Understanding and Advocating for LGBTQ+ People

Fairness WV Facilitators: Natasha Stone Pronouns: she/her Contact: [email protected] Session Learning Objectives

● Participants will increase their knowledge of LGBTQ identities, including the unique challenges LGBTQ people in West Virginia face

● Participants will improve their skills to effectively understand and communicate with LGBTQ patients about their sexual orientation or gender identity

● Participants will demonstrate improved attitudes toward LGBTQ people through understanding health disparities and barriers to care this population experiences

● Participants will learn a series of best practices to accommodate LGBTQ patients who access their services Disclaimers/Acknowledgements

• This is a foundational course • Fairness WV is a non-partisan organization • We are not engaging in electioneering • We are not trying to sell you a service • We are not trying to advertise for a service or prescription medication • This training is supported by Grant #A-18-013 awarded by the Office on Violence Against Women, U.S. Department of Justice. Points of view or opinions in this training are those of the presenters and do not necessarily represent the official position or policies of the Office on Violence Against Women or DOJ. • The West Virginia Transgender Health Initiative has been made possible in part by a grant from The Greater Kanawha Valley Foundation. 4 Ways to Provide Competent and Compassionate Care

1. Understand what it means to be LGBTQ

2. Identify unique struggles LGBTQ people/youth face

3. Acknowledge the state of LGBTQ affairs in West Virginia

4. Promote inclusivity in your spaces through trainings and policies The Basics: What is LGBTQ?

• LGBTQ refers to lesbian, gay, bisexual, transgender, queer and questioning people collectively. • Sexual and Gender Minorities (SGMs) • There are a lot of identities within the umbrella, but it’s not critical to know exactly what all of them mean! • We will provide you with tools to respond with if someone identifies with a sexual orientation or gender identity you are not familiar with Sex and Gender Identity

• Assigned Male/Female at Birth (AMAB/AFAB) • Intersex • Gender Binary/Heteronormative • Gender Identity • Transgender/Cisgender • Transitioning • Medical/social The Medical/Science Side

• Sexual Orientation vs. Sexual Identity • S.O.: Same-sex, bisexual, heterosexual • S.I.: Gay, lesbian, queer, demisexual, pansexual, etc • Biological Sex vs. Gender Identity • Strictly biological vs. biopsychological • Cultural Considerations • “down-low” “discreet” • Societal expectations • Important: Ask who they have sex with, not their orientation The Cultural/Sociological Side

• Sex is based on biological factors such as external appearance of genitalia, chromosomal make up, and hormones/reproductive organs. • Almost always assigned at birth. • Intersex surgery. • Gender is based on an individual’s internal sense of self (identity). • Everybody has a gender identity, even if that identity is “neither” or “none of the above.” Keep Them Separate!

• Biological Sex/Assigned Sex at Birth • Gender Identity • Gender Expression • Sexual Orientation • Sexual Preference • Sexual Behavior • It is important to remember that while aspects may inform each other, they are all separate pieces of one’s identity • Very common with sexual behavior (sex work, etc.) • Gender expression also varies a great deal between people of the same gender identity Transgender should NOT be Confused With

• Drag Queens/Drag Kings • These are either jobs or hobbies: taking on a caricatured version of femininity or masculinity as part of a performance - ANYONE can do drag • Crossdressers • Crossdressing is a hobby - typically a less caricatured version of femininity when compared to drag • Women can’t really “crossdress” in the traditional sense anymore - shifting of social norms • Gender non-conforming people • GNC is when your gender expression runs counter to what we would assume the expectations of your gender identity to be - ANYONE can be GNC Transgender should NOT be Confused With [Part 2]

• Transsexual • Former word used to describe trans people ( we use transgender now) • Potentially used by some trans people to denote medical transition or desire to medically transition (more common in older trans people) • Heavily stigmatized (pornography and sex work) • Avoid using unless a specific person uses it to identify themselves • Transvestite • A BIG no-no - this cannot be stressed enough • Psychological disorder! Requires a diagnosis! • Solely for sexual gratification or arousal • Different from cross-dressing or gender non-conforming What a Transgender Person Is

