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Heteronorma)ve  Bias  and

Discrimina)on  in  Public  Health

Hannah  Spector,  MPH

[email protected]

(2)

Community

 Individual

Public  Policy

   Interpersonal

Community

(3)

Objec)ves

1.

Define  

heteronorma)ve  &  other  useful  terms

2.

Explain  

how  heteronorma)ve  bias  &  discrimina)on  affect

public  health

(4)
(5)

What  is  Bias?

(6)

Defining  “Heteronorma)ve”

(7)
(8)
(9)
(10)

Other  Useful  Terms

Bisexual

Queer

LGBTQ2-S

(11)

Heteronorma)ve  Bias

in  Public  Health

(12)

Sexuality  and  Gender:

Implica)ons  for  Health  Care

     Biological  sex

     Sexual  orienta1on

     Sexual  iden1ty

     Sexual  a4rac1on      

     Sexual  behavior

     Gender  iden1ty  

     Gender  expression

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Sexuality  and  Gender:

Implica)ons  for  Health  Care

     Biological  sex

     Sexual  orienta1on

     Sexual  iden1ty

     Sexual  a4rac1on      

     Sexual  behavior

     Gender  iden1ty  

     Gender  expression

What  are  the  rela)onships  among  the  following  concepts?

     Biological  sex

     Sexual  orienta1on

     

Sexual  iden1ty

     Sexual  a4rac1on      

     

Sexual  behavior

     Gender  iden1ty  

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Sexuality  and  Gender:

Implica)ons  for  Health  Care

     Biological  sex

     Sexual  orienta1on

     Sexual  iden1ty

     Sexual  a4rac1on      

     Sexual  behavior

     Gender  iden1ty  

     Gender  expression

What  are  the  rela)onships  among  the  following  concepts?

     Biological  sex

     Sexual  orienta1on

     

Sexual  iden1ty

     Sexual  a4rac1on      

     

Sexual  behavior

     Gender  iden1ty  

(15)

Enabling  Services

Popula)on-­‐Based  Services

Sexuality  and  Gender:

(16)
(17)
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There  are  few  moments  in  our  lives  that  call  for  greater  compassion  and  companionship  than  when  a  loved  one is  admiZed  to  the  hospital.  In  these  hours  of  need  and  moments  of  pain  and  anxiety,  all  of  us  would  hope  to have  a  hand  to  hold,  a  shoulder  on  which  to  lean  -­‐-­‐  a  loved  one  to  be  there  for  us,  as  we  would  be  there  for them.

Yet  every  day,  all  across  America,  pa)ents  are  denied  the  kindnesses  and  caring  of  a  loved  one  at  their  sides  -­‐-­‐ whether  in  a  sudden  medical  emergency  or  a  prolonged  hospital  stay.  O]en,  a  widow  or  widower  with  no children  is  denied  the  support  and  comfort  of  a  good  friend.  Members  of  religious  orders  are  some)mes unable  to  choose  someone  other  than  an  immediate  family  member  to  visit  them  and  make  medical  decisions on  their  behalf.

Also  uniquely  affected  are  gay  and  lesbian  Americans  who  are  o]en  barred  from  the  bedsides  of  the  partners with  whom  they  may  have  spent  decades  of  their  lives  -­‐-­‐  unable  to  be  there  for  the  person  they  love,  and unable  to  act  as  a  legal  surrogate  if  their  partner  is  incapacitated.

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There  are  few  moments  in  our  lives  that  call  for  greater  compassion  and  companionship  than  when  a  loved  one is  admiZed  to  the  hospital.  In  these  hours  of  need  and  moments  of  pain  and  anxiety,  all  of  us  would  hope  to have  a  hand  to  hold,  a  shoulder  on  which  to  lean  -­‐-­‐  a  loved  one  to  be  there  for  us,  as  we  would  be  there  for them.

