Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
MissouriIoundalionforHeaIlhIubIicalion
Issue Statement
LesbiangaybisexuaIandlransgenderLGTindividuaIsexerienceoorerheaIlhoulcomes
lhanlheirhelerosexuaIeers
TheseooroulcomesarearesuIlofdierencesinaccesslo
heaIlhcoverageIimiledavaiIabiIilyofcuIluraIIycomelenlheaIlhcareservicesabsenceof
medicaIseingslhalarearmingandfreeofdiscriminalionscarcilyofmedicaIslalrained
inLGTheaIlhissuesheaIlhbehaviorslhaldonolfoslergoodheaIlhandsociaIandeconomic
syslemslhalhavenolsuorledandrolecledminorilies
ThisaerdravsonresearchfrommuIliIesourceslhereforeavarielyoflermsareusedlo
describesexuaIandgenderminoriliesSGMThebackgroundseclionoflhisaerresenls
denilionsoflhelermsusedasveIIandanexIanalionofvhyoneoverarchinglermvasnol
seIecledIoIIovinglhebackgroundlhisissuebriefexIorescommonexeriencesamongLGT
individuaIslhalimacllheirabiIilyloIeadheaIlhyIivesThisaerconcIudesvilharevievof
currenloIiciesinMissouriandoersoIicyrecommendalionslhalviIIIeadlogrealerheaIlh
equilyandimrovedheaIlhoulcomesforaIIMissourianseIovisaIisloflhedisarilies
highIighledinlhisaer
LGTMissouriansaremorelhanlviceasIikeIylonolreceiveneededmedicaIcareor
surgerycomaredlolhegeneraIouIalion
SexuaIandgenderminoriliesinMissouriarelimesmoreIikeIylobeuninsuredlhanlhe
generaIouIalion
IeverlhanofrimarycarehysiciansinlheslalehaveregisleredasLGT
arminginlheGayandLesbianMedicaIAssocialionsonIinerovidernelvork
LGTMissouriansvhobeIongloraciaIandelhnicminorilygrousexeriencehigherrales
ofnegaliveheaIlhoulcomes
MissourisMedicaidcoverageexIicilIyexcIudeslransgenderlransilioncarebulsurgery
isrequiredforalransgenderersonlochangelhegendermarkeronslaleidenlicalion
documenls
MorelhanonelhirdofgayandIesbianyoungeoIehavenoldiscIosedlheirsexuaI
orienlalionlolheirdoclors
MorelhanlvolhirdsofheaIlhcareorganizalionsdonolrequirelhalhysiciansaend
cuIluraIcomelencylraininglhalincIudesLGTheaIlhissues
TheaveragemedicaIsludenlsendsfeverlhanhoursIearningaboulLGTheaIlhissues
andlhema|orilyoflhallimeisdedicaledloHIVAIDS
LGTfamiIiesinlheUSaremoreIikeIylobeoorunderemIoyedandmuIliraciaIlhan
nonLGTfamiIies
OneinsevenLGTMissouriansreorlsexeriencingdiscriminalioninlhevorkIace
MIHHeaIlhIoIicyIubIicalion
Background
Health Equity
IorlheuroseoflhisaerheaIlhequily
referslolheresenceofraclicesoIicies
andsyslemsromolingheaIlhandequaI
accessloheaIlhcare
ThelermheaIlhdisarilieshasbeen
assignedmuIliIedenilionsinlheasl
years
GeneraIIylhelermdisarily
isusedloreferloanobserveddierence
belveengrousDravingfromlhis
denilionlheNalionaIInslilulesofHeaIlh
hasdenedaheaIlhdisarilyaslhe
dierenceinlheincidencerevaIence
morbidilymorlaIilyandburdenofdiseases
andolheradverseheaIlhcondilions
lhalexislamongsecicouIalion
grous
OverlheIasldecadelhislerm
hasbeenexandedbysomeIlnovrefers
loinequaIiliesinheaIlhoulcomesand
inequiliesinaccessloheaIlhcarelhalare
exeriencedbyminorilygrousincIuding
raciaIandelhnicminorilieseoIeIiving
vilhdisabiIiliesIoverincomeindividuaIs
andfamiIiessexuaIminoriliesruraI
andurbanouIalionsandimmigranl
communilies
Insomecasesdenilions
ofheaIlhdisarilieshavebeenexlendedlo
incIudedelerminanlslhalimaclindividuaI
andcommunilyheaIlh
Someoflhese
delerminanlsincIudeincomeandsociaI
slalussociaIsuorlnelvorkseducalion
emIoymenlsociaIandbuiIlenvironmenls
genelicandbioIogicaIvarialionersonaI
heaIlhraclicesandcoingskiIIsand
heaIlhychiIddeveIomenl
VariousubIicandrivaleenlilieshave
oulIinedlheirdelerminalionsoflhefaclors
lhalconlribulelodierencesinheaIlh
Someagenciessearaledelerminanlsof
heaIlhinlocalegoriessuchasavoidabIe
andunavoidabIeolherscalegorizelhem
asfairversusun|uslinorigin
As
lheseoorheaIlhoulcomeshavebeen
How Many People are Lesbian, Gay,
Bisexual or Transgender (LGBT) in the
United States?
Percent and Number of U.S. Adults who
Identify as LGBT
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
Transgender
Bisexual
Lesbian/Gay
Transgender Men Women
2,648,033
(2.2%)
1,359,801
(1.1%)
1,539,912
(1.4%)
2,491,034
(2.2%)
697,529
(0.3%)
GJ Gates, How Many People are Lesbian, Gay, Bisexual
and Transgender, The Williams Institute, April 2011.
Percent of Adults Who Report Any
Same-Sex Attraction and Behavior
0%
2%
4%
6%
8%
10%
12% Same-Sex Behavior
Same-Sex Attraction
General
Social Survey,
2008
National Survey of
Family Growth,
2006-2008
(Ages 18-44)
11.0%
8.8%
6.9%
GJ Gates, How Many People are Lesbian, Gay, Bisexual
and Transgender, The Williams Institute, April 2011.
MissouriIoundalionforHeaIlhIubIicalion
examinedmorecIoseIyheaIlhrofessionaIscommunilyIeadersandoIicymakershavefound
lhalheaIlhdisariliesoenareassocialedvilhoIiciesandraclicesinlheheaIlhcaresyslem
andolherseclorslhalimaclheaIlh
LGTindividuaIsexerienceoorerheaIlhoulcomeslhanlheirhelerosexuaIeers
TheseoulcomesaredueinarllodierenliaIaccessloheaIlhinsurancecoverageIimiled
avaiIabiIilyofheaIlhcareserviceslhalarecuIluraIIycomelenlandcomassionaleandlhe
imaclofsligmaharassmenlandsyslemicdiscriminalion
IndividuaIsbeIonginglomuIliIe
minorilygroussuchasaLalinogaymanoranAfricanAmericanlransvomanexerience
exonenliaIIyvorseheaIlhcareandheaIlhoulcomescomaredlolheirvhilehelerosexuaI
neighbors
TheCenlersforDiseaseConlroIandIrevenlionhasrecognizedlhesedisarilies
andacknovIedgedLGTcommuniliesasmedicaIIyunderservedouIalionsinHeaIlhyIeoIe
AddilionaIrecognilionoflhesedisariliescameinvhenlheInsliluleofMedicine
IOMreIeasedTncHca|incjIcs|ianGaq
Biscxua|an!Transgcn!crPccp|cBui|!inga
|cun!aiicnjcrBccrUn!crsian!ingvhich
resenledexislingknovIedgeonlheheaIlh
issuesofsexuaIandgenderminorilygrous
andsuggesledresearchgaslobeexIored
forabeerunderslandingoflheheaIlhof
LGTcommunilies
ThelermLGTisusedinscienlicIileralure
andouIarmedialocoIIecliveIyreferlo
muIliIeouIalionsincIudingIesbians
gaymenbisexuaImenandvomen
lransgenderersonsandindividuaIsvho
donolconformlogenderidenlilynorms}uslaseachraciaIandelhnicgrouinlheUSis
uniqueinilsexeriencesandhisloryeachouIalioninLGTcommuniliesresenlsilsovn
uniqueheaIlhconcernsanddislinclexressionsofresiIiencySexuaIminorilygrousandgender
nonconformingersonsIikeolherminorilygrousareoenreferredloasonecommunily
LGTbecauseofcommonexeriencesofre|udiceandinequilyasveIIassharedhisloricaI
viclimizalionsociaIsligmalizalionanddiscriminalion
Inlhefaceofsyslemicdiscriminalion
lhesecommunilieshavecomelogelherloadvocaleforequilabIelrealmenlforLGTindividuaIs
andlheirfamiIies
Sexual Orientation
TheIOMhasdenedsexuaIorienlalionasanenduringaernofordisosilionlo
exeriencesexuaIorromanlicdesiresforandreIalionshisvilheoIeofonessamesex
lheolhersexorbolhsexes
AccordinglolhisdenilionlhelermsIesbiangayandbisexuaI
LGreferlosexuaIorienlalionvhereaslhelermlransgenderreferslogenderidenlily
MuchoflheoriginaIresearchonsexuaIminoriliesfocusedonindividuaIsvhosesexuaI
orienlalionvasnolexcIusiveIyhelerosexuaIlhereforeheaIlhresearchhasIargeIyexcIuded
lransgenderersonsandfocusedonIesbiansgaymenandbisexuaImenandvomen
ResearchaIsohasfocusedonindividuaIsvhohavesexuaIreIalionshisvilheoIeoflhe
samesexbulmaynolidenlifyasIesbiangayorbisexuaI
Insomesludiesresenledinlhis
issuebrieflheseindividuaIsarereferredloasMSMmenvhohavesexvilhmenandWSW
In Missouri, sexual and
gender minorities are more
than twice as likely to not
receive needed medical care
or surgery, compared to the
general population.
