A Provider’s Handbook on CulturallyCulturally CompetentCompetent CareCare LESBIAN, GAY, BISEXUAL AND TRANSGENDER POPULATION 2ND EDITION Kaiser Permanente National Diversity Council and Kaiser Permanente National Diversity A PROVIDER’S HANDBOOK ON CULTURALLY COMPETENT CARE LESBIAN, GAY, BISEXUAL AND TRANSGENDER POPULATION 2ND EDITION Kaiser Permanente National Diversity Council and Kaiser Permanente National Diversity TABLE OF CONTENTS INTRODUCTION........................................................................................................6 DEMOGRAPHICS .......................................................................................................7 Definitions & Terminology..................................................................................7 LGBT Relationships..............................................................................................9 LGBT Families......................................................................................................9 Education, Income and Occupation.................................................................10 Health Care Coverage........................................................................................10 Research Constraints..........................................................................................11 Methodological Constraints ...............................................................................11 Implications for Kaiser Permanente Care Providers........................................11 HEALTH BELIEFS AND BEHAVIORS......................................................................12 Effects of Homophobia and Heterosexism on Health Care............................12 Older LGBT Adults ............................................................................................14 People of Color..................................................................................................14 Religion...............................................................................................................16 Role of Non-Traditional Families in Medical Decision-Making ......................17 Taking Medical Histories ...................................................................................17 Confidentiality ....................................................................................................17 Implications for Kaiser Permanente Care Providers........................................18 RISK FACTORS .........................................................................................................20 Socioeconomic Risk Factors..............................................................................20 Homophobia and Heterosexism .................................................................20 Hate Violence...............................................................................................21 Medical Bias .................................................................................................22 Implications for Kaiser Permanente Care Providers........................................23 Behavioral and Lifestyle Risk Factors ...............................................................24 Sexual Practices............................................................................................24 Substance Use ..............................................................................................26 Circuit Parties ...............................................................................................28 Implications for Kaiser Permanente Care Providers........................................29 MAJOR DISEASES ....................................................................................................30 Cardiovascular Disease......................................................................................30 Cancer.................................................................................................................30 Anal Carcinoma............................................................................................31 Support Groups............................................................................................31 Infectious Disease ..............................................................................................32 HIV/AIDS......................................................................................................32 Prevention and Safer Sex Risk Assessment..........................................32 Confidential Versus Anonymous HIV Testing......................................33 Risk of HIV Transmission Amongst Lesbian and Bisexual Persons ...34 Opportunistic Infections and Complications........................................34 Hepatitis........................................................................................................35 Hepatitis B..............................................................................................35 Hepatitis A..............................................................................................35 Hepatitis C..............................................................................................36 Other Sexually Transmitted Diseases .........................................................36 General Considerations about Men Having Sex with Men.................36 General Considerations about Women Having Sex with Women......37 Gonorrhea ..............................................................................................37 Chlamydia...............................................................................................37 Syphillis ..................................................................................................37 Human Papilloma Virus ........................................................................38 Lesbians and HPV..................................................................................38 Herpes Simplex Virus ............................................................................38 Implications for Kaiser Permanente Care Providers........................................39 TRANSGENDER HEALTH CARE..............................................................................40 Important Terms.................................................................................................40 The Spectrum of Transgender Identity.............................................................41 The Transgender Person....................................................................................42 Psychiatric Perspective.......................................................................................42 Caring for the Transgender Patient...................................................................43 Confidentiality ....................................................................................................44 Standards of Care for Gender Dysphoria.........................................................44 Harry Benjamin Standards of Care .............................................................44 Health Law Standards of Care ....................................................................44 Stages of Gender Transition..............................................................................45 Stage One: The Real Life Experience.........................................................45 Stage Two: Hormonal Therapy...................................................................45 Stage Three: Genital Reconstructive and Breast Surgery ..........................46 HIV/AIDS in the Transgender Population........................................................47 Implications for Kaiser Permanente Care Providers........................................47 SPECIAL AREAS OF CLINICAL FOCUS: INTERSEXUALITY ..................................48 Introduction........................................................................................................48 Treatment............................................................................................................48 Implications for Kaiser Permanente Care Providers........................................49 SPECIAL AREAS OF CLINICAL FOCUS: OBSTETRICS/GYNECOLOGY ...............50 Barriers to Health Care......................................................................................50 General Patient Interview Principles ................................................................50 Sexuality and Health..........................................................................................51 Sexual Practices of Women Having Sex with Women ....................................51 Sexually Transmitted Diseases ..........................................................................51 4 HIV......................................................................................................................51 Cancer.................................................................................................................52 Fertility and Obstetrics.......................................................................................52 Implications for Kaiser Permanente Care Providers........................................53 SPECIAL AREAS OF CLINICAL FOCUS: CHILD AND ADOLESCENT HEALTH...54 Adolescent Health Care Issues..........................................................................54 Sexually Transmitted Disease......................................................................54 Suicide ..........................................................................................................54