Nov 212016
 

On October 6, 2016 the National Institutes of Health in the United States designated gender and sexual minorities a disparity population for the purposes of research. This is tremendous news. The NIH is the health research arm of the US government. It gives grants. Scientists working there do crucial research. The NIH provides training and research opportunities for students and professionals alike.

Long time readers of Open Minded Health may remember the many times I’ve said “we need more research.” This is part of how we get that research. Through incentives that can now be provided by the NIH, and through the hard work of all connected with it.

Slowly but surely gender and sexual minority health is becoming better understood. And only through understanding it can we even begin to improve it. Ultimately so that we can all live healthier, longer, happier lives.

Read the full declaration below.

Sexual and Gender Minorities Formally Designated as a Health Disparity Population for Research Purposes

On behalf of many colleagues who have worked together to make today possible, I am proud to announce the formal designation of sexual and gender minorities (SGMs) as a health disparity population for NIH research. The term SGM encompasses lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms.

Mounting evidence indicates that SGM populations have less access to health care and higher burdens of certain diseases, such as depression, cancer, and HIV/AIDS. But the extent and causes of health disparities are not fully understood, and research on how to close these gaps is lacking.

In addition, SGM populations have unique health challenges. More research is needed to understand these challenges, such as transgender people taking exogenous hormones.

Progress has been made in recent years, with gains in legal rights and changing social attitudes. However, stigmatization, hate-violence, and discrimination are still major barriers to the health and well-being of SGM populations. Research shows that sexual and gender minorities who live in communities with high levels of anti-SGM prejudice die sooner—12 years on average—than those living in more accepting communities.

The Minority Health and Health Disparities Research and Education Act of 2000 authorizes the Director of the National Institute on Minority Health and Health Disparities (NIMHD), in consultation with the director of the Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services, to define health disparity populations. This month, with strong support from AHRQ Director Andrew Bindman, M.D., I formally designate sexual and gender minorities as a disparity population for research purposes.

The designation builds on previous steps by NIH to advance SGM health research. In 2011, the Institute of Medicine (now The National Academies of Sciences, Engineering, and Medicine) published an NIH-commissioned report on LGBT health issues. In response to the report recommendations, NIH extended its research portfolio and created the Sexual and Gender Minority Research Office (SGMRO). The SGMRO, within the Office of the Director, coordinates NIH-supported activities on SGM health issues and provides guidance to researchers within and outside of NIH.

I offer my gratitude to inaugural SGMRO Director Karen L. Parker, Ph.D., M.S.W., and NIH Principal Deputy Director Lawrence A. Tabak, D.D.S., Ph.D., who led the proposal for designation. I also offer my gratitude to colleagues across NIH who served on the NIH-established working group for their careful consideration on this matter.

This designation marks an important and necessary step in realizing NIH’s mission to advance the health of all Americans.

Source

Nov 092016
 

Dearest readers,

The US election may be terrible blow to minority rights throughout the 50 states, DC, and territories. All gender and sexual minorities, along with our Muslim and Black loved ones and many others, may be at risk.

We know how ugly some parts of America can be. We know that every time one of us is murdered. We’ve all had the slurs thrown at us, or our family or friends. Or been quietly denied housing, healthcare, marriage. And last night those ugliest bits won in our political system, a move that jeopardizes our safety and our rights for decades to come.Light in the Darkness

It’s okay to grieve.

It’s okay to be scared.

It’s even okay to be angry.

If you are in crisis right now, stop reading and call one of these hotlines:

For me, I am reminded of Proposition 8. That was the ballot measure in California that took away same sex marriage rights in 2012. My (now) wife and I sat and watched the news unfold with disbelief. The state we’d thought was so progressive, that we’d thought was safe, turned on us. President Trump, and the Republican Senate and House, are far worse. But the emotions I hear echoing throughout our communities are the same: fear, disbelief, despair, a loss of safety. I never thought I’d trust my neighbors again. But we did ultimately gain the right to marry again, and public opinion continues to support us doing so.

Now for me, the emotion that boils to the surface most strongly now is determination. I can’t fix politics. I cannot, by myself, change the views of the country. Nor can I undo what has been done. But there is a lot I can do. I refuse to run and hide. I refuse to sit down and be quiet.

I will be a light in the darkness.