Yet  every  day,  all  across  America,  pa)ents  are  denied  the  kindnesses  and  caring  of  a  loved  one  at  their  sides  -­‐-­‐ whether  in  a  sudden  medical  emergency  or  a  prolonged  hospital  stay.  O]en,  a  widow  or  widower  with  no children  is  denied  the  support  and  comfort  of  a  good  friend.  Members  of  religious  orders  are  some)mes unable  to  choose  someone  other  than  an  immediate  family  member  to  visit  them  and  make  medical  decisions on  their  behalf.

Also  uniquely  affected  are  gay  and  lesbian  Americans  who  are  o]en  barred  from  the  bedsides  of  the  partners with  whom  they  may  have  spent  decades  of  their  lives  -­‐-­‐  unable  to  be  there  for  the  person  they  love,  and unable  to  act  as  a  legal  surrogate  if  their  partner  is  incapacitated.

For  all  of  these  Americans,  the  failure  to  have  their  wishes  respected  concerning  who  may  visit  them  or  make medical  decisions  on  their  behalf  has  real  consequences.  It  means  that  doctors  and  nurses  do  not  always  have the  best  informa)on  about  pa)ents'  medica)ons  and  medical  histories  and  that  friends  and  certain  family members  are  unable  to  serve  as  intermediaries  to  help  communicate  pa)ents'  needs.  It  means  that  a  stressful and  at  )mes  terrifying  experience  for  pa)ents  is  senselessly  compounded  by  indignity  and  unfairness.  And  it means  that  all  too  o]en,  people  are  made  to  suffer  or  even  to  pass  away  alone,  denied  the  comfort  of companionship  in  their  final  moments  while  a  loved  one  is  le]  worrying  and  pacing  down  the  hall…

…uniquely  affected  are  gay  and  lesbian  Americans

who  are  o@en  barred  from  the  bedsides  of  the

(21)
(22)

Legal  Discrimina)on

(23)
(24)
(25)
(26)

Health  Consequences  of

Repressive  Laws:

HIV  prevalence  in  men  who  have  sex  with  men  (MSM)  in  the  Caribbean

Countries  that  criminalize

sex  between  men

Countries  that  

sex  between  men

do  not

 criminalize

(27)
(28)

 Tobacco

Gay  men  &  lesbians  are

 

1.5  -­‐  2.0  (mes

 as  likely  to  smoke

 as

their  heterosexual  counterparts

(29)

 Tobacco

Gay  men  &  lesbians  are

 

1.5  -­‐  2.0  (mes

 as  likely  to  smoke

 as

their  heterosexual  counterparts

 Suicide

Lesbian,  gay,  and  bisexual

 

adolescents

 are  

2  (mes

   as

likely  to  report  suicide  idea1on  or  a  suicide  a4empt

 as

heterosexual  adolescents

(30)
(31)
(32)
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(34)
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Healthy  People  2020:

 

Lesbian,  Gay,  Bisexual,  and  Transgender  Health

                       

GOAL:

(36)

How  Can  We  Take  Ac)on

(37)

References

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hZp://www.opencongress.org/bill/111-­‐h6109/text.

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(5)  Diamant  AL,  Schuster  MA,  McGuigan  K,  Lever  J.  Lesbians'  sexual  history  with  men:  implica)ons  for  taking  a sexual  history.  Arch  Intern  Med  1999;159(22):2730.

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(11)  Laumann  EO,  Gagnon  JH,  Michael  RT,  Michaels  S.  The  social  organiza)on  of  sexuality:  Sexual  prac)ces  in  the  United States.  :  University  of  Chicago  Press;  2000.

(12)  Lee  JGL,  Griffin  GK,  Melvin  CL.  Tobacco  use  among  sexual  minori)es  in  the  USA,  1987  to  May  2007:  a  systema)c review.  Tob  Control  2009;18(4):275.

(13)  Lee  JGL.  Social  ecology  of  tobacco  surveillance  data  for  sexual  and  gender  minority  popula)ons.  Nico)ne  Tobacco Res  2009.

