6/19/2019
International Student Travelers and Gender Concerns: A Brief Overview
CATHERINE EBELKE PA-C, CTH CISTM 16 WASHINGTON DC Greetings from Montana State 7 JUNE 2019 University!
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What we’ll discuss in this session Underappreciated yet crucial LGBTQI+ Gender-related concerns often not discussed – in travel or other appointments
Definitions Profound impacts on travel health and safety - and on life in general Travel (and non-travel) considerations Not a huge time investment to include in travel discussion Health challenges in this population Important opportunity too often missed Risks with International Travel Excellent resources available for students and providers College Travel Health possibilities for the LGBTQI+ traveler Resources We are in a position in conducting a travel consult or teaching an International Travel Health and Safety Class to open doors and have a Broader context and perspective will be addressed positive impact – traveling or not traveling
We won’t be discussing the Solo Female Traveler or related concerns We do not need to be experts….we can open the door and start the dialog due to time constraints…but great resources are available for that! and offer resources…do not let that inhibit us from asking and caring
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Terminology / Definitions
Can be confusing but very important to understand working with students – and others! It is respectful – and essential – to have good working knowledge of current terminology However, don’t let terminology be a barrier to opening a discussion…we are all continually learning…..and many terms are continually changing Resources abound to help us all learn more Many colleges offer or mandate training such as Safe Zone Project
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Basic Terminology / Definitions LBGTQI+
L – Lesbian G – Gay B – Bisexual T – Transgender Q - Queer or Questioning I – Intersex + - includes multiple other identities often considered too numerous to delineate
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Identifying as LGBTQI+ has broad and far-reaching significance on many levels
Global Community Local Personal
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Identifying as LGBTQI+ has broad and far-reaching significance
Personal Local Community Global
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What is going on at home for Issues at home…. US LGBTQI+ students ? Become issues while traveling…..
Stunning report from the CDC …..often with greater risks and higher stakes High School students …..and little if any support or community 2007 – 2017 data Very relevant to our populations
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Many resources available
To all types of providers Medical Mental Health Others Many are excellent Many are free More openness in this discussion is crucial – and we can play a role with our traveling students!
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So, Let’s Talk Traveling Students!
As with all of Travel Health, advance planning makes a world of difference ! Discussions with Study Abroad re good destination options Discussions with Health Care Provider, CPS, etc Excellent communication plans in advance
As with providing Travel Health care in our college settings, this can be an excellent opportunity to address student health and wellbeing in many ways beyond travel issues
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Destination Choice is Critical for this population
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Travel Consult For Which Destinations? All!
An opportunity to open doors Potentially valuable if traveling or not Possibility to initiate discussions Good possibility that support would be very helpful and has not been sought opportunity to provide resources as well consider and evaluate itinerary regarding orientation consider wisdom of travels if in questioning or active transition
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Travel Consult As an example of one approach, here are a few items from our Travel Health Questionnaire, ASK ! completed in advance online Open the door
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PHQ : Included with every Travel Health Questionnaire
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Mental Health history very important as well Other important things to cover in the Occasionally not disclosed, but often opens Tr a v e l C o n s u l t
important dialogue opportunities….. Travel Health Questionnaire answers Receiving regular care anywhere? Appointments with regular providers – PCP, specialists, MH to discuss travels If Transgender and actively transitioning
Many additional considerations
Must arrange appointments with regular providers well in advance
Meds?
Injectables?
Monitoring?
Leaving support community at home?
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More Travel Consult Thoughts More Travel Consult Thoughts
Always leaving the door open for changing plans is important Destination changes Provide a welcoming, respectful and safe environment Delaying or canceling travels Encourage and enable open communication Wherever you go there you are……Taking care of business at home first Provide direct and appropriate information Travel as an escape? Provide resources Referrals and recommendations as appropriate on campus Excellent plans for communication and support – multiple options important in community WhatsApp (not in China) – preload contacts national and international Skype for travel Email ? Phone use Provide answers to questions or offer to facilitate learning answers Leave the door open for another appointment and future communication
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Risks Risks Violence Sexual activity while traveling Frequency of sex and numbers of partners usually increases abroad Interpersonal (multiple studies from multiple countries) Social STD Risks Sexual assault Hooking Up Apps make this much easier now (Tinder, Grindr,etc) Substance use Newly found freedom Mental health issues Not constrained by friends, family, community or expectations / assumptions at home Isolation Anonymity Discrimination Discuss and counsel re risks Others Intimate partner violence risk Increased substance use may also be present Be open and honest when discussing Legal and cultural risks
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Additional Related Considerations Additional Related Considerations
Bringing condoms from home – may increase use Importance of protection must be emphasized PrEP? Good opportunity to discuss with certain populations…. Inconsistent use Traveling or not! Frequency of sex and numbers of partners usually increases PEP? abroad (multiple studies from multiple countries) Healthcare resources abroad HIV ISTM, IAMAT, Embassies Hepatitis B – complete full series, check titer Hepatitis C Rx availability and quality Potential for higher endemic HIV, Hep B and Hep C rates on Appropriate evaluation including sample sourcing and timing travels of testing GC, CT STEP and Emergency planning Syphilis Discussion in advance of travel is optimal! Zika
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Non-Academic Travel Finding Support Abroad
How to reach students to invite for appointment? Medical Often “just going to Europe” it often does not cross their mind to seek a travel consult Emotional May involve higher risk activities Mental Health Gay Pride Festival travels Community Travels directly related to sex tourism or greater opportunities Advance knowledge very helpful Many missed opportunities for education and discussions that could be significant for all concerned
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Practical Concerns to Discuss
Roommate Homestay Group travel Cultural considerations TSA and other security Finding restrooms and other facilities Sensitive / exposed situations
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RESOURCES for our students ABOUND!!!!
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Many university websites have excellent info
Great youtube from Univ of Minnesota https://www.youtube.com/watch?v=U-a93xd7SxY&feature=youtu.be
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Michigan State University
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Michigan State University
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Thank You !!!
Catherine Ebelke PA-C, CTH Montana State University
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