• Someone who’s assigned sex at birth does not match their gender identity • An innate part of who someone is • NOT a hobby, or a form of gender expression, or a job, or a disorder • Gender dysphoria IS listed as a mental illness in the DSM-V • The distress that might come with being transgender can be considered a mental illness in the same vein as depression • Being transgender is not in and of itself a mental illness Genderqueer/Non-binary

• Neither man nor woman • Both man and woman • Some combination of the two? • Rejects the concept of gender altogether • While typically associated with androgyny, expression and appearance are not confined in this way • Some pop culture celebrities that are genderqueer or non-binary include: Ruby Rose, Cara Delevingne, and Sam Smith Prevalence in the United States

• A 2017 Gallup poll found about 4.5% of American adults identify as LGBT1 • Slightly more prevalent in women/feminine identifying individuals (5.1% vs. 3.9% in men/masculine identifying individuals) • 8.2% of Millennials! • A separate study by the Williams Institute in 2016 estimates about 0.6% of adults identify as transgender2 • That’s about 1 in every 160 people. • Higher prevalence in young people • CDC research estimates about 8% of youth ages 13-17 are LGB.3 • The Williams Institute also estimates about 0.7% of youth ages 13-17 identify as transgender4 What about in West Virginia

• Fairness WV estimates that roughly 60,000 adults (or 2.8% of the population) identify as LGBT.5 • West Virginia actually has the highest percentage of youth who identify as transgender compared to any other state (1.04%)6 • Take that Hawaii (No. 2)6 LGBTQ Discrimination

• Due to the Bostock decision in June 2020, it is now illegal to fire, deny to hire, or deny a promotion based on sexual orientation or gender identity. • However, discrimination is still legal in other ways. • For instance, in 28 states, you can be denied housing for being LGBTQ. • 29 for transgender people. • In 29 states, you can be denied public accommodations for being LGBTQ. • 30 for transgender people. Information gathered from HRC State Equality Maps found here: https://www.hrc.org/state-maps/ LGBTQ Discrimination in WV

● West Virginia has no statewide protections from discrimination for employment, housing, or public accommodations for sexual orientation or gender identity. ● This means that you can be denied housing, or refused service in a public business for being LGBTQ or even being perceived as LGBTQ. ● 13 cities/municipalities have adopted non-discrimination ordinances for LGBTQ people ● Kanawha County has a non-discrimination policy for county employees ● Elkins has a non-discrimination policy for city employees

Health Disparities Amongst the LGB Population

• Less likely to have insurance (77% vs 82%) • More likely to delay or not seek medical care (29% vs 17%) • More likely to delay or forgo prescription medications (22% vs 13%) • More likely to smoke (27% vs 16%) and abuse alcohol (44% vs 33%) • More likely to experience psychological distress (20% vs 9% in the past year) • LGB Youth are much more likely to attempt suicide (35% vs 10%) Health Risks of LBG People

• Gay/Bisexual Men • Lesbians • Body Image • Obesity (25% more likely) • Anabolic Steroids • IPV and Domestic Abuse • ED • Uterine, breast, and cervical • HIV/AIDS cancers • IPV and Domestic Abuse • Less likely to get mammograms and pap smears, etc. • Bisexual Women • Body Image*** • Eating Disorders******* • IPV and Domestic Abuse Health Disparities For Transgender People

• Much more likely to attempt suicide than general population (41% vs 4.6%) • Twelve (!) times more likely to have attempted suicide in the past year (7% vs 0.6%) • 28% had postponed medical care due to fear of discrimination, 48% postponed medical care due to cost • 26% had been physically assaulted in a health care setting • 10% had been sexually assaulted in a health care setting • 19% reported being refused medical care

Statistics by: FORGE at https://forge-forward.org/wp-content/docs/fast-facts-healthcare.pdf Health Risks for Transgender People

• Trans people more likely to work in underground economies • Domestic Violence, IPV, Sexual Violence • HIV/AIDS (more common in TWOC – sex work) • Body Image (compounded by gender dysphoria) • Suicide • Depression • Hormone related issues (DVT for trans women, heart attacks for trans men) The WV Transgender Health Survey

