Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals are found in all races, ethnicities, religions, and social classes. The health issues for the LGBT include health care disparities suffered by this group, which is a source of social discrimination, social stigmatization, and diminishing of their human and civil rights. 3.8% of citizens in the United State of America, which amounts to more than 9 million people, are identified as the LGBT population according to the Williams Institute from UCLA (2016). The LGBT population experiences worse physical, mental, and sexual health than heterosexuals and non-transgender people.
This issue causes ominous biological, psychological, and social problems in the health field for this community such as:
- substance abuse;
- decreased self-steam.
In addition to these problems, it is important to consider the stress that is provoked by discrimination on the job's places, promotions, and professional specialization. All of these factors have long-lasting effects not only on the individual but also on the family and society. Acceptance of this group plays a significant role in health development. The paper will try to find and explain the main health issues that are experienced by the LGBT population and will use Healthy People 2020 as a leading notebook and the next generation of FNP to focus on the improvement of primary attention to this community.
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There is a number of journal articles that discuss issues of LGBT health. In particular, many researchers examine the determinants of health and reasons for homosexual behavior. Thus, Knauer (2013) argues that there is a wave of truism towards representatives of the LGBT group. The author studies the problem in the historical aspect. According to the article, LGBT individuals have experienced the boundaries of criminality, mental illnesses, degeneracy, and religious condemnation. Determinants of the LGBT health are estimated by constructing contemporary identities of the LGBT group.
Despite particular progress in LGBT acceptance, this group still faces difficulties and stigma. Mediana and Hassan (2015) also study the characteristic feature of health determinants of the LGBT community. Particularly, the authors pay attention to their emotional intelligence. Moreover, the article examines the problem of gay tendencies and social learning theory. Mediana and Hassan (2015) have found that different kinds of homosexuality are characterized by different phases of identity and emotional intelligence formation.
Much attention is paid to effective clinical prevention interventions that influence individual and population health outcomes using health information technology and data sources. Thus, Allison, Adams, Klindera, Poteat, and Wolf (2014) emphasize the need of providing more innovative care technology-based and prevention programs to address an increasing number of LGBT individuals who live with HIV and those who are in the risk group. The authors argue that effective communication technologies can contribute to LGBT health. In particular, innovative technologies can help people living with HIV.
Analyzing key competencies and strategies used while rendering health services to the LGBT community, Fredriksen-Goldsen, Hoy-Ellis, Goldsen, Emlet, and Hooyman (2014) underline the role of culturally competent practice. The authors discuss culturally responsive and patient-centered strategies in working with LGBT older adults. The article highlights the need to include the cultural component into professional practice in order to enhance LGBT well-being.
Some attention is paid to the examination of nurses’ role in providing care for the LGBT community. Burkholder and Burbank (2012) study the strategies of care for LGBT individuals and their children. The article is aimed at providing useful information that can be used by health care professionals for addressing the health care needs of families from the LGBT group. Burkholder and Burbank (2012) examine problems that are faced by LGBT families and develop possible nurse strategies to overcome them. The authors have reviewed nursing journals for articles that are dedicated to discussing LGBT health and have found that nursing authors are silent on health issues related to the LGBT group.
Ford, Barnes, Rompalo, and Hook (2013) discuss the history of stigma and discrimination that is related to sexual health outcomes. The authors emphasize the importance of sexual health education. In addition, they examine both challenges and advantages of educating health care professionals and patients.
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Data, Determinants of Health, and Role of Genetics
In recent years, there is a considerable shift in the perception of gays, lesbians, bisexuals, and transsexuals. According to Knauer (2013), “the last twenty years have seen a remarkable shift in public opinion regarding LGBT civil rights” (p. 363). Representatives of the LGBT group currently exploit a groundbreaking level of political and social acceptance (Knauer, 2013, p. 364). However, it is crucial to understand that gay couples do not receive full freedoms and rights. Thus, they cannot enjoy marriage equality. LGBT individuals are not protected by federal anti-discrimination regulations. They face health inequalities that are related to discrimination, stigma, and denial of their human and civil rights.
Discrimination against representatives of the LGBT group is associated with high levels of substance abuse, psychiatric disorders, and suicide. According to Healthy People 2020 (n.d.), LGBT youth are more likely to be homeless and attempt suicide. The experiences of victimization and violence are often faced by LGBT individuals. These factors have a long-lasting influence on the person and the community. Moreover, personal safety and mental health of LGBT individuals are also affected by social, family, and personal acceptance of their gender identity and sexual orientation.
The conditions, in which people are born, grow, live, work, and age, including the health system, are social determinants of health. These circumstances are shaped by the distribution of resources, power, and money at local, national, and global levels, which, in turn, affects the current policy. Social determinants of health are the primary reasons for health inequities, i.e. unfair and preventable differences in health status observed between and within countries. According to Healthy People 2020 (n.d.), a key social determinant that affects the health of the LGBT community is discrimination and oppression. It includes discrimination in access to employment, marriage, housing, health insurance, retirement benefits, and adoption.
There is also a lack of laws that protect LGBT individuals from school bullying. There are a few social programs, which are aimed at improving the status of the LGBT community. A crucial problem is a shortage of health professionals who are competent in questions of LGBT health. Prejudice and discrimination affect both societies as a whole and individuals in particular. At the social level, prejudices and discrimination against lesbians, gays, and bisexuals take the form of daily stereotypes about these groups. These stereotypes continue to exist despite the fact that they are not supported by evidence.
