LGBT

This month’s column features our first guest-post from Liz Borkowski, MPH. Liz is the managing editor of Women’s Health Issues and a researcher at the George Washington University Milken Institute School of Public Health. She focuses on reproductive health, paid leave, and US health policy, and is a regular contributor to the public health blog The Pump Handle.

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What’s the best way to help lesbian and bisexual (LB) women lose weight, when their communities may question the very goal of weight loss? That’s a question behind the “Healthy Weight in Lesbian and Bisexual Women: Striving for a Healthy Community” (HWLB) initiative. The answer they came up with was to focus the program on physical activity and nutrition, rather than numbers on a scale. Their findings suggest that this can be an effective approach for helping lesbian and bisexual women adopt healthier habits. Nearly all (95%) of participants achieved one or more of the health objectives, which included nutrition and physical activity goals as well as weight reduction. That included 57% of participants increasing their weekly physical activity minutes by 20% – habits that, if sustained, could contribute to years of improved health.

The Women’s Health Issues supplement about the study contains lessons for healthcare providers who serve lesbian and bisexual women. As Natalie Ingraham and her colleagues explain in an article about provider interventions, lesbian and bisexual women may not disclose their sexuality to providers who seem to presume heterosexuality; lack of disclosure can lead to inadequate care. Weight bias can also be common among healthcare providers:

“…stigma and discrimination related to sexual orientation and gender identity may be compounded by stigma related to weight and body size.”

To address this, the researchers developed and evaluated two curricula for providers to enhance their ability to provide high-quality care to LB “women of size” (overweight or obese). Focus group participants explained that they wanted providers’ help in overcoming barriers to healthy habits, not providers making them feel shamed or blamed for their weight. Based on this feedback and prior studies, the team developed two curricula that involved cultural competency training and motivational interviewing (MI) techniques:

“Rather than trying to convince clients to change, providers trained in MI elicit arguments for change from the clients themselves…These techniques help clients to explore and resolve ambivalence, develop self-efficacy, and set personal goals.”

The team pilot tested the “academic format” training with physicians, residents, and medical students at universities in Washington, DC and Nashville, Tennessee. They pilot tested the “clinic format” training with staff and providers at Lyon-Martin Health Services, a Program of HealthRight360, which provides care to LGBT clients in the San Francisco Bay Area. Ninety-six participants completed tests before and after the trainings; results showed the most change on questions about patient-provider interactions and LB women’s avoidance of care.

Specifically, after the trainings, more participants (correctly) agreed with the statements “Lesbians and bisexual women may avoid health care because they don’t trust the practitioner to be culturally competent” and “Overweight and obese women often delay or avoid health care if they feel their health care provider holds a bias against women who are large.” More participants also (correctly) disagreed with the statement “Physicians/nurses should always instruct their overweight/obese patients to lose weight.” There was also more (correct) agreement with this statement, which encapsulates what providers can do to help overweight clients:

“Patients who are advised by their physician how to modify their behavior to lose weight are more likely to lose weight than those who do not get this advice.”

While the authors of this article note the need for additional research on these curricula – including studies to see whether they improve clinical practice – their findings, combined with the findings of the overall HWLB study, have some clear implications. Instead of instructing all overweight or obese lesbian and bisexual patients to lose weight, providers should offer advice on adopting healthier behaviors. It is key that this advice be presented in ways that don’t contribute to stigma on the basis of larger size or sexual orientation.  To better serve lesbian and bisexual patients, health care providers should familiarize themselves with cultural norms and problematic stigmas that LB women may face. Then, during patient interactions they should make sure to sensitively include “open and positive acknowledgement of sexual orientation.”

On February 4, 2010 John Carroll University, a Jesuit school in suburban Cleveland, was the site of an LGBTQ protest that interrupted a basketball game. At issue is the university’s refusal to provide anti-bias protection employment policies.

University officials are letting LGBTQ colleagues hang out to dry. These officials defend their decision stating that employment policies are based on state and federal laws. Since state and federal law doesn’t include sexual orientation or gender identity and expression protections, they argue, the university doesn’t have to, either. But, as Bridgette P. LaVictoire reports on the blog LezGetReal, this explanation conflicts with an official university statement:

Rather than rely on the limitations provided under current federal and state law, the university strives to achieve a much higher standard based upon its Jesuit and Catholic mission and teachings.

Backpedaling JCU President Robert Niehoff says the policy should not be changed because it would go against “traditional Catholic moral teaching.”

Don’t let us down, John Carroll University! We expect more from an institution of higher learning. Don’t we turn to universities to lead the way in advancing knowledge and eradicating injustice? That’s the idea, anyway. In the meantime: JCU, we’re watching you! And so is Perez Hilton who tweeted, Awesome! RT Watch: Jesuit Students Stage Gay Rights Sit-in at College Game.

The peaceful demonstrators staged a sit-in while the university band played “Hot Stuff.” Police hovered nearby and the protesters were escorted from the floor without incident. You can watch the whole thing here.

P.S. Many thanks to Kate Arons for tipping off Girl With Pen about this issue!

Hate is on the rise. It is.  Really.

Sunday, the CNN Headline read: “New York immigrant dead in apparent hate crime.”

A 31-year-old Ecuadorean man who was beaten last Sunday in what New York City authorities say may have been a hate crime has died at a Queens hospital, his brother said Saturday.

Jose Sucuzhanay and his brother, Romel, had left a party on December 7 at St. Brigid’s Roman Catholic Church when several men approached them in a car in the Bushwick section of Brooklyn, police said. The men allegedly began shouting anti-gay and anti-Latino vulgarities at the two men.

Jose Sucuzhanay suffered severe head trauma and was taken to Elmhurst Hospital. He died Friday night from his injuries.

The ironic twist? Sucuzhanay is not even gay. Evidently, the two men were walking arm-in-arm, which is likely the cause of the confusion.

It sounds more like the next Cohen Brothers movie than an actual news headline, but it is a perfect example of complete ignorance and hatred prevailing over any kind of logic or human decency—something which has become more and more frequent in our society, of late.

In October of this year, the FBI released a report whose findings showed: “6 percent increase in anti-gay hate crimes.” The report “is purely statistical and does not assign a cause,” but it certainly begs the question: what is it about this cultural moment that is causing people to act out against the gay community?

So what IS the reason behind this surge? Is it the economy? Proposition 8, or the recent election of Obama (which seems unlikely, since Obama has made no effort to align himself with the gay community)? Could it be Susan Faludi’s observations about our increased reliance on gender roles post-9/11 in her book Terror Dream are coming to a head in a very violent, apocalyptic fashion?

One thing is for sure: the federal government is doing very little to address the issue. “Neither the federal hate crimes statute nor 21 states include sexual orientation in their hate crime laws,” reports Chip Alfred to Out and About.

In nature, a period of general chaos typically ensues before a major change occurs. I am hopeful that this, and other expressions of hatred, ignorance, and fear, are merely people’s natural response to the anticipation of change in our country (although Obama’s not painting a very hopeful tomorrow for LGBT–cough cough–Rick Warren–cough cough).

-Melinda Parrish