• Conducted by Fairness WV in 2019 • Surveyed transgender Wvians (and former Wvians) about their experiences and perceptions of healthcare providers level of competency in the state • Over ¾’s of respondents were between the ages of 18-35 • Also gauged what kinds of transition related care people would want to access • Over 80% of respondents are or would like to receive transition related healthcare The WV Transgender Health Survey

• Discrimination: • 60% experience intentional misgendering • 12.5% reported having unnecessary procedure performed on them due to being transgender • 20% were refused healthcare outright by providers • Barriers • 64% delayed care due to financial concerns • 69% delayed care due to fear of discrimination • 64% went without care • 36% travelled out of state to receive care How can we help?

• Use inclusive language • Welcoming and safe spaces • Call out discrimination • Bathrooms • Trans-inclusive spaces and care • Inclusion through Policy Pronouns

• The most important thing you can do is get their name and pronouns correct! • If you make a mistake, apologize and move on. Don’t dwell. • Have a section on patient intake forms for this. • “Hi, my name is [x], and my pronouns are [y]” • “What is your name and pronouns? • Everybody should be asked this question! • This gets its own slide because it’s very important. Inclusive Language

• Avoid using gendered language when speaking generally • E.g. (firefighter vs. fireman, partner vs wife/husband, “they” vs “he or she”) • Avoid using male/female unless in a medical context • Avoid “homosexual.” Use “lesbian” or “gay.” • Avoid “born male/born female.” Use “assigned male/female at birth.” Inclusive Language (cont.)

• Remember, gay, bisexual and transgender are adjectives • E.g. a gay person/a gay man, not “a gay” or “the gays” • Listen to individuals and how they talk about themselves. • For instance, if they call their partner their wife, you can also refer to them that way • If you don’t know, it’s okay to ask! • Obviously, avoid slurs, keeping in mind that some members of the community may use it as a way to “reclaim” those slurs • For instance, a transgender woman using “tranny.” How to Make a Welcoming Space

• Use visual cues! • For example, prominently displaying a rainbow flag in a common area • Include LGBTQ people in your publications/information even when it does not specifically apply to LGBTQ people/services • Maintain confidentiality of LGBTQ staff/people using your services • Provide training to everyone on your staff on LGBTQ issues • Be mindful of transgender individuals, especially if you have gendered spaces (like bathrooms or locker rooms) • Always use the correct pronouns and name of a person (again, if you don’t know for sure, ask)! • If you have an intake form, preferred name and pronouns (and gender!) should be listed to fill out Bathrooms

• Always let a person use the bathroom of their gender • E.g. a trans woman would use the women’s bathroom, a trans man would use the men’s • Gender-neutral restrooms • Keep in mind that an individual may use the “wrong” restroom for safety purposes • A trans woman who does not pass and is still presenting as a man may use the men’s restroom, for instance What about Mandatory Reporting?

• Only applies to minors • Do not disclose a minor’s S.O./G.I. to their parents without their explicit permission • Be upfront about what you can’t keep confidential • Keep records that are congruent with patients gender identity • With their permission Resources/Organizations

• Lambda Legal: https://www.lambdalegal.org/ • ACLU: https://www.aclu.org/ • Transgender Law Center: https://transgenderlawcenter.org/ • National Center for Transgender Equality: https://transequality.org/ • Fairness WV: fairnesswv.org Transgender Health Guide

● Connect transgender people with healthcare providers in their area ● This guide is found on Fairness WV’s website under the resources page ● We’re always accepting sign-ups, and attending this training allows you to join Conclusion

• LGBT people are more likely to experience systemic discrimination and have barriers to accessing public services such as housing, employment, and healthcare • LGBT youth are more likely to experience violence including sexual violence and rape • LGBT youth are more likely to have poor physical and mental health, and are more likely to attempt suicide • By fostering a welcoming space for LGBT people accessing a particular service, we can both reduce stigma surrounding them and help them achieve better outcomes across a range of factors