5
MIHHeaIlhIoIicyIubIicalion
vomenvhohavesexvilhvomenThese
lvolermshavecomeunderscrulinyin
recenlyearsassomehoIdlhallheyIimil
individuaIsandcanbesligmalizing
Gender Identity and Gender
Expression
WhiIelhelermLGreeclssexuaI
orienlalionlhelermslransgender
andlransareusedcoIIecliveIylorefer
loindividuaIsvhosegenderidenlily
innalesenseofbeingmaIefemaIeor
anolhergenderorgenderexression
reresenlalionofersonaIilyaearance
andbehaviormaynolcorresondvilh
cuIluraIexeclalionsorslereolyesoflhe
sexassignedlolhemalbirlh
These
umbreIIalermsincIudelranssexuaIs
crossdresserslransgenderislsbigender
genderqueerandlvosirilindividuaIs
Inlhisissuebriefsomedalaareresenled
forLGTcommuniliesvhiIeolherdala
arereorledsoIeIyforsexuaIminorilies
ieIesbiansgaymenandbisexuaImen
andvomendenoledasLGorgender
minoriliesielransgenderandgender
nonconformingindividuaIsreferredloas
lransgenderorlrans
Intersectionality of Minority Status
AsresearchaboullheheaIlhofsexuaIandgenderminorilieshasbecomemorevideIy
romoledaddilionaIheaIlhdisarilieshavebeenidenliedinsubouIalionsofLGT
communiliesThesedisariliesinheaIlhoulcomes
havebeenarlicuIarIyseriousamongcommunily
membersvhoareaIsomembersofraciaIandelhnic
minorilygrousIiveinruraIcommuniliesorIack
IegaIdocumenlalionofcilizenshiTheinlerseclions
ofraceelhnicilysexuaIorienlalionorgenderidenlily
geograhysocioeconomicslalusageheaIlhIileracyand
immigralionslalushavebeenfoundlohavemuIliIicalive
eeclsonheaIlhoulcomes
IederaIIyfundedheaIlh
The Intersection of Multiple Identities
Types of identity:
Lesbian
African-American
Older
Adult
Rural
J Rummens, Conceptualizing Identity and Diversity:
Overlaps, Intersections, and Processes, Canadian Ethnic
Studies, 35, 3, (2003): 10-25.
In Missouri, sexual and gender
minorities are 1.5 times more
likely to be uninsured than the
general population.
5
Sex, gender
Age
Socioeconomic, class
Sexual orientation
Race/ethnicity
Disability
Cultural
Religious
Linguistic
Territorial,
geographical
Indigenous,
newcomer
Below is a depiction of the intersecting identities for
an African-American lesbian who is an older adult
and living in a rural area.
MissouriIoundalionforHeaIlhIubIicalion
researchhasnolhisloricaIIyrequiredlhaldalabecoIIecledonsexuaIorienlalionandgender
idenlilyandlodalenofederaIheaIlhsurveyhasoeredmembersoflheLGTouIaliona
meanslofuIIyidenlifylhemseIvesbyraceelhnicilysexuaIorienlalionandgenderidenlily
SeveraIslaleshaveconducledslalevideheaIlhsurveyslhalincIudedqueslionsonsexuaI
orienlalionandgenderidenlily
AndseveraIIocaIandregionaIheaIlhsurveysinMissourihave
incIudedsexuaIorienlalionandgenderidenlilyullherehasbeennocomrehensiveheaIlh
surveylhalincIudessuchdemograhicinformalionforMissouriasavhoIeIorlheurose
oflhisaerIocaIMissouridalaviIIberovidedvhereavaiIabIeSuorlivedalafromolher
USregionaIsurveysviIIbeusedinareas
vhereslalevideMissouridalahavenolyel
beencoIIecledorubIished
Health Factors
HeaIlhfaclorsarelhecondilionsinan
individuaIsIifelhalfoslerordiscourage
goodheaIlhoulcomesThisaerexIores
heaIlhfaclorsandheaIlhoulcomesIaclors
essenliaIlogoodheaIlhincIude
accessloheaIlhinsuranceandlhecare
incIudedincoverage
quaIilyandreguIarilyofaersons
cIinicaIcare
cuIluraIcomelencyinheaIlhcare
services
accesslorevenlivecare
lhesociaIandeconomicenvironmenlin
vhichanindividuaIIivesvorksand
Iaysand
anindividuaIsheaIlhbehaviors
Access to Care
LGTcommuniliesinMissouriand
lhroughoullhenalionfaceinequaIiliesin
lhereguIarilyandquaIilyoflheirheaIlh
careandinaccessloheaIlhcoverageand
cuIluraIIycomelenlheaIlhservices
ThroughoullheUShelerosexuaIaduIls
aremoreIikeIylobecoveredbyheaIlh
insurancecoveragelhansexuaIand
genderminoriliescoverageforLG
Percent of Adults Delaying or Not
Seeking Health Care
0%
5%
10%
15%
20%
25%
30%
35%
LGB Heterosexual
White Latino/a Asian
or Pacic
Islander
African-
American
21%
29%
22%
28%
31%
12%
13%
21%
J Krehely, How to Close the LGBT Health Disparities Gap:
Disparities by Race and Ethnicity, Center for American
Progress, 2009.
Percent of Missouri Adults Without
Health Coverage
J McElroy & K Everett, Out, Proud and Healthy Project:
SGM Health Behaviors and Access to Care, (PowerPoint
presentation), April 27, 2012.
0% 5% 10% 15% 20% 25% 30% 35%
Transgender Adults
Bisexual Women
Bisexual Men
Gay Men
Lesbians
All Adults 15%
25%
21%
35%
27%
27%
MIHHeaIlhIoIicyIubIicalion
aduIlscoverageforlransaduIls
ThesamelrendsexislamongsexuaIand
genderminoriliesSGMinMissourias
SGMindividuaIsareonaveragelimes
moreIikeIylobeuninsuredlhanlheir
helerosexuaIeers
TheIackofadverlisemenlofLGT
armingrovidersaIsoresenlsbarrierslo
careInlherevererimarycare
hysiciansoeringservicesinMissouris
counliesandSlLouisCily
Iever
lhanoflhesehaveregisleredvilhlhe
GayandLesbianMedicaIAssocialions
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SixbehavioraIheaIlhrovidersandlvo
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regisleredasveIcomingenvironmenls
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AII
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miIesofurbanareasSlLouisKansas
CilyCoIumbiaandSringeIdInolhervordsruraIMissouriansvhoseekLGTarming
medicaIcareandbehavioraIheaIlhservicescannolreIyonubIicIyavaiIabIeinformalionlo
idenlifyaveIcomingandlruslvorlhyrovider
TransgenderindividuaIsfaceaddilionaIdisariliesinheaIlhcoverageaslhema|orilyof
heaIlhinsuranceIansdonolcoverlransseciccareandgenderseciccareTranssecic
caremayincIudehormonelrealmenlssexorgenderreassignmenlsurgeryandlransilion
reIaledcareGendersecicroulinecaremayincIudegynecoIogicaIexamsforalransmanor
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conlinueloreferlolhisrocedureasexerimenlaI
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insuranceandveleransheaIlhcareThroughoullheUSrivaleinsurancecomanieshave
beenfoundlo
denycoverageongendersecicroulinecare
noloerIanslhalrovidecoverageforlransgenderindividuaIsregardIessofcosland
iIIegaIIyre|eclcIaimsforlransgenderindividuaIs
InsomecasesemIoyersIaborunionsandensionfundshavesuccessfuIIyadvocaledfor
incIusiverivaleinsuranceoIiciesMedicareandveleransIansdonolcovermosllransilion
reIaledcareMedicaidcoverageisdelerminedbyeachslaleandcurrenlIyslalesexIicilIy
excIudelransilionreIaledcareincIudingMissouri
Tvenlyeighlslalesdonolhavesecic
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regardIessofheaIlhrovidersdelerminalionlhalilisnololionaI
MissouriIoundalionforHeaIlhIubIicalion
ecauseinsurancecomaniesdonoloer
cerlainlyesofcoveragelransgender
individuaIsoenseekheaIlhcareservices
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quaIifyforhormoneandlransilioncareMoslinsurersdonolcoverlransilioncareregardIess
ofaGIDdiagnosis
Clinical Care
NalionaIIysexuaIandgenderminoriliesexeriencedierencesinlheiraccesslocIinicaIdenlaI
andrevenlivecarecomaredlolheirhelerosexuaIandgenderconformingcounlerarls
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fromrovidersTheseareexerienceslhalimaclanindividuaIsviIIingnessloseekfulure
medicaIcare
LesbiansgaymenandbisexuaIindividuaIsaremoreIikeIylhanhelerosexuaI
individuaIslodeIayoravoidseekingheaIlhcareandmoreIikeIylodeIayIIingrescrilion
medicines
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emergencyroomscomaredlo
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careorsurgeryvhenilisneeded
Thesedierencesinaccesslocareareexaggeraledvhenrace
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vhohaveIosllheir|obslhoseinvoIvedinsexvorkdrugsaIesorlheunderground
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hadsamesexreIalionshishadexerienceddiscriminalioninheaIlhcareseings
Among
Percent of Transgender Adults Refused
Care According to Medical Setting
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.
0% 5% 10% 15% 20% 25%
Doctor's Oce (24%)
Emergency Room (13%)
Mental Health Clinic (11%)
EMT (5%)
Drug Treatment Program (3%)
MissouriIoundalionforHeaIlhIubIicalion
lransgenderalienlsoneinfouroflhose
surveyedhadbeenharassedinadoclors
oceorhosilaI
ThisbiasrangesfromarovidersIack
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alienlsInmorelhaningayandIesbianyoungaduIlsdidnoldiscIoselheir
sexuaIorienlalionlolheirdoclors
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resuIlindeIayedlrealmenlIackofrevenlivecareandIesscareforchroniccondilions
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beerconlroIanybiaseslhalmayimacllhecarelheyrovideThesecanbeunconsciousIy
communicaledcrealinganuninlenlionaIIy
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alienlsUninlendednegaliveaclionsand
communicalionslemmingfromrovider
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OveraeriodoflimelheseaclsresuIl
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individuaIsfromrelurningforfulure
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genderidenlily
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examIeofmicroaggressionInconlrasl
vhenaraclilionerrefusesloacknovIedge
Percent of Missouri Adults Not
Receiving Needed Medical Care
J McElroy & K Everett, Out, Proud and Healthy Project:
SGM Health Behaviors and Access to Care, (PowerPoint
presentation), April 27, 2012.
7%
0%
5%
10%
15%
20%
Sexual and Gender Minorities
General Population
Adults >65 years All Adults
17%
5%
11%
Percent of Health Professionals
Required to Complete Training Within
Organizations Oering LGBT-Inclusive
Cultural Competency Trainings
A DelPercio, (Edited by E Kahn & T Sullivan), Healthcare
Equality Index Survey 2011: Creating a National Standard
for Equal Treatment of Lesbian, Gay, Bisexual and
Transgender Patients and Their Families, Human Rights
Campaign Family Foundation Project, 2011.
