LGBT: a Vulnerable Population 1
LGBT: A vulnerable population 1
LGBT: A vulnerable population
By Shelly Parker
Ferris State University
NUR 340
Abstract
In this paper, I have described the factors that cause vulnerability in lesbians, gays, bisexual and transgender (LGBT) individuals. I have worked with LGBT patients at various times throughout my twenty three years as a nurse and will discuss my own personal awareness with this population. I will describe the demographics based on information obtained from various websites. I will review my own personal attitude before and after learning information on the LGBT population. Lastly, I will reflect on how my own bias can help improve the delivery of care and ideas to impact public policy to diminish the disparities in the LGBT population.
LGBT: A vulnerable population
Historically, the topic of lesbian, gay, bisexual and transgender (LGBT) individuals was not typically openly discussed. However, the number of LGBT individuals has increased resulting in the need to address important health care issues specific to the population. It is important to ensure the LGBT population receives the types of services required to maintain the health and well-being of these individuals.
There are many factors related to the vulnerability of the LGBT population. There are of course increased risks with sexual behavior and account for some disparities, but in addition, LGBT individuals are often subjected to stigma and discrimination which causes further disparities and vulnerability to LGBT individuals (CDC, 2013). When Aids was first identified, it was thought to be a disease caused by homosexual individuals and the population was blamed for causing a public epidemic. In the 1970’s, the American Psychiatric Association argued whether homosexuality was a pathological illness, but eventually was deemed “not a psychiatric illness” (Mayer, Bradford, Makadon, Stall, Goldhammer, Landers, 2008). Other factors include sexually transmitted infections, substance abuse, depression and stress related to social stigma and discrimination.
I really had to stop and think about my own personal feelings and bias toward LGBT individuals. I grew up in a very conservative rural area in a catholic family where the sanction of marriage and the nuclear family was a must. I do not recall ever even coming into contact with anyone who was a LGBT individual or not that I knew of anyway. My first exposure to diversity was in college where there was a student gay rights organization on campus. My next interactions were with my first job as a nurse. I was assigned care to a young man who had fallen off a roof and broke his back and required inpatient therapy. He was a very nice young man and I was a caught off guard when he asked me if I could help him arrange private time with his significant other. I had not realized he was gay until that moment honestly. I ended up placing a do not disturb sign on the door to allow he and his significant other privacy. There were a lot of jokes going around the nurse’s station about it and many nurses were upset about it. I also had a patient who had been stabbed multiple times by his same sex partner. It was his first relationship with a man after his marriage failed. He told me that he always knew he was gay, but he could never tell anyone he had those feelings because he would have been rejected by his family and friends. Another experience which made me sad was a patient who was admitted for end of life care who had AIDS. I was so surprised by the reaction of the nursing staff to his admission. Many nurses were angry that he had been accepted into the facility because they felt he did not belong there. I also became close friends with a gay male nurse and his significant other. We often did things together and through them I met a number of people who were either lesbian, gay, bisexual or transgender. For me it really became normal in my adult years. I do think I had placed stereotypes on this population though. I thought it was easy to identify those individuals based on looks or mannerisms. If a man looked or acted feminine, he was gay, if a woman looked manly or acted tough, she was a lesbian and a transgender was very flamboyant with lots of makeup and dressed in clothing of the opposite sex. If someone had AIDS or HIV it was a stereotype that they must be a LGBT individual. I feel that before I began this paper, I am open- minded and although I am heterosexual, I have never really had any negative feelings toward this population. However, in saying that, I have been one of those nurses who have engaged in making jokes behind closed doors sometimes when coming in contact with this patient population.
According to an article in Williams Institute, there are at least 8 million LGBT individuals living in the United States (Gates, 2011). LGBT individuals live in all communities and like everyone else come from all ages, race, ethnic and socioeconomic backgrounds. There is currently a new objective in the Healthy People 2020 initiative to improve the health and safety of the LGBT population (Healthy People 2020, 2013). A challenge for collecting data to determine the needs of the LGBT population is that asking sexual and gender orientation questions is generally not asked on surveys or the questions asked are very limited. This makes it difficult to truly understand and identify the demographics, health care needs and the amount of people who are LGBT. I learned a great deal of information that surprised me in the Healthy People 2020 objective for the LGBT population. Some of the items that saddened me are that LGBT youth are 2 to 3 times more likely to attempt suicide and become homeless. Other facts are that the transgender population have a high prevalence of victimization and mental health issues and at the same time are less likely to have health insurance than any of the other sexual orientation groups (Healthy People 2020, 2013).
There are several reasons the LGBT population are not always forthcoming with information about sexual orientation with health care providers. Sometimes the patient does not disclose important information to providers out of fear of being judged, resulting in possibly not receiving the necessary medical care. In the health care environment, I have seen providers often make jokes and become reluctant to care for patients such as the patient I described earlier with AIDS. There is also the current controversy of same sex marriages. There has been legislation passed in some states to allow same sex marriages, however, there is still a lack of acknowledging the marriage to the extent that the partner can be covered with the spouse’s health insurance resulting in lack of insurance for some individuals. There is also the risk of being discriminated and losing employment if one discloses the fact that they are an LGBT individual.
In reflecting on what I have learned about the LGBT population, I guess I never realized that the needs of this population are really unique and the fact that it not only includes adults but the youth as well. I had never really given much thought to the bias of health care providers and honestly, I felt that the LGBT patient had the same types of issues as anyone else. However, after reading the research, I have a much better understanding of the societal stigma and discrimination and how this impacts the onset of depression, substance abuse, suicide and other health related issues. I also think that it gave me a better perspective to be more compassionate and understanding to LGBT patients when providing care. The research really gave me a broader perspective on the challenges LGBT patients face and how I should be alert to these challenges to make sure I get the necessary resources needed. I also realize after reading the research that the stereotypes I have labeled for this population are not true.
To improve care to this population in public policy, I believe it is important to mandate sensitivity education to all health care providers. Where I currently work, there is annual education for cultural competencies, but none of the education is about LGBT patients. The educationshould not only teach people to be sensitive and nonjudgmental to avoid societal stigma and discrimination, but also about the unique care needs and how to be prepared to obtain the appropriate resources for this population. I also think that it is important to ask about sexual orientation with assessments as well as state and national surveys regarding census and diseases to get an accurate picture of what is needed. Improved data will results in better programs to meet the health care needs and improve the health of the LGBT population.
References
Centers for Disease and Control and Prevention (2013, March).Lesbian, gay, bisexual and
transgenderhealth. Retrieved from:
Gates, G., (2011, April). How many people are lesbian, gay, bisexual and transgender?
Retrieved from:
studies/how-many-people-are-lesbian-gay-bisexual-and-transgender/
Healthy People 2020 (2013, April). Lesbian, gay, bisexual and transgender health. Retrieved
from:
Mayer, K., Bradford, J., Makadon, H., Stall, R., Goldhammer, H., Landers, S. (2008, June).
Sexual andgender minority health: what we know and what needs to be done. Retrieved
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