Please, join me.

If you can…

Lastly, remember all that our communities have survived. From the Holocaust to Stonewall to AIDS to now. We did so by working as a community. By looking out for one another and protecting one another. By calling out injustice when we saw it. By protesting when we needed to.

We survived. We will survive. Better yet, we will thrive.

Because, after all, living well is the best victory of all.

Be that light in the darkness.

Jun 132016
 

The recent shooting in Pulse, a gay nightclub, in Orlando is horrific. I struggle to find words. This was a senseless act of hatred.

Black Ribbon - a symbol of mourn

Black Ribbon – a symbol of mourn

Support comes in many forms. If you’re local, the Orlando LGBT Center has information on how you can help, including a GoFundMe donation page. If you can give blood, money, or time — then please do so. As John Scalzi so eloquently put it, “In the aftermath of terrible violence, offer thoughts, and prayers, if it is your desire to do so. Then offer more than thoughts and prayers.”

Take care of yourself too. If you need, there is an LGBT Hotline available. Call a friend, visit your local community center, see a counselor, or go for a long run. Do what you need to do.

But please, don’t turn this tragedy into an anti-Muslim cry. This was not an attack organized by an entire religion. This was an attack by one individual. We must all stand together in love and against hate. I highly recommend reading this press release and this article, if you want to know more.

This is not the first time that gender and sexual minority communities have been attacked. This is not the first time that an act of hate is being used to attack another minority group. It will likely not be the last.

We mourn. We weep. We give. We change, and we act to prevent. And we will dance. Because to not dance is to let the hatred and fear kill the joy of life. And that would be the ultimate loss.

Stand together in love, friends.

Jan 182016
 

There’s been a cluster of publications and news recently that I won’t be able to dig fully into and write a full article on, but still needs mentioned. So this week’s post is a quick summary of a bunch of them!

Several articles came out pointing out that various health care professionals have a role to play in gender/sexual minority health. Articles like this are important in helping the wider medical community understand why learning about gender and sexual minority health issues is important. The articles include…

  • Obstetricians can help screen fetuses for being intersex and help to manage the medical aspect of intersex medical conditions. Gynecologists can help adult intersex people with both medical and social issues associated with being intersex. See the article.
  • Pharmacists can help with the care of trans people above and beyond just filling a prescription. They can help make sure that certain laboratory calculations are done correctly, based on the hormonal status of the patient. They can counsel on the various forms of hormones (e.g., pill vs patch vs injection). See the article.
  • Dermatologists may be able to assist in medical transition by providing hair removal and other noninvasive, aesthetic procedures. See the article.

Asking about sexual orientation and gender identity and recording it in the electronic health record is now a required part of all electronic health records by Medicare/Medicaid. This is part of “meaningful use”, and is part of the larger goal of having electronic health records that actually cooperate with each other and record the same things. Here’s a quick abstract discussing this. This is really the beginning of a change in health care around the United States — there’s now a financial incentive to screen for sexual orientation and gender identity and to handle patients who aren’t cisgender and straight. It’s good stuff.

A study of examined the effectiveness of therapy intended to change same sex sexual attraction as performed within the Church of Jesus Christ of Latter-day Saints. Less than 4% of those surveyed experienced a change. 42% reported that it wasn’t effective, and 37% found it to be moderately to severely harmful. Those who seek to modify their sexual orientation should keep this in mind — therapy intended to change sexual orientation is far more likely to do harm than good. For context, if this therapy was a new drug the FDA would never allow it into the marketplace. It would never get past early clinical trials. In contrast, acceptance therapy (i.e., therapy meant to help one be accepting of one’s orientation) in this study was found not only to reduce depression and improve self esteem but also improved relationships with family. See the abstract.

It’s well known that lesbian, gay, and bisexual cisgender people are at higher risk of suicide than the general public. A study recently clarified some of that risk, finding that bisexual cis women are at nearly 6 times higher risk of suicide than straight cis women (roughly 4-9% of the women). Gay men were 7 times more likely to attempt than straight men (roughly 3.5-13% of gay men). Lesbian and bisexual women were also more likely to attempt suicide at a younger age than straight women — roughly 16 years old vs 19 years old. Sad news. See the abstract.