47.9%
0% 10% 20% 30% 40% 50%
Medical Assistants & Technicians
Administrative Personnel
Allied Health Professionals
Nurses
Physicians 31.6%
45.0%
45.7%
45.0%
MIHHeaIlhIoIicyIubIicalion
lheroIesexuaIorienlalionmayIayinaersonsIifelhisIackofrecognilionisaIsoa
resuIlofbias
WeIImeaningmedicaIraclilionersmayuninlenlionaIIyromoleahosliIe
environmenlbyassuminghelerosexuaIilyofaIIalienlsresenlingmaleriaIsandbrochures
lhalonIydeiclheleronormalivefamiIiesfaiIingloincIudesexuaIorienlalionandgender
idenlilyoninlakeformsandmakingslereolyicaIassumlionsaboulalienlsvhochooselo
comeoullolheirroviders
NearIyaIImedicaIassocialionsinlheUSsuorlelhicaIslandardslhalrohibildiscriminalion
againslLGTeoIeinlheracliceofmedicineInaneorllosuorlalienlsheaIlhmany
oflheseassocialionslogelhervilhlheIOM}oinlCommissionandDearlmenlofHeaIlh
andHumanServicesDHHSarerecognizinglheimorlanceofcuIluraIcomelencyamong
rovidersinimrovingalienlsheaIlhoulcomesThe}oinlCommissionanaccrediling
organizalionlhalcerlieslhequaIilyerformanceofmorelhanheaIlhcareorganizalions
lhroughoul
lheUSurges
hosilaIsandheaIlh
rovidersloavoid
discriminalion
andlakelhe
Ieadincrealing
communicalive
veIcoming
environmenlsfor
aIIalienlsThe
}oinlCommission
recognizeslhallheIeadersofheaIlhorganizalionsmusldirecllheseinilialivesandensurelhal
lheneedsofsexuaIminorilyalienlsandfamiIiesareconsideredinlheIanningdeIiveryand
evaIualionofaIIheaIlhcareservices
InaddilionloencouraginggrealercuIluraIcomelency
lhroughIeadershilhe}oinlCommissionaIsorovidesguideIinesforcuIluraIcomelency
inlherovisionofcarelrealmenlandservicesvorkforcedeveIomenldalacoIIeclionand
useandalienlfamiIyandcommunilyengagemenlIrovidingcheckIislsloensureeeclive
communicalionandcuIluraIcomelencylhe}oinlCommissionhasoeredhosilaIsandheaIlh
careorganizalionsausefuIlooIloensurecomIianceandfosleramorecuIluraIIycomelenl
alienlcenleredmedicaIenvironmenl
TheHeaIlhcareIquaIilyIndexHIISurvey
conducledbylheHumanRighlsCommissionis
anolherlooIusedbyheaIlhcareorganizalionsloevaIualelheincIusivenessoflheiroIiciesfor
alienlsandslaandlhebreadlhoflheircuIluraIcomelencylrainingsHosilaIsandheaIlh
careroviderscanarlicialeinlhissurveylorecordlheirrogressaslheyslrivelomake
lheirfaciIiliesmorecuIluraIIycomelenlandalienlcenleredAcrosslhenalionheaIlhcare
organizalionsarlicialedinlhesurveyreresenlingfaciIiliesNalionaIIylheHIISurvey
idenliedlhalfeverlhanhaIfoflheagenciesrovidingLGTincIusivecuIluraIcomelency
lrainingsloslamembersacluaIIyrequirearlicialionAndfeverlhanonelhirdof
lheorganizalionsrequirelheirhysicianslocomIelelhem
InMissourilvoorganizalions
reresenlingfaciIiliesarlicialedinlhesurveyGrealerarlicialionisneededfrom
MissourisheaIlhcareorganizalionsinorderlobeerunderslandhovlheslalecomareslo
nalionaIlrendsinLGTincIusiveoIiciesandrocedures
Most physicians are not required to complete cultural
competency training that includes LGBT health issues. In
fact, more than two thirds of health care organizations
oering cultural competency trainings on LGBT issues do
not require physicians to attend.
11
MissouriIoundalionforHeaIlhIubIicalion
IxaminingchangesinheaIlhimaclandalienlsalisfaclionralesreIaledlocuIluraI
comelencylrainingscanbechaIIengingvhenlrainingsareolionaIIndividuaIsservedin
heaIlhcareorganizalionsvilholionaIcuIluraIcomelencylrainingsmayhavedierenl
exeriencesandoulcomesvhenslamembersarelrained
dierenlIyvilhinlhesameorganizalionThesedierencesmay
maskcuIluraIcomelencylrainingsimaclonalienlsalisfaclion
reorlsandheaIlhoulcomes
ManymedicaIschooIsandubIicheaIlhlrainingrograms
donolrequirelheincIusionofinformaliononsexuaIminorily
ouIalionsDalaIimilalionsoenareciledaslhereasonfor
medicaIschooIsIimiledcoverageofLGTheaIlhissuesand
cuIluraIcomelencyMorelhanhaIfofmedicaIschooIcurricuIa
donolconlainanyinformalionongayandIesbianouIalions
WhensexuaIminorilyheaIlhissuesarediscussedmedicaI
schooIcurricuIaoenIimillheirleachingloHIVAIDSinlheLGTcommunilyAsurvey
foundlhalmedicaIschooIssenlanaverageofhoursoverayeareriodleachingon
LGTheaIlhloics
ymedicaIschooIsreorledsendinganaverageofhourson
lheseissues
AnemhasisonHIVAIDSremainsinmedicaIeducalionbulisdueinarllo
researchfocusingondiseaseralherlhan
onLGTouIalionheaIlhexeriences
osiliveheaIlhoulcomesandresiIiency
LackofcuIluraIcomelencyandsensilivily
invorkingvilhlransalienlsremainsa
concernandlheseissuesusuaIIyarenol
addressedinUSmedicaIschooIs
SimiIarIylhema|orilyofUSubIicheaIlh
schooIsdonolincIudecoursevorkaboul
LGTheaIlhdisariliesandlhoselhal
dofocusrimariIyonHIVAIDSAmong
ubIicheaIlhrogramssurveyed
feverlhanercenlhadoeredacourse
coveringLGTheaIlhloicsbeyondHIVAIDS
OflhosesameschooIsercenlIanned
looersuchacourseinlhenexllhreeyearsAndvhiIelhema|orilyoflheseschooIs
oerednondiscriminaloryheaIlhinsurancecoverageforsexuaIorienlalioninemIoymenland
educalionmosldidnoloerheaIlhinsurancefordomeslicarlnersoffacuIlyorslaor
domeslicarlnersofsludenls
Prevention
MembersoflheLGTcommunilyareIessIikeIyloreceiverevenlivecaresuchascancer
screenings
WhencouIedvilholherIimilalionsinaccessandbehaviorlhishasresuIledin
IesbianshavinglhehigheslriskfaclorsforbreaslcancerofaIIvomenvorIdvide
Dalafrom
lheCaIiforniaHeaIlhInlervievSurveyreveaIedlhalvhiIesexuaIminorilyvomenand
helerosexuaIvomenhaddieringmammogramralesoverlhereviouslvoyearslhese
dierencesgrevdramalicaIIyvhensubouIalionsvereexaminedbasedonraceandelhnicily
Fewer than 10 percent of
public health programs
oer courses covering
LGBT health topics
beyond HIV/AIDS.
31
During 4 years of education,
the average medical student
spends about 5 hours learning
about LGBT health issues, the
majority of which is focused
on HIV/AIDS.
12
MIHHeaIlhIoIicyIubIicalion
LesbiansareaIsoalincreasedriskforsomegynecoIogicaIcancers
andaresignicanlIyIess
IikeIyloreorlreceivingIasmearsinlhereviousmonlhsofIesbianscomared
vilhofhelerosexuaIandofbisexuaIvomen
DalafromKansasCilyMissouri
indicalelhalercenlofIocaIWSWoveragehadalIeasloneIasmeareachyear
AccordinglolheIuIseercenlofWSWreorledhavinglherecommendedagearoriale
screeningsforbreaslandcervicaIcancersThesamesurveyfoundlhalonIyercenlof
WSWhadreceivedrecommendedagearorialescreeningsforcoIoreclaIcancerThese
dalarovideaIookinloralesofcancerscreeningsaccordingloagebullheydonolrovide
screeningralesaccordingloraceandelhnicily
InlheUSdisariliesinrevenlivecareandcancerscreeningsaIsoexislforgaymenAsgay
menhavehigherralesofanaIcancersandanaIaiIIomalhanhelerosexuaImenilisimorlanl
lhalgaymenreceiveHIVscreeningsbeginningalageandcancerscreenings
TheIuIse
foundlhalercenlofgaymenoveragehadbeenscreenedforanaIcancerusinglheIa
smearAmongKansasCilyMSMageoroIderercenlhadreceivedarorialeroslale
cancerscreeningbulmorelhanhaIfhadnolreceivedcoIoreclaIcancerscreening
Higher
ralesofHIVAIDSamonggaymenhavemolivaledmanyindividuaIsinlheLGTcommunily
lobereguIarIy
lesledforHIV
ReguIarHIV
leslingamonggay
mendemonslrales
lheimacllhal
ubIicheaIlh
camaignscan
haveandshovslhe
resiIienceofLGT
communilies
WhiIeslaleIeveI
dalaonrevenlive
careamongsexuaI
minoriliesdo
nolyelexislin
MissouriseveraI
IocaIsurveysrovidevaIuabIeinformalionfromsamIeouIalionsacrosslheslaleTheIuIse
foundlhalmorelhanhaIfofMSMcomIelinglhesurveyhadbeenlesledforHIVinlhe
aslyearTheIuIseaIsofoundlhalMSMvereIessIikeIyloreorlreguIarhysicaIexamsand
receivedenlaIexamslhanWSWvilhercenlandercenlreorlinglhallheyhadnever
receiveddenlaIcareresecliveIy
TransgenderindividuaIsexerienceIoverralesofcancerscreeningsandlhereforeexerience
ooreroulcomesanddeIayeddiagnoses
ThisisarlicuIarIylrueforcancerinreroduclive
organs
SomerovidersrefuselolrealcancersinlransgenderindividuaIsvhosereroduclive
organsdierfromlheirgenderidenlily
Transmenremainalriskforulerineovarianand
breaslcancervhiIelransvomenremainalriskforroslalecancer
MissouriIoundalionforHeaIlhIubIicalion
Social and Economic Factors
HeaIlhrofessionaIsareincreasingIyrecognizinglhecrilicaIroIelhalonessociaIandeconomic
environmenlsIayinonesheaIlhAccordinglolheCounlyHeaIlhRankingsaersons
sociaIandeconomicenvironmenlscombineloimaclanindividuaIsheaIlhmorelhanaccess
loheaIlhinsuranceorlhequaIilyandreguIarilyofcIinicaIcare
LessaccessloemIoyer
sonsoredheaIlhcoveragehasbeenidenliedasaconlribulorlooorerheaIlhoulcomesand
feverheaIlhcarevisilsamongsexuaIandgenderminorilies
Disariliesindomeslicarlner
insurancecoverageimaclLGTcouIesandfamiIiesabiIilyloaccessheaIlhcare
SexuaI
minoriliesreceivingarlnerbenelsfromemIoyersonsoredheaIlhcoveragearelaxedon
lhesebenelsaslhoughlheyareincome
ThisaddilionaIlaxonincomecanrovearlicuIarIy
burdensomebecauseilcomoundslhenanciaIinequaIiliesexeriencedbysexuaIandgender
minoriliesLGTindividuaIsfacehigherralesofunemIoymenlandunderemIoymenland
IoverincomeslhanlheirhelerosexuaIeers
TransgenderindividuaIsexeriencelvice
lheralesofunemIoymenlandoverlylhanlhegeneraIouIalion
Amonglransgender
individuaIsofcoIoroverlyralesaresignicanlIyhigherIoverlyralesareercenlfor
lhegeneraIouIalionercenlforaIIlransgenderindividuaIsercenlformuIliraciaI
lransgenderersonsercenlforLalinolransgenderersonsandercenlforbIack
lransgenderindividuaIs
Table 1. Percent of U.S. Poor Children in Coupled Families by Household Type, by Race,
Ethnicity, and Age of Child
Married Dierent-Sex Male Couples Female Couples
All
Householder & Partner 9.4 20.9* 19.7*
Race
White 6.8 15.9* 13.8*
Black 13.1 27.9* 31.6*
Native American/Alaskan 21.5 41.1* 29.4
Asian/Pacic Islander 14.1 23.2 16.3
Other Race 21.4 23 24.7
Ethnicity
Hispanic 23.8 26.9 31.9*
Non-Hispanic 6.6 17.8* 16.6*
Age
0-5 10.5 22.9* 21.1*
6-13 9.2 19.5* 19.4*
14-18 8 19.7* 17.2*
Abelda, R., Lee Badgett, M. V., Schneebaum, A., and Gates, G. J. Poverty in the Lesbian, Gay, and Bisexual Community. The Williams
Institute. 2009. Tabulations from 5% Public Use Microdata Sample (PUMS) Files, U.S. Decennial Census, 2000. *Dierence from married
dierent-sex is statistically signicant at the 5% level.
