Becoming an Ally: Fostering Culturally Sensitive Interactions with the LGBTQ+ Community

1. Becoming an Ally: Fostering Culturally Sensitive Interactions with the LGBTQ+ Community Maggie L. Hogan, MS Austin C. Folger, BS Carolyn M. Tucker, PhD

2. LGBTQ+ Identities Gender Identity Intuitive sense of who you are, in terms of gender. It can incorporate how you want other people to see you, how you relate to others, and how you see yourself. Sexual Orientation The pattern your sexual attraction takes based on gender. In other words, sexual orientation is about the gender of the people you tend to find sexually attractive. Taken From: http://sja.sdes.ucf.edu/docs/lgbtq-terminology.pdf

5. Invisible Identity • People who identify as LGBTQ+ often hide their identity from others because they fear the hostility and negative consequences they may face from identity disclosure. • Constantly monitoring verbal and non-verbal behaviors impacts cognitive ability. “When a person of color walks into the room, they [are] associated with an ethnic group.  When a wheelchair user enters a room, they are branded as disabled.  When a person comes into a room regardless of gender, it is automatically assumed they are heterosexual.” (Madera, 2010)

6. Health and Health Care Disparities

7. Physical Health Disparities • Research suggests that lesbian and bisexual women are more likely to have obesity/overweight when compared to heterosexual women. (Rizer, Mauery, Haynes, Couser, & Gruman, 2015) • Lesbian and bisexual women have an increased risk of developing breast cancer as compared to heterosexual women. (Austin et al., 2012; Dibble, Roberts, & Nussey, 2004) • The CDC (2017) found that gay and bisexual men are most at risk for contracting HIV, accounting for about 56% of people with HIV in the United States.

8. Mental Health Disparities • Compared to 1.6% of the general population, 41% of the transgender community reported that they have attempted suicide. (Grant et al., 2010) • Gay, lesbian, and bisexual individuals are more likely to experience depression and anxiety and are more likely to attempt suicide when compared to heterosexual individuals. (King et al., 2008)

9. Health Care Disparities • 19% of the Transgender respondents reported that providers refused to provide them treatment because of their gender identity. • Disclosing gender identity to providers increases the chance of physical and/or verbal abuse. (Grant et al., 2010) • Many insurance companies do not cover health services that are specific to the Transgender community. (Office of Disease Prevention and Health Promotion, 2010) • Additional health care barriers among the Transgender community include: lack of providers with training in gender affirmative care, use of incorrect names and/or pronouns, and limited access to hormone therapy. (Gridley et al., 2016)

10. Intersectionality • Lesbian and bisexual women experience higher rates of overweight and obesity when compared to their heterosexual counterparts. However, the highest rates of obesity are observed among Hispanic lesbian women and non-Hispanic Black bisexual women. (Lew, Dorsen, Melkus, & Maclean, 2018) • Racial/ethnic minority men who have sex with men (MSM) and MSM of low socioeconomic status experience a disproportionate incidence of reported STDs as compared to White MSM and MSM of a higher socioeconomic status, retrospectively. (CDC, 2017) “…while LGBT populations in the U.S. are oppressed and disenfranchised, the intersection of sexual orientation, gender, race, and ethnicity compounds their marginalization.” (Wheeler, 2003)

11. Culturally sensitive communication strategies

12. Culturally Sensitive Communication StrategiesNonverbal

13. Intake Form

14. Verbal Culturally Sensitive Communication Strategies • Avoid assuming someone’s sexual orientation or gender identity based on physical and/or personality characteristics • Ask in a Respectful Way • Make this a Routine Question • Use correct pronouns and chosen name • Use gender neutral language

15. Culturally Sensitive Communication StrategiesMaking Mistakes I apologize. I know I am still learning, but I am open and willing to learn how to best meet your needs in patient care. If you ever feel uncomfortable or feel that I am not meeting your needs or the staff is not meeting your needs, will you please let us know so that we can address these feelings?

16. Culturally Sensitive Health Care Understand that LGBTQ+ patients may experience trust difficulties and/or discomfort due to previous negative health care experiences. Educate yourself on LGBTQ+ health care needs. Dismantle assumptions about LGBTQ+ individuals. Do not presume that someone from the LGBTQ+ community knows everything about the community.

17. Interactive Discussion Roles of Community Health Workers in Fostering a Culturally Sensitive Health Care Environment for LGBTQ+ Individuals

18. Question and Answer Session

19. Additional Resources

20. Contact Information Maggie L. Hogan, MS Department of Psychology University of Florida 945 Center Drive P.O. Box 112250 Gainesville, FL 32611 Email: maggielhogan@ufl.edu Carolyn M. Tucker, PhD Department of Psychology University of Florida 945 Center Drive P.O. Box 112250 Gainesville, FL 32611 Email: cmtucker@ufl.edu Phone: 352-273-2167 Austin Folger, BS Counseling Psychology University of Oregon 5251 University of Oregon Eugene, OR 97403 Email: afolger@uoregon.edu

21. References • Austin, S.B., Pazaris, M.J., Rosner, B., Bowen, D., Rich-Edwards, J., & Spiegelman, D. (2012). Application of the Rosner-Colditz risk prediction model to estimate sexual orientation group disparities in breast cancer risk in a U.S. cohort of premenopausal women. Cancer Epidemiol Biomarkers Prev, 21, 2201–2208. • Centers for Disease Control and Prevention. (2017). Sexually Transmitted Disease Surveillance 2016. Atlanta: U.S. Department of Health and Human Services. • Dibble, S. L., Roberts, S. A., & Nussey, B. (2004). Comparing breast cancer risk between lesbians and their heterosexual sisters. Women’s Health Issues, 14(2), 60-68. • Grant, J. M., Mottet, L. A., Tanis, J., Herman, J. L., Harrison, J., & Keisling, M. (2010). National transgender discrimination survey report on health and health care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force. • Gridley, S. J., Crouch, J. M., Evans, Y., Eng, W., Antoon, E., Lyapustina, M., … Breland, D. J. (2016). Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth. Journal of Adolescent Health, 59(3), 254–261. • Lew, K.N., Dorsen, C., Melkus, G.D., & Maclean, M. (2018). Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Women of Diverse Races/Ethnicities: Findings From the 2014-2015 BRFSS Surveys. The Diabetes Educator, 44(4), 348 – 360. • Lyon-Martin Health Services (2018). Intake Forms. Retrieved from http://lyon-martin.org/intake-forms/ • Madera, J. M. (2010). The cognitive effects of hiding one’s homosexuality in the workplace. Industrial and Organizational Psychology, 3(1), 86-89. • Office of Disease Prevention and Health Promotion (2010). Health People 2020 Transgender Fact Sheet. http://www.lgbttobacco.org/files/TransgenderHealthFact.pdf • Rizer, A. M., Mauery, R., Haynes, S. G., Couser, B., & Gruman, C. (2015). Challenges in intervention research for lesbian and bisexual women. LGBT Health, 2(2). • Wheeler, D. P. (2003). Methodological issues in conducting community-based health and social services research among urban Black and African American LGBT populations. Journal of Gay & Lesbian Social Services, 15(1-2), 65-78.