Double Vulnerable Adolescents Advanced Age People of Color and LGBT Module from the ADIEM LGBT Residency Curriculum Instructors No financial conflicts of interest Joel Moll Paul Krieger ID: 1040634
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1. Academy of Diversity and Inclusion in Emergency MedicineDouble VulnerableAdolescents, Advanced Age, People of Color and LGBTModule from the ADIEM LGBT Residency Curriculum
2. Instructors* No financial conflicts of interestJoel MollPaul KriegerThea James
3. Today’s SessionSectionLeaderIntroductionJoel MollADIEM ModulesJoel MollSmall Group CasesAll FacultyPowerPoint PresentationAll FacultyPost Test & ReviewThea JamesSummary and QuestionsPaul Krieger
4. Question for youWho are you?FacultyResidentsStudentsOther
5. ADIEM Curriculum ModulesIntroduction to LGBT Health in EMEthics and Legal ConsiderationsHealthcare disparities of gay men and lesbiansTransgender HealthPediatric and Adolescent LGBTGeriatric LGBT
6. Case Discussions
7. LGBT People of Color
8. LGBT and People of ColorSubject to same disparities as all LGBT peopleCultural beliefs may conflict with LGBT statusLess likely confide sexuality to physician1 in 3 LGBT families are of color
9. African American and HIVAmong all gay and bisexual men, African Americans are the racial/ethnic group most affected by HIV.Young African American gay and bisexual men accounted for the highest number of new HIV infections recent study of gay and bisexual showed a 19% increase in self-reported sex without condoms in HIV-positive African American gay and bisexual men—from 47% in 2005 to 56% in 2011.
10. http://www.cdc.gov/hiv/risk/racialethnic/bmsm/facts/index.html
11. CDC: Why LGB URM men high risk HIVSmall population size and the prevalence of HIV in that population, African American gay and bisexual men have a greater statistical risk of being exposed to HIV Sexual relationships with older men, more likely to have HIV, also may increase risk for exposure Younger African American men less likely to know statusStigma, discrimination, conflicts with cultural beliefshttp://www.cdc.gov/hiv/risk/racialethnic/bmsm/facts/index.html
12. Best PracticesCreate safe environment for disclosureConsider conflicts in community and sexualityEncourage to know HIV statusCounsel of safer sex, PrEP and PEP
13. LGBT Youth
14. LGBT YouthWho are todays youth?7-8.7% of adolescents report having at least 1 same sex partner or romantic interest.Although fewer identify as being homosexual, bisexual or unsure (1-3%). Only 16% told there physician they were gay
15. Youth DisparitiesTwice as likely to have attempted suicideTwice as likely to experiment with drugs and alcoholMore likely to be physically abusedTwice as likely to have been verbally harassed or physically assaulted20-40 % of homeless youth are LGBTSubstance abuse, risky sexual behavior, mental health disorders, victimization15
16. Growing up LGBT in AmericaLGBT YouthNon-accepting families 26%School/bullying problems 21%Fear of being out or open 18%Non-LGBT YouthClasses/exams/ grades 25%College career 14%Financial pressures related to college or job16http://www.hrc.org/files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf
17. Best PracticesUse Open Ended QuestionsScreening for STD’s and pregnancyPrEP and PEPScreen for Suicidal ideation and depressionAppropriate referrals and community resourcesConsider assessing home situation and support systemDiscuss recommended vaccinationsHepatitis A and B, HPVKnow privacy rights for minors
18. Mature LGBT
19. LGBT Maturity 1.5 million LGB Americans over the age of 65 37% of LGB-identified adults have had a child at some time in their lives, compared to 74% of all Americans Elder LGB individuals are twice as likely to live alone and be single, and may be estranged from what biological family
20. LGBT extended care facility residents, only 22% felt comfortable being open about their sexuality and 43% reported mistreatment based on their sexuality. Over half of LGB people over age 65 are depressed, 39% have contemplated suicide, and 53% feel isolated.
21. http://www.cdc.gov/hiv/risk/age/olderamericans/index.html
22. Concerns with Death or DisabilityMarriage equalityAdvanced DirectivesHospital VisitationChild guardianshipECF SeparationDeath taxProbateEstranged Family threat
23. Best PracticesScreen for Suicidal ideation and depressionConsider social factors, isolation, in long term care decisionsMature LGBT should consult lawyer for estate and disability planningCMS mandates choice of visitation
24. Module Post Test1. Which group has the highest rate of new HIV infection among LGBT individuals?A. Latino Bisexual men of all agesB. African American young men (age 13-24)C. Men age 55 or greaterD. Women under age 18
25. Module Post Test2. Compared to heterosexuals of the same age, LGBT individuals over >65 have a very high rate of A. HIV infection B. Heart disease C. Intimate Partner Violence D. Depression and Suicidal Ideation
26. Module Post Test3. What percentage of homeless youth are LGBT? A. 40% B. 10% C. 90% D. 5%
27. SummaryLGBT patients are ubiquitous to EMAdditional barriers and challenges exist for those who are double vulnerableLGBT URM carry a heavy burden of HIV LGBT Youth have social challenges in addition to health disparitiesvulnerable to STD and homelessnessMature LGBT very high rates of depressionMature LGBT less support and resources, less legal recognition and protection
28. Coming Next Year…With approval from SAEM Program CommitteeTransgender Health in Emergency Medicine
29. Thank you!Questions?Thea Jamestljlcj@gmail.comPaul KriegerPKrieger@chpnet.orgJoel Molljmoll@mcvh-vcu.edu