MIHHeaIlhIoIicyIubIicalion
ConlraryloslereolyesromolinglhalsexuaIminoriliesonIyresideinurbanareasandare
moreauenllhanlheirhelerosexuaIeersLGfamiIiesvilhchiIdrenIiveinercenlof
UScounliesandaremoreIikeIylobeIivinginlheSoulh
InMissouriercenlof
counlieshavesamesexcouIesdescribinglhemseIvesassousesorunmarriedarlners
MuIliIesludieshavedelerminedlhalsamesexcouIesareasIikeIyormoreIikeIylobe
IivinginoverlylhandierenlsexcouIes
CIoserexaminalionoflhesesludiesreveaIs
videreconomicdisariliesforsamesexcouIesvhenlheyaregrouedaccordinglolheir
geograhicaIIocalionmelrooIilanslalusandraciaIandelhnicbackground
Accordinglo
lheNalionaISurveyofIamiIyGrovlhLGmenandvomenveremoreIikeIylobeoor
IivinginafamiIyvilhanincomebeIovlhefederaIoverlyIeveIlhanhelerosexuaImenand
vomenInarlicuIarIesbianandbisexuaIvomenaresignicanlIymoreIikeIylobeoorlhan
helerosexuaIvomenandresecliveIy
LesbianandbisexuaIvomenarelvice
asIikeIyloreceivefoodslamsvhencomaredlohelerosexuaIvomenand
resecliveIyIconomicdisariliesincreasefurlheramongfamiIiesvilhchiIdrenIivinginlhe
homeaschiIdrenofLGfamiIiesarelviceasIikeIylobeoorlhanchiIdreninhelerosexuaI
famiIies
IoverlyralesarearlicuIarIyhighamongyoungchiIdrenvilhsamesexarenls
vhoareIackNaliveAmericanAIaskanorHisanicAsLGfamiIiesaremoreIikeIylobe
muIliraciaIlhanhelerosexuaIfamiIiessamesexarenlsandlheirchiIdrenmayencounler
discriminalionandre|udicebecauseoflheirraciaIandelhnicbackgroundsandlheirsexuaI
orienlalionandgenderidenlilies
Wnrkp!accdiscriminatinn
DiscriminaliononlhebasisofonessexuaIorienlalionorgenderidenlilycanoccurinavariely
ofvaysincIuding
beingred
beingdeniedemIoymenlorromolion
beingoverIookedforaddedresonsibiIilies
Percent of Poor Householders and Partners in Coupled Families by Metropolitan Status
13
0%
2%
4%
6%
8%
10%
12%
Female Same-Sex Couples Male Same-Sex Couples Dierent-Sex Married
Non Metro (Rural) Small Metro Med Metro Big Metro
5%
3%
6%
5%
4%
7%
5%
6%
8%
7%
9%
12%
R Abelda et al., Poverty in the Lesbian, Gay, and Bisexual Community, The Williams Institute, 2009.
MissouriIoundalionforHeaIlhIubIicalion
verbaIandhysicaIharassmenl
verbaIhysicaIorsexuaIabuse
vandaIizedvorksaceand
unequaIayorbenels
DiscriminalionandsligmalizalioninlhevorkIaceandheaIlhcareseingsnegaliveIyimacl
lheheaIlhofsexuaIandgenderminorilies
WhiIeaGaIIuoIIreorledlhalercenl
ofAmericansbeIieveLGindividuaIsshouIdhaveequaI|oboorlunilies
vorkIace
discriminalionagainslsexuaIandgenderminoriliesersislsSludiesexaminingvorkIace
discriminalionhavefoundlhalbelveenandercenlofLGmenandvomenreorl
havingbeendiscriminaledagainslbecauseoflheirsexuaIorienlalion
TheIuIsefoundlhalercenlofsexuaIminoriliesreorleddiscriminalioninlhevorkIace
InlhissurveyralesofvorkIace
discriminalionverehigheslamong
MSMvhovereoveryearsoIdand
WSWagesloyears
Ralesof
emIoymenldiscriminalionareaIsohigh
amonggenderminorilieslransgender
individuaIsforexamIeexeriencedoubIe
lheunemIoymenlraleoflhegeneraI
ouIalionNalionaIIynearIyhaIfof
lransgendereoIeexressedbeingred
nolhiredordeniedaromolionbecause
ofnonconformancelogendernorms
AddilionaIIyercenloflransgender
individuaIsreorledbeingharassedor
mislrealedvhiIeonlhe|oborhavinglohide
lheirgenderidenlilyloavoidharassmenl
Morelhanoneinfourlransgender
individuaIsreorlbeingredduelogender
idenlilyandhaIfofgendernonconforming
individuaIsreorlbeingharassed
WhenindividuaIsareredforgender
idenlilylheirunemIoymenlIaces
lhemalincreasedriskofnegaliveheaIlh
oulcomesandfaclorsTheseincIude
becominghomeIessconlraclingHIV
andmisusingsubslanceslocoevilhmislrealmenlAccordinglolheNalionaITransgender
DiscriminalionsludysurveyarlicianlsvhohadIosllheir|obsbecauseofbiasexerienced
fourlimeslheraleofhomeIessnessercenlmorecurrenldrinkingormisuseofdrugslo
coevilhmislrealmenlercenlmoreincarceralionmorelhandoubIelheralevorkingin
lheundergroundeconomyandmorelhandoubIelheHIVinfeclionralecomaredlolhose
vhodidnolIosea|obduelobias
MIHHeaIlhIoIicyIubIicalion
5chnn!5cings
SociaIsligmadiscriminalionandisoIalionfromfamiIyandeersaIsoconlribulelonegalive
heaIlhoulcomesamongsexuaIandgenderminoriliesincIudingincreasedriskforcancer
higherralesofmenlaIandhysicaIiIInessesandhigherriskforsychoIogicaIdislress
AmonglhegeneraIouIalionercenlofsludenlsreorlbeingbuIIiedonlheirschooI
camusesfourercenlofsludenlsagesreorlbeingviclimized
inlherevious
sixmonlhsandIesslhanlvoercenlofsludenlsagesreorlexeriencingvioIenl
viclimizalion
orseriousvioIenlviclimizalion
vhichincIudehysicaIandsexuaIassauIl
In
lheNalionaISchooICIimaleSurveyfoundlhalnearIynineinlenLGTsludenls
reorledbeingharassedalschooIforlheirsexuaIorienlalion
Missourisludenlsexeriencehigherrales
ofhysicaIassauIlinschooIbecauseof
acluaIorerceivedsexuaIorienlalion
andgenderidenlilycomaredlonalionaI
averages
AhighIeveIofviclimizalion
andharassmenlexeriencedbyLGT
youlhinschooIsisassocialedvilhhigher
IeveIsofderessionanxielyandIovseIf
esleem
TransgenderindividuaIsvho
exressedlheirgenderidenlilyduringlheir
youlhreorlexeriencinghigherralesof
harassmenlhysicaIassauIl
andsexuaIvioIenceinKschooI
seingsvhencomaredvilhlhegeneraI
ouIalion
TheNalionaITransgender
DiscriminalionSurveyfoundlhal
sludenlsvhohadbeenbuIIiedharassed
orassauIledvhiIealschooIexerienced
higherralesofsuicideaemlsdrugand
aIcohoIusehomeIessnessandHIVlhan
lransgendersludenlsvhohadnolbeen
viclimizedalschooINolabIysludenlsvho
hadbeenharassedorassauIledbyleachers
alschooIexeriencedlhehigheslralesofaemledsuicideAemlsverenoledamong
ercenloflranssludenlsvhohadbeenharassedbyleachersercenloflranssludenls
vhohadbeensexuaIIyassauIledbyleachersandercenloflranssludenlsvhohadbeen
hysicaIIyassauIledbyleachers
TransgendersludenlsvhodroedoulofschooIbecauseof
lheinlensilyofharassmenlandassauIlaIsohadhigherIeveIsofsuicideaemls
NalionaIIyLGTsecondarysludenlsverefourlimesmoreIikeIylohavemissedalIeaslone
dayofschooIinlhereviousmonlhbecauseoffeeIingunsafeoruncomforlabIeofLGT
sludenlscomaredlooflhegeneraIsludenlouIalion
SchooIbuIIyingharassmenl
andassauIlimaclsludenlsIearningandhavebeenassocialedvilhoorermenlaIand
WhereviclimizalioniscalegorizedaslhevioIenlviclimizalionandseriousvioIenlviclimizalion
WherevioIenlviclimizalionincIudesseriousvioIenlcrimesandsimIeassauIl
WhereseriousvioIenlviclimizalionincIudesraesexuaIassauIlrobberyandaggravaledassauIl
Comparison of Missouri and U.S. Reports
of Physical Assault of Students at School
(Based on Actual or Perceived Identity)
JG Kosciw et al., The 2009 National School Climate Survey:
The Experiences of Lesbian, Gay, Bisexual and Transgender
Youth in our Nations Schools, GLSEN, 2010.
