EMS World

AUG 2018

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EMSWORLD.com | AUGUST 2018 45 Cross- dressing—In and of itself, this refers to a behavior that's independent of gender identity and not synonymous with a transgender identity. Queer—An umbrella term that embraces a variety of sexual orientations and gender identities. The term "queer" may not be adopted by all people who self-identify as LGBT. Questioning—A person who is in the pro- cess of questioning their gender identity and/or sexual orientation. Ally—A person who confronts homopho- bia, heterosexism, transphobia, and het- erosexual privilege in themselves and others; respectfully shows concern for the well-being of people who identify as LGBTQ; and believes that heterosexism, homophobia, and transphobia are social justice issues. Homophobia—The fear of, discrimination against, or hatred of people who do not conform to rigid sex roles and sexuality stereotypes. Coming out—May refer to the process by which one recognizes, acknowledges, and/or embraces one's own sexuality or gender identity (to "come out" to oneself). This term may also refer to the process by which one shares one's sexuality or gen- der identity with others (to "come out" to friends, family, etc.). Tolerance—The act of putting up with something. Acceptance—Regarding something as proper, normal, or inevitable. Why Discuss LGBT Health? LGBT persons have several health dis- parities compared to non-LGBT people. LGBT persons are more likely to be smok- ers, drink alcohol, and have mental health problems, which is likely due to lower socioeconomic status and marginaliza- tion compared to straight people. 5 They may also be less likely to access health- care services for fear of stigmatization. 6 The suicide rate among LGBT people is higher than for straight people. Suicide is the second-leading cause of death among 15–24-year-olds, with suicide rates four times higher in gay and lesbian teens. 7 Gay men have higher risk for anal cancer, HIV/AIDS, suicidality, and eating disorders. Lesbians are at increased risk of breast cancer, obesity, substance abuse, and cardiovascular disease. 6 Many of these pathologies may relate to disparities in disease screening. Trans- gender men and women experience more physical and sexual violence, increased rates of suicide and depression, lack of health insurance due to lack of stable employment, and complications from sex- reassignment therapy that may include hormones and/or surgery. 6 It is important to know these popu- lations are more susceptible to certain health conditions but may seek healthcare less often due to fears of stigmatization. 8 This means LGBT people often present to healthcare providers in the later stages of disease compared to their straight counterparts. It is important, then, that healthcare workers are aware of the dis- parities and work to make their organiza- tions welcoming to all patients, especially those least likely to seek care. LGBT Rights and Healthcare The debate about access to healthcare in the United States is still unsettled. In many ways the furor over the Affordable Care Act and how healthcare should be structured in the country revolves around the right to healthcare. There are laws in place that help pre- vent discrimination against the most severely sick who need medical attention, including the Emergency Medical Treat- ment and Active Labor Act and Americans With Disabilities Act. And of course there are Medicaid and Medicare to catch those who cannot afford private insurance. The 1990 CARE Act (later named the Ryan White Act) set aside federal funding to help treat marginalized victims of the HIV/ AIDS crisis. 9 In fact, the HIV/AIDS crisis in the United States was a catalyst for debate about access to medical care, and it resulted in both the American Medical Association and American Dental Association updat- ing their ethical codes to make it unethical to refuse to treat someone on the basis of their HIV or AIDS status. Today these ethical codes are often written into healthcare contracts, and with the addition of the ADA's prohibition of dis- crimination on the basis of disability, most will receive care when they really need it, at least in emergencies. (Despite this, some suggest it's murky at best whether U.S. physicians have a duty to care in all cases. 10 ) However, there is still no clear U.S. federal law that prohibits discrimination based on sexual orientation or gender identity in all situations. Title VI of the Civil Rights Act of 1964 prohibits discrimination by federally funded programs on the basis of "race, color, or national origin," but there is no obvious protection based on sexual orientation or gender identity. 11 There are federal protec tions for employment and workplace harassment, TRANSGENDER COMMUNICATION TIPS • The idea of "passing" for one gender or another is a controversial subject in the trans community. It can imply that a person is not genuinely what they appear to be. It's not appropriate to comment on the extent to which a trans person appears to be cisgendered. • It is not a requirement that a trans person "out" themselves to you or other healthcare providers. It is also untrue that you will be able to immediately tell who is transgender and who is not. Rather, try to get used to the fact that gender does not imply a binary of man or woman but instead exists on a spectrum. • It's important to honor the pronoun each person uses. An unfamiliar or seemingly counterintuitive pronoun can cause anxiety. Some may even balk at using a person's chosen pronoun due to a conflict of values or perceptions. It is OK to make a mistake and correct yourself. It will take time to lose this anxiety. Try normalizing pronoun choice by indicating your own pronoun in your interaction or on your nametag. When you don't know someone's pronoun, use a gender-neutral one such as "they." This will show your support for people across the gender spectrum.

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