Gay and bisexual men may be more likely to rely on chosen family for social and economic support than lesbian and bisexual women and heterosexuals, who may rely more on blood relatives. See the abstract.

And very exciting — the FDA has changed their blood donation policy for men who have sex with men! Instead of an “indefinite deferral”, people who quality as “men who have had sex with men” need to wait 12 months after the last sexual encounter to donate. This brings the guidelines for sex who have sex with men roughly equivalent to the guidelines for others who are at higher risk for HIV.

If you are transgender, the guidelines are still unclear. Transgender women who had ever had sex with a man (unclear if cis or trans) used to count as “men who have sex with men” in the FDA’s eyes. Now the FDA advises that transgender people should self report their gender. What this seems to say is that trans women should be counted as women and trans men should be counted as men regardless of hormonal/surgical status. So according to the guidelines, this should be the logic…

  • If you are a cis/trans man who has had sex with another cis/trans man once since 1977, but over 12 months ago: You may donate blood.
  • If you are a cis/trans man who has had sex with another cis/trans man within the past 12 months: Wait until 12 months after that sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, and that cis/trans man has had sex with a cis/trans man in the past year: Wait until 12 months after your sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has not had sex with a cis/trans man in the past year: You may donate blood.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, but that cis/trans man has not had sex with a cis/trans man in the past year: You may donate blood.

Confusing enough? I hope that still helped. Keep in mind that all of the guidelines I attempted to simplify assumes that you’re not HIV+ (no one who is HIV+ may donate). If you’re confused still, take a look at the new guidelines or reach out to your local blood donation center.

And that’s it for this week! I hope this was fun, interesting, and helpful! Have a wonderful week.

Sep 142015
 

A cluster of studies came out this week looking at different aspects of mental health for gay, lesbian, and bisexual people. Rather than do a deep dive on each one I thought it’d be fun to do a birds eye view of all of them and talk about the results as a group. Ready?

Why look at mental health in lesbian, gay and bisexual (LGB/GLB) people at all, and why might their health be different from their straight peers? Because of minority stress! If you’re a long time reader of the blog that term may sound familiar. Minority stress is the concept that solely by being a minority in a culture you have a higher level of stress. That stress is even worse when you’re a minority that is discriminated against. It’s also worse if you are a member of multiple minorities. Stress is associated with certain mental illnesses, including eating disorders, substance use/abuse, depression, and anxiety. Stress also makes it harder to cope with life’s everyday events.

So what about these studies?

Study #1 looked at disordered eating patterns in young women and compared that eating between gay, bisexual, and straight men and women. The researchers didn’t look at diagnoses or treatments of eating disorders directly. Instead, they screened patients in a primary care clinic for eating patterns and thoughts about eating that are associated with eating disorders. The researchers found that gay and bisexual men were at higher risk for disordered eating than heterosexual men. Among women, bisexual women were at higher risk for disordered eating than both lesbian and straight women.

Study #2 looked at both mental and physical health in LGB and heterosexual people seeking treatment for substance use. They found that gay and bisexual men and women were more likely to have a psychiatric diagnosis (in addition to substance use) than their heterosexual peers. Gay and bisexual men and women were also more likely to have psychiatric prescription medications. Gay/bisexual men and bisexual women, but not lesbian women, were more likely to be receiving psychotherapy and were more likely to have physical health problems and to be using health care services. Anywhere from 1/2 to 3/4 of LGB people seeking substance abuse treatment have had other psychiatric diagnoses, indicating that there is a potential need for additional care beyond substance abuse treatment in LGB people.

Study #3 examined the effects of domestic violence in same sex and opposite sex couples. The researchers found that domestic violence in same sex couples resulted in more symptoms of depression and physical violence than in opposite sex couples.

What does all this mean, and how do we think about this?

First, these studies add to the research that shows that gay, lesbian, and bisexual people are at higher risk for mental health difficulties than their heterosexual peers. However, they add an interesting wrinkle. Gay and bisexual men and bisexual women may be at higher risk than lesbian women. We’ll have to wait for more studies to come out to see if this is a true difference, or just a random quirk of the data. But it’s an interesting thought.

And secondly, that people in same-sex relationships may fare worse when domestic violence happens than people in opposite-sex relationships. This is likely because of the lack of resources and public awareness around domestic violence than anything to do with the relationship itself.

What do you think about these studies?