GLSEN, School Climate in Missouri, GLSEN, 2011.
0% 5% 10% 15% 20%
U.S. Students
Missouri Students
Sexual
Orientation
Gender
Identity
Gender
Religion
Race/
Ethnicity
Disability
3.0%
3.3%
2.0%
4.2%
7%
5.2%
7%
7.8%
14%
12.5%
20.0%
18.8%
MissouriIoundalionforHeaIlhIubIicalion
hysicaIheaIlhoulcomesincIudingincreasedralesofseIfin|uryfeeIingsofguiIlandshame
deressionandanxielyIoslTraumalicSlressDisorderITSDhighriskbehaviorsandsociaI
isoIalion
TherearesignicanldierencesbelveenlheheaIlhrisksofsludenlsvho
exerienceIovIeveIsofleenageviclimizalionandlhoseexeriencinghighIeveIsSludenls
exeriencinghighIeveIsofleenageviclimizalionarelimesmoreIikeIylobederessed
limesmoreIikeIyloaemlsuicidelimesmoreIikeIylohavesubslanceabuserobIems
limesmoreIikeIylobediagnosedvilhasexuaIIylransmiedinfeclionSTIand
limesmoreIikeIyloreorlHIVriskasayoungaduIl
LGBTYnuth
TodaylheaverageageofindividuaIs
comingoulorverbaIizinglheirsexuaI
orienlalionandgenderidenlilylolheir
famiIyandfriendsisyears
Thisis
nearIyadecadeyoungerlhanlheaverage
agelhalindividuaIschoselocomeoul
yearsagoThisagedierencebringsa
uniquechaIIengeasmanyoflheseyoulh
aresliIIdeendenlonlheirarenlsor
caregiversAccelancefromfamiIyand
eershasbeenfoundlohaveroleclive
heaIlheeclsvhiIesligmaisoIalion
andnegalivereaclionsaboulonessexuaI
orienlalionfromarenlsfamiIyandeersareassocialedvilhnegaliveheaIlhoulcomes
IamiIiaIandsociaIsuorlaIsoareassocialedvilhgrealerresiIiencyandcoingskiIIsin
discriminaloryubIicseings
Asurveyofmorelhanleensfoundlhalfeverlhan
haIfofLGTleensreorledhavingalIeasloneaduIlfamiIymemberlolurnloforheI
vhiIeercenlofnonLGTleensreorledlhesame
LGTyoulharedisroorlionaleIyreresenledamonghomeIessouIalionsInilvas
eslimaledlhalbelveenmiIIionandmiIIionyoulhagesyearsverehomeIessin
lheUS
WhiIeloercenlofaIIyoulhidenlifyasLGTeslimalessuggesllhallo
Youth Descriptions of the Most Important Problems They are Currently Facing
Most Important Problems
Identied by LGBT Youth
50
Most Important Problems
Identied by Non-LGBT Youth
50
Non-accepting families (26%)
1
Class/exams/grades (25%)
School/bullying problems (21%)
2
College/career (14%)
Fear of being out or open (18%)
3
Financial pressures related to college or job (11%)
Human Rights Campaign, Growing Up LGBT in America: HRC Youth Survey Report Key Findings, HRC, June 2012.
LGBT youth who have
experienced high levels of
family rejection are 8 times
more likely to attempt
suicide than LGBT peers not
experiencing family rejection.
48
MIHHeaIlhIoIicyIubIicalion
ercenlofhomeIessyoulhidenlify
asLGTAmongsludieslhalincIuded
homeIessyoulhfromMissouri
ercenloflhehomeIessyoulhsurveyed
idenliedasLGT
IamiIyre|eclionand
isoIalionareassocialedvilhlheincreased
riskofhomeIessnessamongLGTyoulh
TheyareaIsodisroorlionaleIyyoulhof
coIorNalionaIIyercenlofhomeIess
LGTyoulhareIackandercenlare
HisanicThisdisarilyisevengrealer
amonglransgenderhomeIessyoulh
IackHisanic
HomeIessLGTyoulharemoreIikeIyloaemlsuicidebecomeviclimsofsexuaIvioIence
besoIiciledforsexinexchangeforfoodcIolhingorsheIlerandhaveITSDlhanlheir
helerosexuaIhomeIesseers
Oen
sociaIsafelynelsinlendedlorovidecare
lohomeIessyoulhincIudingfoslercare
|uveniIe|uslicefaciIiliesandhomeIess
sheIlersarenolcuIluraIIycomelenlin
rovidingcareforLGThomeIessyoulh
SexuaIandgenderminorilyyoulhoen
exeriencingvioIenceanddiscriminalion
inlhesecarefaciIiliesaremoreIikeIy
loIeavesafelynelagenciesandrelurn
lohomeIessnessIamiIyre|eclionand
homeIessnessmakeLGTleensmore
vuInerabIelosociaIandeconomicfaclorslhalconlribulelonegaliveheaIlhbehaviorsand
oulcomesThesefaclorsincIudechaIIengesinaccessingubIiceducalionduringhousing
inslabiIilyanddicuIlyaccessingheaIlhcareservices
LGBTE!dcrs
HavingagedinasocielyvhereilvasiIIegaIlobeanylhingbulhelerosexuaIoIderLGTaduIls
ageyearsandabovereorlhighralesofIifelimeviclimizalionInanalionaIsurveyofmore
lhanoIderLGTaduIlsagesercenlreorledhavingbeenviclimizedalIeasl
onceinlheirIivesvilhercenlhavingbeenviclimizedalIeasllhreelimesThesurvey
vhichincIudedresondenlsfromMissourifoundlhefoIIovingIifelimeIeveIsofviclimizalion
anddiscriminalionreorledbyLGTeIders
hysicaIassauIl
roerlydamage
deniaIof|obromolions
lhrealofbeingouled
harassmenlbyoIice
Individuals with families who
accept them are less likely to
engage in negative health
behaviors, and less likely to
experience negative health
outcomes.
26
Homeless Youths Who Have Been
Sexually Assaulted
58%
33%
0% 10% 20% 30% 40% 50% 60%
LGBT
Non LGBT
NS Quintana, J Rosenthal, & J Krehely, On the Streets:
The Federal Response to Gay and Transgender Homeless
Youth, Center for American Progress, June 2010.
MissouriIoundalionforHeaIlhIubIicalion
lhrealofhysicaIvioIenceand
verbaIassauIl
WhiIelhema|orilyofLGTeIdersareoullofamiIyandcommunilymemberslheyareaIso
moreIikeIylobesociaIIyisoIaledlhanhelerosexuaIoIderaduIlsLGTeIdersareaIsoIessIikeIy
lohaveaarlnerorbemarriedlhannonLGTeIdersNearIyoneinlhreeLGTeIders
reorllhallheydonolhavesomeoneinlheirIivesloIovelhemandmakelhemfeeIvanled
ThecomanyofaarlnerorsouseaordsseniorssociaIsuorlandrovidesnanciaI
securilyandassislancevilhhousingcoslsLackingsociaIsuorlisassocialedvilhdecreased
menlaIandhysicaIheaIlhremalurechronicdiseasesandremaluredealhDesile
discriminalionandisoIalionsludieshavefoundlhalLGTeIdersmainlainosilivilyand
resiIiencyasinLGTeIdersreorlfeeIinggoodaboulbeIonginglolheircommunilies
Health Behaviors
IndividuaIsaclionsandbehaviorsaIsoimacllheirheaIlhHeaIlhbehaviorsbolhosiliveand
negalivecanbeusedlocoevilhslressTheGayandLesbianMedicaIAssocialionGLMA
hasvarnedlhallheexerienceofslressandanxielycausedbydiscriminalioncanIeadlo
increasedriskforhearldiseaseforsexuaIminoriliesinlheUS
Higherralesofsmoking
andobesilyincreaselheriskofhearldiseaseamongsexuaIminorilies
SmokingandaIcohoI
consumlionareassocialedvilhincreasedriskforemhysemacancersosleoorosisandhearl
diseaseinIesbianandbisexuaIvomen
andIungcancerIungdiseasehyerlensionandhearl
diseaseingayandbisexuaImen
InMissouriSGMhavesignicanlIyhigherralesofsmokinglhanlheirnonLGTeers
SGMcomaredlononLGT
WhiIeercenlofhelerosexuaIvomenreorlsmoking
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ercenlofbisexuaIvomenreorllhesame
SexuaIandgenderminoriliesaIsoreorlhigher
ralesofbingedrinkingandsubslanceuselhanlhegeneraIouIalionAslalevideheaIlh
surveyinMassachusesfoundlhalsexuaIminoriliesveremoreIikeIyloreorldaylension
orvorrydruguseandcurrenlsmokinglhanhelerosexuaIs
Aslalevidesurveyconducled
bylheCoIoradoDearlmenlofIubIicHeaIlhandInvironmenlfoundlhalsomeIesbiangay
andbisexuaIindividuaIsvereusingsmokingandsubslanceabuselodeaIvilhvorkIaceand
socielaIdiscriminalionfamiIyandsociaIre|eclionandminorilyslressThesludyfoundlrends
simiIarlolhoseinnalionaIsurveysvhichshovedlhalbingedrinkingvasmorecommon
amongIesbianandgayresondenlsandbisexuaIresondenlslhanhelerosexuaI
individuaIsThissamesludyfound
lhalIesbianandgayindividuaIsreorled
lvicelheraleofunemIoymenlformore
lhanoneyearcomaredlooflhe
generaIouIalion
SomeindividuaIscoevilhdiscriminalion
andlraumabyengaginginhighrisk
behaviorsOlherscoelhroughveIIness
acliviliessociaIevenlsandhysicaI
lnessWhiIeeachersonexeriences
uniqueslressorsandraclicesindividuaI
Percent of Adults Reporting Excellent or
Very Good Health
0% 20% 40% 60% 80% 100%
Transgender
LGB
Heterosexual
67%
77%
83%
J Krehely, How to Close the LGBT Health Disparities Gap,
Center for American Progress, 2009.