(14)  Makadon  HJ,  Mayer  KH,  PoZer  J.  The  Fenway  guide  to  lesbian,  gay,  bisexual,  and  transgender  health.  Amer  College of  Physicians;  2008.

(15)  Marrazzo  JM.  Barriers  to  infec)ous  disease  care  among  lesbians.  Emerging  Infec)ous  Diseases 2004;10(11):1974–1978.

(16)  Marrazzo  JM,  Coffey  P,  Bingham  A.  Sexual  prac)ces,  risk  percep)on  and  knowledge  of  sexually  transmiZed  disease risk  among  lesbian  and  bisexual  women.  Perspec)ves  on  sexual  and  reproduc)ve  health  2005;37(1):6-­‐12.

(17)  McLeroy  KR,  Bibeau  D,  Steckler  A,  Glanz  K.  An  ecological  perspec)ve  on  health  promo)on  programs.  Health Educa)on  &  Behavior  1988;15(4):351.

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hZp://www.queerthecensus.org/.  (20)  Parker-­‐Pope  T.  Kept  From  a  Dying  Partner’s  Bedside.  N  Y  Times  2009;Health. [cited  18  Dec  2010].  Available  from:  hZp://www.ny)mes.com/2009/05/19/health/19well.html.

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(39)

(23)  Ryan,  C.  Helping  Families  Support  Their  Lesbian,  Gay,  Bisexual,  and  Transgender  (LGBT)  Children.  Washington,  DC: Na)onal  Center  for  Cultural  Competence,  Georgetown  University  Center  for  Child  and  Human  Development.  2009; [cited  15  Feb  2011].  Available  from:  hZp://nccc.georgetown.edu/documents/LGBT_Brief.pdf.

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(25)  Saewyc  EM,  Bearinger  LH,  Blum  RW,  Resnick  MD.  Sexual  intercourse,  abuse  and  pregnancy  among  adolescent women:  does  sexual  orienta)on  make  a  difference?  Fam  Plann  Perspect  1999;31(3):127-­‐131.

(26)  UNC  Chapel  Hill  Lesbian,  Gay,  Bisexual,  Transgender,  and  Queer  Center.  Safe  Zone  Resource  Manual  2009-­‐2010. 2009.

(27)  UNAIDS.  Universal  access  in  the  Caribbean  must  include  men  who  have  sex  with  men.  2011;  [cited  18  Mar  2011]. Available  from:  hZp://www.unaids.org/en/resources/presscentre/featurestories/2010/march/20100316msmcaribbean. (28)  Savin-­‐Williams  RC,  Ream  GL.  Prevalence  and  stability  of  sexual  orienta)on  components  during  adolescence  and young  adulthood.  Arch  Sex  Behav  2007;36(3):385-­‐394.

(29)  Ungvarski  PJ,  Grossman  AH.  Health  problems  of  gay  and  bisexual  men.  Nurs  Clin  North  Am  1999  Jun;34(2):313-­‐331. (30)  Washington  HA.  Burning  love:  big  tobacco  takes  aim  at  LGBT  youths.  Am  J  Public  Health  2002;92(7):1086.

(31)  White  House  Office  of  Public  Engagement.  Hospital  Visita)on  Regula)ons  Go  Into  Effect  Today.  2011;  [cited  18  Dec 2010].  Available  from:  hZp://www.whitehouse.gov/blog/2011/01/18/hospital-­‐visita)on-­‐regula)ons-­‐go-­‐effect-­‐today. (32)  White  House  Office  of  the  Press  Secretary.  Memorandum  for  the  Secretary  of  Health  and  Human  Services  -­‐  Hospital Visita)on:  Respec)ng  the  Rights  of  Hospital  Pa)ents  to  Receive  Visitors  and  to  Designate  Surrogate  Decision  Makers  for Medical  Emergencies.  2010;  [cited  18  Dec  2010].  Available  from:  hZp://www.whitehouse.gov/the-­‐press-­‐

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