality, and conform to social pressures. This makes them far less likely to take part in monogamous relationships and more likely to take part in unprotected sex. Black gay men also sought affirmation through sex which they weren’t getting from a close loved one in their life. Some also said that having unprotected sex showed trust and love for one’s partner. Since the community they were from expected them to act aggressive and free of any feminine behaviors, they were forced to either conform or be ostracized. Drug use, drinking, fighting and other such risky behavior was taken part in so as to prove their masculinity and fit in.

According to Dr. Fields, “The findings of our study reveal a clear clash between internal sexual identity and external expectations at a critical developmental stage,” As a result, “This clash creates loneliness and low self-esteem and appears to drive these boys and men to risky behaviors, sexual and otherwise.” These young men were also constantly worried that they would be found out. If they were found out they would lose their friends and family, so they needed their secret to be safe. “It’s a true catch-22 for these youngsters,” said Fields. “On one hand, they are dealing with the chronic anxiety of hiding their homosexuality, but on the other they face the prospect of becoming social pariahs if they come out as gay or bisexual.”

Dr. M. Mirza – 2014
lgbt health wellness .com

Nana Akufo-Addo: Marriage Equality won’t be Legalized in Ghana

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Ghana’s President Nana Addo Dankwa Akufo-Addo has stated that same-sex marriage will not be legalized in Ghana under his presidency.

Speaking at St. Micheal and All Angels Cathedral in Asante Mampong during the installation of the Second Archbishop of the Anglican Church of Ghana, the President said he won’t legalize same-sex marriage in the country.

“For same-sex marriage to be legalized in Ghana, it will not happen in my time as President,” Nana Addo said at the ceremony.

This President’s comment comes in the wake of pressure on the government to come clear and state its position on activities of persons who identify as Lesbian, Gay, Bisexual, Transgender and Intersex. (LGBTI+)

The opening of an LGBTI+ office at Ashongman in Accra has sparked a national debate as to whether Ghana will legalize LGBTI+.

Whoi is  Nana Akufo-Addo?

Nana Addo Dankwa Akufo-Addo, born 29 March 1944) is a Ghanaian politician who is the current president of the Republic of Ghana. He has been in office since 7 January 2017.He previously served as Attorney General from 2001 to 2003 and as Minister for Foreign Affairs from 2003 to 2007 under the Kufuor-led administration. He is also currently serving his second term as the chairman of the Economic Community of West African States (ECOWAS)

LGBTQ Parenting: Recognizing Rights

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The generation that followed the baby boom is reaching parenting age. Simultaneously, the sexual revolution is coming full circle. More LGBTQ people within that particular age bracket are being recognized with equal rights

Heterosexual and homosexual couples share the same human qualities: love, aspirations, plans for the future, shared finances; that’s all a given in any healthy relationship.

Biologically speaking, the complex issue of children tends to be where the two respective camps split. The paths divide at this point. Heterosexual couples must make an effort, for most of the span of their relationships, to actively avoid pregnancy, while LGBTQ couples must make a concerted effort to pursue having children, by way of either IVF or adoption. IVF therapies for lesbian couples are expensive, time-consuming, and often a strain on the health of the partner who would be carrying the child. Hormone therapy is often a necessary precursor to conception.

And yet, the LGBTQ community is reproducing in greater numbers than ever before. With an atmosphere of greater social acceptance and a wider array of options, an entire generation of LGBTQ parents is on the rise, recognized or not.

Americans Identifying as LGBTI+ Increased

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According to a recent survey from the Gallup research firm, 5.6 percent of Americans are lesbian, gay, bisexual, transgender or intersex people. This significant increase, which means about 18 million people, is attributed to the greater acceptance of LGBTI+ individuals in the society.

While this rate was 4.5 percent in Gallup’s 2017 survey, the result from the 2020 survey indicates a record jump of 24 percent. The main reason for the increase is from Generation Z adults aged 18-23. 15.9 percent of this generation say they are LGBTI+.

“At a time when the public is increasingly promoting equal rights for lesbian, gay, bisexual, transgender, ınterex + people, a growing percentage of Americans identify as LGBTI+,” the Gallup website said.

In the 2020 election, the US saw Pete Buttigieg as the first openly gay presidential candidate. LGBTI+ candidates have had multiple historic wins, including Sarah McBride, the first open transgender state senator.

According to the Washington-based research center Public Religion Research Institute, Americans’ support for same sex marriage, which was legalized in 2015 and seen largely as a synonym for LGBTI+ rights, rose from 36 percent in 2007 to 62 percent in 2020.

The Gallup survey shows that 54.6 percent of LGBTI+ Americans identify as bisexual, 24.5 percent are gay men, 11.7 percent are lesbians and 11.3 percent are transgender.

For the first survey conducted in 2012, 15,000 Americans were randomly interviewed by phone throughout 2020. While 86.7 percent of the respondents identified themselves as heterosexual, 7.6 percent refused to respond to the interviewers. This rate was around 5 percent in past surveys.

There were significant differences between generations. Among those born before 1946, seniors were much less likely to see themselves as LGBTI+. The lowest rate was recorded as 1.3 percent.

Researchers found that women were more likely to describe themselves as LGBTI+ than men. While this rate was 4.9 percent for men, it was 6.4 percent for women. From a political point of view, 13 percent of liberal respondents and 2.3 percent of conservatives identified themselves as LGBTI+.

It is noted that there is a similar trend in England. According to government data, the proportion of people identifying themselves as lesbian, gay or bisexual increased from 1.6 percent in 2016 to 2.2 percent in 2018.