MIHHeaIlhIoIicyIubIicalion
slressreIievingacliviliesidenlifyinglrendsamongsubgrousoflheouIalioncanbe
heIfuIinidenlifyingeecliveslralegiesloromoleheaIlhycoingskiIIsandimroveheaIlh
oulcomesThema|orilyofLGTeIdersreorlengaginginveIInessacliviliesvilh
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aclivilyLGToIderaduIlsaIsohavehigherralesofsmokingcigareesanddrinkingaIcohoI
SlalevideandIocaIsurveysconrmlheselrendsInaMassachusesslalevidesurveygay
menverelimesmoreIikeIylouseiIIicildrugslhanlheirhelerosexuaIcounlerarls
Gay
menvereequaIIyIikeIylo
engageinbingedrinking
Lesbiansverelviceas
IikeIylouseiIIicildrugs
andbisexuaIvomenvere
ninelimesmoreIikeIy
louseiIIicildrugslhan
helerosexuaIvomen
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andonehof
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drinksvilhinacouIehoursalIeaslonceamonlhonaveragecomaredvilhercenlof
helerosexuaIvomen
ResuIlsfromlheNalionaITransgenderDiscriminalionSurveyfound
lhalvhiIenearIyoneinlhreelransgenderindividuaIsreorledsmokingdaiIylhese
ercenlagesincreasedamonglransindividuaIsvhohadbeenviclimsofhysicaIassauIl
andsexuaIassauIlduelobias
GayandbisexuaImenreorlhigherralesofsexuaIrisklakinglhanlheirhelerosexuaIeers
OnesurveyinMissourifoundlhalercenlofmenhavingsexvilhmenreorledneverusing
acondomvhiIeercenlofMSMreorledneverusingacondomfororaIsexMSMaIso
reorlmorefrequenlHIVleslingbulHIVleslingvasfoundnollocorreIalelolhenumber
ofsexuaIarlnersamanhadinlhereviousyearAddilionaIIyercenlofMSMreorled
neverhavinghadananaIcancerscreeningorHIVscreening
Researchhasfoundlhallhe
morecomorbidmenlaIheaIlhrobIemsexeriencedbyanindividuaIlhegrealerlheoddsof
sexuaIriskbehaviorsegunrolecledsexnumberofarlnersIackofSTIleslingHighIeveIs
ofneighborhoodhomohobiaanddiscriminalionaIsohavebeenfoundloinuencesexuaIrisk
behaviorsashavenegalivecuIluraIandsocielaImessagesaboulhomosexuaIilyInconlrasl
sociaIsuorlresiIiencyandosiliveinlimalereIalionshishavebeenfoundlodecrease
sexuaIriskbehaviorsandsubslanceuse
Health Outcomes
WhenresearchersmeasureheaIlhoulcomeslheyaremeasuringindividuaIshysicaI
heaIlhandmenlaIheaIlhandhovveIIlheyfeeITheseareknovnasmorbidilymeasures
IndividuaIandouIalionheaIlhoulcomesaIsoaremeasuredbyhovIongeoIeIiveand
vhelherdealhsareremalureorrevenlabIeTheseareknovnasmorlaIilymeasures
MissouriIoundalionforHeaIlhIubIicalion
Gay Men
Heterosexual Men
Percent of Men who are Underweight
**
0.6%
1.7%
Bisexual
Lesbian
Heterosexual
Percent of Women who are Obese
17.4%
26.4%
19.6%
LGB
Heterosexual
Percent of Adults with Cancer Diagnosis
*
6.0%
9.0%
Gay
Heterosexual
Percent of Men with Heart Disease
**
2.5%
3.2%
Bisexual
LG
Heterosexual
Percent of Adults with Asthma
**
20.5%
20.2%
15.0%
Bisexual
LG
Heterosexual
Percent of Adults Living with
Activity Limitation Caused by Disability
**
33.8%
20.5%
14.9%
**
TheIOMreorlonLGTheaIlhdrev
aenlionlolhedisariliesinmorbidily
andmorlaIilyexeriencedbysexuaI
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exeriencesofLGTcommunilies
LGTaduIlsareIessIikeIyloexerience
goodheaIlhasercenlofLGaduIls
andercenloflransgenderaduIls
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aclivilyIimilalioncausedbydisabiIily
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hearldisease
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aslhma
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foundlhalLGyoulhverelviceasIikeIy
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idenliedbylheUSDHHSandGLMA
asariskfaclorforolherheaIlhreIaled
concerns
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foundlhalercenlofMSMand
ercenlofWSWseIfreorledbeing
overveighlorobeseOIderLGTaduIlsaIso
exeriencehigherralesofdisabiIilylhan
nonLGToIderaduIlsNearIyonehaIfof
LGTeIdersareIivingvilhadisabiIily
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higherralesofHIVandSTIs
Less
lhanoneercenloflhegeneraI
USouIalionisIivingvilhHIVvhiIe
Disparities in Health Outcomes
* J Krehely, How to Close the LGBT Health Disparities
Gap, Center for American Progress, 2009.
** KJ Conron, MJ Mimiaga & SJ Landers, A Population-
Based Study of Sexual Orientation Identity and Gender
Dierences in Adult Health, American Journal of Public
Health, 100, 10, (2010):1953-1960.
MIHHeaIlhIoIicyIubIicalion
ercenloflransgenderindividuaIs
areIivingvilhHIV
Whenlransgender
individuaIsresonsesverecalegorized
accordingloraceandelhnicilyIack
LalinoandAmericanIndianlransgender
individuaIsreorledhigherralesofHIV
andresecliveIy
AmongMSMinanurbanareaofMissouri
ercenlareIivingvilhHIVThissame
IocaIsurveyfoundlhalercenlofWSW
haveSTIs
AccordinglolheCenlersfor
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lolherevasaercenlincrease
inlheincidenceofHIVamongyoung
eoIeagesThisincreasevas
redominanlIyamongyoungMSM
andmoslnolabIyamongyoungAfrican
AmericanMSM
DisariliesinnegaliveheaIlhbehaviors
suchasaIcohoIabuseandhighersmoking
ralesconlribulelodisaraleheaIlh
oulcomesamongLGTouIalions
SexuaIminoriliesreorlhigherralesof
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receivinghormonelrealmenlsmuslbecauliousvhendrinkingaIcohoIaslhecombinalion
increasesonesriskofIiverdamage
HeaIlhfaclorssuchassociaIandeconomicinuenceshavebeenfoundloimaclbolh
hysicaIandmenlaIheaIlhoulcomesSeIfidenlicalionasLGTisnolariskfaclorfor
suicidebulexeriencesofsligmaanddiscriminalionareassocialedvilhderessionand
anxielyIovseIfesleemandsociaIisoIalionTheseareconsideredriskfaclorsforsuicidaI
idealionLGaduIlsaremoreIikeIyloexeriencesychoIogicaIdislressandmoreIikeIy
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eersaccordingloasludy
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suicideaemlsasnonLGyoulhcomaredlo
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AmericansaremoslIikeIyloexeriencesychoIogicaIdislressandresecliveIy
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lhanLGcommunilymembersandnonLGTindividuaIs
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foundlhalercenlofgaymenhadaemledsuicidecomaredloercenloflheir
helerosexuaIcounlerarlsAddilionaIIyercenlofgaymenhadmadeasuicideIan
HIV Infection Among Trans Population,
By Race, Compared to U.S. General
Population
26
0.60%
0% 5% 10% 15% 20% 25%
Multiracial
White
Latino/a
Black
Asian
American Indian
U.S. General Population
2.64%
7.04%
24.90%
10.92%
0.78%
3.52%
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.
MissouriIoundalionforHeaIlhIubIicalion
accordinglolhesamesludy
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oorercIinicaIcareandIimiledrevenlion
rogramsareaIIimacledbysociaIand
economicfaclorsMembersofLGT
communilieshaveoorerheaIlhoulcomes
duelominorilyslressfromsyslemic
discriminalionTheidenliliesandrighls
ofSGMarereguIarIydebaledinIegisIalive
sessionsYoungeoIereorlhearing
frequenldiscriminaloryremarksinschooIs
SGMexeriencehighralesofvioIenceand
viclimizalionbasedonlheiridenlilies
IquaImarriagerighlsequaIemIoymenl
oorluniliesandequaIhousingoIicies
arenonexislenlinmanyslalesandregions
ThesefaclorsgrealIyimacllhemenlaI
andhysicaIheaIlhofLGTindividuaIs
IoIicyolionslhalcanimroveheaIlh
andreducedisariliesfacedbyLGT
communiliesincIudesociaIandeconomic
faclorssuchasreIalionshirecognilionand
nondiscriminalionroleclionsTheseare
inexlricabIyIinkedloheaIlhoulcomes
AcccsstnCarc
WhenindividuaIsdonolhaveaccesslo
heaIlhinsurancelheyaremoreIikeIylo
deIayneededrevenlionandcareThe
AordabIeCareAclACAaIIovsslales
loexandMedicaidaccessloindividuaIs
vilhincomesalorbeIovercenlof
lhefederaIoverlyIineAddilionaIIymosl
eoIeinlheUSviIIberequiredin
lohaveheaIlhinsuranceorayaenaIly
Recommended Policies
Access to Care
Public insurance programs
include transition-related care.
Public insurance programs
reach out to enroll LGBT
Missourians.
Legal recognition of same-sex
relationships.
Employer recognition of same-
sex relationships.
Employer non-discrimination
policies include sexual orientation
and gender identity.
Domestic partner insurance
coverage required of employers
oering health insurance plans.
End taxation of domestic
partner insurance coverage.
MIHHeaIlhIoIicyIubIicalion
TheexansionofheaIlhcoveragehaslhe
olenliaIloimaclMissouriansheaIlhin
osilivevaysbuladdilionaIoIicychanges
areneededlomakeheaIlhinsuranceaccess
moreequilabIeforLGTcommunilies
IubIicinsurancerogramsandmoslrivale
insurersdonolcoverlransilionreIaledcare
forlransgenderindividuaIsWhiIemany
lransgenderAmericansmayquaIifyfor
ubIicinsurancelheseindividuaIssliIIhave
loayoulofockelcoslsfornecessary
lransilioncareIncIudinglransilioncare
inubIicinsuranceIansandcomIeling
oulreachloindividuaIsvhoareeIigibIefor
MedicaidandMedicareviIIheIloensure
lhalLGTAmericanshavelhecoverageand
carelheyneed
MoslAmericanshaveheaIlhcoverage
lhroughemIoyersonsoredinsurance
LGTAmericansareIessIikeIylobe
insured
andmoreIikeIyloquaIifyfor
ubIicinsurance
WilhoulemIoymenl
roleclionsforsexuaIorienlalionand
genderidenlilyLGTAmericansand
lhosevilhnonslandardgenderexression
regardIessofsexuaIorienlalionexerience
higherralesofunemIoymenland
underemIoymenl
UnemIoymenland
underemIoymenlimaclanindividuaIs
abiIilyloaccessnecessaryheaIlhservices
ToeIiminaledisariliesinaccessand
coveragebusinessesmuslroleclvorkers
basedonsexuaIorienlaliongenderidenlily
andgenderexression
IquaImarriagerighlsandIegaIrecognilion
ofdomeslicarlnerreIalionshislhrough
domeslicarlnerregislriesareimorlanl
slesingainingaccessloemIoyer
sonsoredheaIlhcoverageforLGT
MissouriansandlheirarlnersIighlynine
ercenlofIorlunecomaniesoer
domeslicarlnerheaIlhinsuranceand
ercenloerlransgenderincIusiveheaIlh
coverageIans
InasurveyoflheIargesl
Recommended Policies
Clinical Care
Patients Bill of Rights include
sexual orientation, gender
identity, and gender expression.
Non-discrimination policies
include sexual orientation, gender
identity, and gender expression.
Visitation policies explicitly
include same-sex couples and
parents in denition of family.
Cultural Competency trainings
offered to staff and medical
students include LGBT health
care issues.
Intake forms include sexual
orientation and gender identity.
Oce environments are LGBT
inclusive and arming.
MissouriIoundalionforHeaIlhIubIicalion
IorlunecomaniesandIargesl
federaIgovernmenlconlraclorsercenl
slaledlhaldiversilyoIiciesandgenerous
benelackagesveregoodforlheir
businessesMorelhanhaIfoflhose
surveyedslaledlhallheirboomIinesvere
imrovedbyrohibilingdiscriminalion
basedonsexuaIorienlalionandgender
idenlilyandbyoeringdomeslicarlner
benelslolheiremIoyees
UnderlheACAsmaIIbusinessesareabIe
lhroughalaxcredillooeremIoyer
sonsoredheaIlhcoveragelolheir
emIoyeesAsmoresmaIIbusinessesare
oeringcoverageilisimorlanllhallhey
exlendlherighllocoverageloaIIemIoyees
andlheirfamiIiesincIudinglhosevilh
domeslicarlners
CurrenlIyemIoyeesvilhinsuranceIans
coveringadomeslicarlnerarelaxedon
lhevaIueoflhecoverageIanmeaning
lhalsamesexcouIesearnIessincome
aerlaxeslhanhelerosexuaIcouIes
Thislaxcanbeadisincenlivelohaving
domeslicarlnercoverageIndinglhelax
ondomeslicarlnerinsurancecoverageviII
aIIovmoreMissouriansaccessloemIoyer
basedheaIlhcoverage
C!inica!Carc
DiscriminalioninheaIlhseingsdiscourages
alienlsfromseekingcareIoIIoving
discriminalionoruonIearningaboul
olhersnegaliveexeriencesLGTalienls
mayfearreealeddiscriminalionandrefrain
fromdiscussinglheirsexuaIorienlalionor
genderidenlilyvilhlheirmedicaIroviders
DeIayingcarecanhavenegaliveheaIlh
consequencesforLGTMissourians
MedicaIrovidersandheaIlhorganizalions
canrevenldiscriminalionbyimIemenling
incIusivenondiscriminalionoIicies
androvidingslalrainingoncuIluraI
comelencyandorganizalionaIoIicies
InorderforaIIMissouriansloreceive
Recommended Policies
Prevention
HIV prevention programs focus
on the whole person.
HIV treatment through
Medicaid is available prior to
disability from AIDS.
Recommended Policies
Health Behaviors
State and federally funded
programs are LGBT arming,
including substance abuse
treatment facilities, mental health
facilities, foster and juvenile justice
facilities, and homeless and
domestic violence shelters.
Health and human service
organizations implement non-
discrimination policies protecting
LGBT clients and sta.
Support clean air and tobacco
control policies.
MIHHeaIlhIoIicyIubIicalion
alienlcenleredcuIluraIIycomelenl
carenondiscriminalionoIiciesmusl
incIudesexuaIorienlaliongenderidenlily
andgenderexression
On}anuaryand}uIyequaI
visilalionrighlsforLGTfamiIiesvenlinlo
eeclinhosilaIsarlicialinginMedicaid
andMedicareandlhoseaccrediledbylhe
}oinlCommissionresecliveIyAccording
lolhesereguIalionshosilaIsareexecled
loaIIovalienlsloseIecllheirvisilors
AddilionaIIyvisilaliondiscriminalion
basedonsexuaIorienlalionandgender
idenlilyisnolermied
InaneorllodecreasevariabiIilyinhov
slamembersinlerrelrequiremenls
hosilaIsareeIeclingloamendlheir
visilalionoIiciesloexIicilIyincIudesame
sexcouIesandarenlsinlhedenilion
offamiIyVisilalionoIicieslhalexIicilIy
incIudesamesexfamiIiesdecreaselhe
IikeIihoodlhalslabiasesviIIimacl
famiIiesrighlslovisillheirIovedones
receivingcare
InsuringlhalslamembersarecuIluraIIy
comelenlinlheirraclicesiscrilicaIlo
reducingdisariliesincIinicaIcarefor
LGTcommunilymembersThiscanbe
accomIishedbyrequiringlhalaIIsla
arlicialeincuIluraIcomelencylrainings
lhalincIudeLGTheaIlhcareissues
ToheIalienlsfeeIveIcomedinmedicaI
seingsilisimorlanllhalocemaleriaIs
anddisIaysincIudeindividuaIsand
famiIiesfromdiversebackgrounds
incIudingSGMInlakeformslhalincIude
sexuaIorienlalionandgenderidenlily
areaIsoimorlanlinensuringlhaloce
environmenlsarearmingandincIusive
loaIIalienls
Prcvcntinn
IubIicheaIlhrevenlionslralegieslargeling
behavioraIchangecanIayasignicanl
Recommended Policies
Health Outcomes
Collect demographic data for
LGBT populations.
Voluntary HIV/AIDS and STI
screenings are mandatory
services covered by Medicaid for
ages 13+.
Employment non-discrimination
policies include sexual orientation
and gender identity.
School anti-bullying policies
protect against bullying based on
sexual orientation, gender identity,
and gender expression.
School district anti-harassment
and non-discrimination
policies protect LGBT students,
teachers, and their allies.
Domestic partner relationships
are granted equal marriage
rights and legal recognition.
Housing non-discrimination
policies protect on the basis
of sexual orientation, gender
identity, and gender expression.
MissouriIoundalionforHeaIlhIubIicalion
roIeineducalingLGTcommunilymembersabouldisariliesinsmokingandsubslanceuse
anddisariliesinriskybehaviorsIducalioncanIayaroIeinrevenlionhovevervilhoul
largelingslrucluraIinequaIiliesandsyslemicdiscriminalionLGTcommuniliesviIIconlinue
lofacedisaraleIeveIsofiIInessresuIlingfromslressandunheaIlhycoingbehaviors
CIiniciansinHIVrevenlionhavefoundlhalvhenrevenlioneorlsfocussoIeIyonnegalive
behaviorsegfaiIurelousecondomsfaiIurelolesllheyIimillheiraudienceandare
Iesseeclive
SlralegieslhalromiselobemoreeeclivefocusonindividuaIsslrenglhs
IromolingmorelhanHIVrevenlionlheseslrenglhbasedaroachesemhasizelhe
imorlanceofinlimacyandheaIlhysexuaIreIalionshisTheyfocusonlhevhoIeerson
ralherlhanonlhedisease
SomeHIVrevenlionrogramsareIimiledinlheiraroachesduelofederaIrequiremenls
lhalnosexuaIorienlalionorbehaviorberomoledinHIVrevenlionrogramslhalreceive
federaIfundingLavslhalIimilHIVeducalionlodiseasecenlricnegalivebehaviorfocused
melhodsaIsoIimilrogramsabiIilyloreseclindividuaIsandcrealeIaslingchangeIor
revenlionrogramslobemosleeclivelheymuslbeermiedloemhasizelhevhoIe
ersonaddressreIalionshisandinlimacyandromoleheaIlhysexuaIily
IoIiciesromolingearIylrealmenlcoverageofHIVheIloIoverviraIIoadslherebyreducing
lhenumberofnevinfeclionsandimrovinglhequaIilyofIifeforeoIeaIreadyIivingvilh
HIVCurrenlIyMedicaidcoverageisnolavaiIabIeforchiIdIessaduIlsIivingvilhHIVunliIlhey
quaIifyforSuIemenlaISecurilyIncomevhichisgranledlolhoseIivingvilhdisabiIilies
WhenchiIdIessaduIlsvhohaveHIVbulhavenolyelrogressedloAIDSaregivenaccess
loMedicaidforlrealmenlilaIIovslheseindividuaIsearIieraccessloinlervenlionIarIier
inlervenlionsincreasesavingsandslrelchIimiledresourcesenabIingmoreaduIlsIivingvilh
HIVAIDSloreceivecare
Hca!thBchavinrs
DisariliesreIaledlosmokingandsubslanceusedisorderedealingandsuicidaIidealion
havebeenIinkedloslresscausedbysyslemicdiscriminalionandslrucluraIinequaIiliesin
asocielyIndividuaIsIookingloaIlerlheirbehaviorssomelimesarereferredlosubslance
abuselrealmenlormenlaIheaIlhfaciIiliesIaciIilieslhalaremeanllobelheraeulicsafe
andrehabiIilalivecanbeunsafeIacesforSGMWhenlherearenooIiciesandrocedures
ensuringlhalorganizalionsroleclLGTersonsindividuaIsseekingsuorlandlrealmenl
mayfacediscriminalionandviclimizalionfromolhercIienlsandslaHeaIlhandhuman
serviceorganizalionscanheIensurelhallheirfaciIiliesarearmingbyimIemenlingnon
discriminalionoIiciesrequiringslalrainingincuIluraIcomelencyvilhLGTouIalions
andcrealingveIcomingenvironmenlsforaIIcIienls
Hca!thOutcnmcs
WhiIeIocaIandnalionaIsurveyshavedocumenleddisaraleheaIlhoulcomesforLGT
individuaIsaddilionaIresearchisneededlobeercommunicalelheheaIlhneedsand
resiIienciesofLGTindividuaIsacrosslhecounlryTodalenonalionaIIyreresenlalive
randomsurveyhasbeenconducledloexamineLGTheaIlhdisariliesallhenalionaIIeveI
ToincreaseunderslandingofandfundingforLGTheaIlhequilyheaIlhsurveysandheaIlh
rovidersmuslbeginlocoIIecldemograhicdalaonsexuaIorienlaliongenderidenlilyrace
andelhnicilygeograhicIocalionandsocioeconomicslalusvhenconduclingheaIlhsurveys
MIHHeaIlhIoIicyIubIicalion
ThehigheslincreasesinHIVinfeclionralesareamongyoungAfricanAmericangayand
bisexuaImenandlransgendervomenofcoIorThisisarlicuIarIylrueamongyoungaduIls
agesyearsSomeoIicieslodecreasedisariliesinHIVlransmissionamongyounggay
andbisexuaImaIesrecommendlhalvoIunlaryscreeningsforHIVAIDSandolherSTIsshouId
becoveredbyMedicaidforaIIaduIlsagesandoIder
IoorheaIlhoulcomesresuIlingfromre|udiceunequaIaccesslocareemIoymenlandhousing
discriminalionandincomeinequaIiliescanbeaddressedlhroughsociaIandeconomicoIicies
lhalromoleequaIrighlsandroleclionsforSGMIquaIroleclionsfromdiscriminalion
harassmenlandbuIIyingareneededinMissourisschooIsbusinesseshousingandubIic
sacesTherighllomarryandlherighlloIegaIrecognilionofdomeslicarlnerreIalionshis
romiseloimrovemenlaIheaIlhoulcomesandreducedisarilies
Conclusion
AsLGTheaIlhresearchrogresseslheevidenceofdisaraleheaIlhoulcomesamongLGT
communilymembersisconvincingIxislingsludiesdemonslralelhalLGTheaIlhdisarilies
slemfrom
dierencesinaccessloheaIlhcoverage
aIackofcuIluraIcomelence
Iimiledaccessloanduseofrevenlivecare
unheaIlhybehaviorsand
sociaIandeconomicsyslemslhaldonolsuorlandroleclindividuaIs
OorluniliesexislforoIicieslobeerroleclandromolelheheaIlhandveIIbeingofaII
MissouriansregardIessoflheirsexuaIorienlalionorgenderidenlilyThisaerrecommends
oIiciesloaddresslhedelerminingfaclorsofheaIlhdisariliesalmuIliIeIeveIsThechaIIenge
remainsforschooIsmedicaIrovidersemIoyersandubIicagenciesloacknovIedge
lheresenceofLGTindividuaIsinourcommuniliesandloaddresslhefaclorslhalare
conlribulinglolheirheaIlhneeds
MissouriIoundalionforHeaIlhIubIicalion
Endnotes
}KreheIyHovloCIoselheLGTHeaIlhDisariliesGaCenlerforAmericanIrogress
K}ConronM}MimiagaS}LandersAIouIalionasedSludyofSexuaIOrienlalionIdenlilyandGenderDierencesin
AduIlHeaIlhAmerican}ournaIofIubIicHeaIlh
InsliluleofMedicineIOMTheHeaIlhofLesbianGayisexuaIandTransgenderIeoIeuiIdingaIoundalionforeer
UnderslandingTheNalionaIAcademiesIress
MarkerGayandLesbianHeaIlhDisariliesIvidenceandRecommendalionsforIIiminalion}ournaIofHeaIlh
DisariliesResearchandIraclice
}McIIroyKIvereOulIroudandHeaIlhyIro|eclSGMHeaIlhehaviorsandAccessloCareIoverIoinl
resenlalionAriI
RoberlGrahamCenlerIoIicySludiesinIamiIyMedicineandIrimaryCareIrimaryCareIhysiciansbySlaleRoberl
GrahamCenlerSelember
GLMAIroviderDirecloryMissouriAvaiIabIealhsgImaimaknelvorkalscommembersonIinenevmembers
dirrovideras
SnasholAdvancingTransgenderIquaIilyMAI
ISGehiGArkIesUnraveIingIn|usliceRaceandCIassImaclofMedicaidIxcIusionsofTransilionReIaledHeaIlhCare
forTransgenderIeoIeSexuaIilyResearchandSociaIIoIicy}ournaIofNSRCDecember
TheHenry}KaiserIamiIyIoundalionInsideOUTAReorlonlheIxeriencesofLesbiansGaysandisexuaIsin
AmericaandlheIubIicsVievsonIssuesandIoIiciesReIaledloSexuaIOrienlalion
ADeIIercioIdiledbyIKahnTSuIIivanHeaIlhcareIquaIilyIndexSurveyCrealingaNalionaISlandardfor
IquaITrealmenlofLesbianGayisexuaIandTransgenderIalienlsandTheirIamiIiesHumanRighlsCamaignIamiIy
IoundalionIro|ecl
}ObedinMaIiverelaILesbianGayisexuaIandTransgenderReIaledConlenlinUndergradualeMedicaIIducalion
}AMAThe}ournaIoflheAmericanMedicaIAssocialion
RAbeIdaelaIIoverlyinlheLesbianGayandisexuaICommunilyTheWiIIiamsInslilule
CenlerforAmericanIrogressIamiIyIquaIilyCounciIMovemenlAdvancemenlIro|eclAIIChiIdrenMaerHov
LegaIandSociaIInequaIiliesHurlLGTIamiIiesIxeculiveSummaryOclober
GayandLesbianMedicaIAssocialionGLMAToTenThingsTransgenderIersonsShouIdDiscussvilhlheirHeaIlhcare
Irovider
TheIULSILGTCommunilyHeaIlhAssessmenlKansasCilyMissouriCilyofKansasCily
VGThomasIxIainingHeaIlhDisarilieselveenAfricanAmericanandWhileIouIalionsWhereDoWeGoIrom
Here}ournaIoflheNalionaIMedicaIAssocialion
USDearlmenlofHeaIlhandHumanServicesDHHSIIiminalingHeaIlhDisariliesSlrenglheningDalaonRace
IlhnicilyandIrimaryLanguageinlheUniledSlalesDHHSNovember
HeaIlhIoIicyriefAchievingIquilyinHeaIlhHeaIlhAairsRoberlWood}ohnsonIoundalionOclober
OCarlerIokrasCaquelWhalisaHeaIlhDisarilyIubIicHeaIlhReorlsSelemberOclober
}KreheIyHovloCIoselheLGTHeaIlhDisariliesGaDisariliesbyRaceandIlhnicilyCenlerforAmerican
Irogress
DHHSNegolialedRuIemakingCommieeonlheDesignalionofMedicaIIyUnderservedIouIalionsandHeaIlh
IrofessionaIShorlageAreasDHHSOclober
SSSicerHeaIlhcareneedsoflhelransgenderhomeIessouIalion}ournaIofGayLesbianMenlaIHeaIlh
AmericanIsychialricAssocialionDiagnoslicandslalislicaImanuaIofmenlaIdisorderslhedlexlrev
CV}ohnsonM}Mimiaga}radfordHeaIlhcareissuesamongIesbiangaybisexuaIlransgenderandinlersexLGTI
ouIalionsinlheUniledSlalesInlroduclion}ournaIofHomosexuaIily
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TransgenderIquaIilyNalionaIGayandLesbianTaskIorce
KSheIlonIADeIgadoRomeroSexuaIOrienlalionMicroaggressionsTheIxerienceofLesbianGayisexuaIand
QueerCIienlsinIsycholheray}ournaIofCounseIingIsychoIogy
}LubsenMenlaIHeaIlhDisariliesImaclinglheLGTCommunilyIoverIoinlresenlalionIebruary
The}oinlCommissionAdvancingIecliveCommunicalionCuIluraIComelenceandIalienlandIamiIyCenleredCare
forlheLesbianGayisexuaIandTransgenderLGTCommunilyAIieIdGuideOclober
LKeIIeyelaIACrilicaIInlervenlioninLesbianGayisexuaIandTransgenderHeaIlhKnovIedgeandAilude
OulcomesamongSecondYearMedicaISludenlsTeachingandLearninginMedicine
HLCorIissMDShankIeMMoyerResearchCurricuIaandResourcesReIaledloLesbianGayisexuaIand
TransgenderHeaIlhinUSSchooIsofIubIicHeaIlhAmerican}ournaIofIubIicHeaIlh
GLMAToTenThingsLesbiansShouIdDiscussvilhlheirHeaIlhcareIrovider
HeaIlhResourcesandServicesAdminislralionMalernaIandChiIdHeaIlhureauWomensHeaIlhUSADHHS
GLMAToTenThingsGayMenShouIdDiscussvilhlheirHeaIlhcareIrovider
RoberlWood}ohnsonIoundalionRW}ICounlyHeaIlhRankingsandRoadmas
MissouriCensusSnasholTheWiIIiamsInslilule
MVLeeadgeelaIiasinlheWorkIaceConsislenlIvidenceofSexuaIOrienlalionandGenderIdenlily
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forIducalionSlalislicsUSDearlmenlofIducalionandureauof}usliceSlalislicsOceof}usliceIrogramsUS
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Camaign}une
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andTransgenderOIderAduIlsSAGIMarch
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}McIIroyKIvereIZaniIeiAnIxaminalionofSmokingehaviorandOinionsAboulSmokefreeInvironmenlsina
LargeSamIeofSexuaIandGenderMinorilyCommunilyMembersNicolineandTobaccoResearch
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NalionaIIack}usliceCoaIilionOulonlheHiIIKeyIederaIIoIiciesandInilialivesforlheLGTCommunily
NalionaIIack}usliceCoaIilion
TaIkingaboulSuicideandLGTIouIalionsMovemenlAdvancemenlIro|eclMAIandTheGayandLesbianAIIiance
AgainslDefamalion
DMAckardelaIIaclorsAssocialedWilhDisorderedIalingAmongSexuaIIyAcliveAdoIescenlMaIesGenderand
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LNeedhamILAuslinSexuaIorienlalionarenlaIsuorlandheaIlhduringlhelransilionloyoungaduIlhood
}ournaIofYoulhAdoIescence
HGoIdhammerandKHMayerIocusingonSexuaIHeaIlhIromolionloInhanceIrevenliveehaviorsamongGayMen
andOlherMenWhoHaveSexvilhMenReorlfromaSlaleoflheArlConferenceAIDSehaviorSS
USDearlmenlof}usliceIxlenlNalureandConsequencesofInlimaleIarlnerVioIenceUSDearlmenlof}uslice
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HGoIdhammerKHMayerIocusingonSexuaIHeaIlhIromolionloInhanceIrevenliveehaviorsamongGayMenand
OlherMenWhoHaveSexvilhMenReorlfromaSlaleoflheArlConferenceAIDSehaviorSS
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