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At the individual level, such prejudices and discrimination can also have negative consequences, especially if lesbians, gays, and bisexuals try to hide or deny their sexual orientation. While many lesbians and gays develop skills that allow them to cope with the pressure of social stigma, this form of prejudice has serious negative consequences for their health and well-being. The impact of stigma on individuals and groups can be reduced or exacerbated because of other features such as race, nationality, religion, or disability. Widespread prejudice, discrimination, and violence, which are often experienced by lesbians and gays, can cause serious harm to their mental health.
An important role is played by the physical environment. It significantly influences the health of LGBT individuals. These factors include access to recreational activities and facilities, safe housing, and schools. Moreover, the physical environment should provide safety and access to health care services. Deep-rooted homophobic and transphobic attitudes along with the lack of legal protection against discrimination that is based on sexual orientation and gender identity subject lesbian, gay, bisexual, and transgender people of all ages and in all regions of the world to flagrant human rights violations. They face discrimination in the job market, in schools, and in hospitals.
There are different views on the factors that can cause homosexual behavior. Particular biological approaches state that hormonal or genetic factors may influence homosexuality development. According to Mediana and Hassan (2015), there is a belief that “gay attributes are likely passed down through the maternal lineage because it is associated with the X chromosome inherited from the mother” (p.17). Hormonal imbalance can become a reason for becoming homosexual.
The sexual orientation of an individual depends on the testosterone level, especially during a sensitive phase of human brain development. Another reason for becoming homosexual consists of an individual’s learning. At the same time, it is believed that reward and punishment can influence sexual orientation (Mediana & Hassan, 2015, p. 17). The main forces that form the basis for adult sexual orientation occur between middle childhood and early adolescence. These models include emotional, sensual, and sexual desire and may be manifested before any sexual experience.
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Clinical Prevention Interventions with the Use of Health Information Technology
Advances in information technology have had a positive impact on the development of new areas of medical care provided to the population. The possibility of TV consultation for patients, monitoring and control in real-time, and the use of systems to remotely capture and transmit physiological parameters take medicine to a new level. Many developed countries have already started actively using the above and many other systems in regular practice in the health sector.
There is a growing public awareness of the great prevalence level of HIV among LGBT representatives. Worldwide, LGBT individuals bear a higher HIV burden than others. Meanwhile, the use of innovative forms of communication technologies (e.g. smartphone apps, Internet use) has exponentially grown over the last years. “Since 2005, the number of people using the Internet globally has more than doubled, going from 16 to 39%” (Allison et al., 2014). While the use of these technologies has increased, there are great differences within and between countries in terms of access. Allison et al. (2015) suggest that LGBT individuals use communication technologies at higher rates than others.
Allison et al. (2014) highlight the effectiveness of innovative technology to affect the HIV epidemic among LGBT groups around the world. Technology can also help increase the reach and effectiveness of programs for HIV prevention among gay men. Many major Internet companies and commercial applications for gay dating with a large number of subscribers already support the initiative for the protection of the health and well-being of their customers. They have the ability to communicate necessary information to people with a high risk of infection and direct them to providers of HIV-related services. The highlighted programs can reach LGBT people both offline and online.
Thus, social marketing campaigns in Sydney and Thailand (ACON) were successfully combined with traditional prints and online strategies. Print media guide the LGBT to online blogs, social networking sites, and videos. In such a way, individuals become engaged in the campaigns, increase knowledge about their sexual health, and receive links to sexual health services. Online media campaigns promote activity among the LGBT community with an idea to be engaged in less risky sexual behavior (Allison et al., 2014). New online programs promote respect and tolerance for LGBT individuals. Relying on increasing access to mobile phones in the world, health information technologies begin to integrate telephone helplines and SMS messaging into the list of health services. SMS messaging can be used to contribute to HIV testing and treatment adherence.
A bright example is “the Text Me! Flash Me! Call Me! program in Ghana, designed to increase access to friendly and confidential HIV/AIDS information, referrals and counseling services” (Allison et al., 2014). Thus, government programs against AIDS must intensively use new information and communication technologies in the development of strategies and policies, as well as increase their technological base and fund appropriate programs.
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Patient-Centered and Culturally Responsive Strategies
As a result of social, historical, and cultural forces, representatives of the LGBT community have been invisible in American society. Today, discrimination and marginalization increase the vulnerability of LGBT individuals given the heightened risk of victimization and potential difficulties in obtaining access to culturally responsive services. Social isolation and criminalization of people because of their sexual orientation in the context of diseases affect the possibility of discussing issues relating to health and the use of health services. On all continents, there are countries in which human rights and the right of access to health care of persons with different sexual orientation and gender identity are still directly or indirectly denied on the levels of legislation, religion, social institutions, and cultural traditions.
Thus, there is a necessity to contribute to the improvement of culturally competent practice. Multicultural competency should be an essential factor in education and practice. According to Fredriksen-Goldsen et al. (2014), “the Patient Protection and Affordable Care Act mandates cultural competency in healthcare settings” with numerous initiatives, which are aimed at addressing health disparities and improving cultural competency with the LGBT population.
Skills, knowledge, and attitudes constitute central components of culturally competent practice. These components are essential for eliminating obstacles to getting access to quality services. In addition, they ensure a qualified workforce in human and health services.
Population-Based Health Policy through Application of Nursing Science
Social work practitioners and students are often in need of adequate knowledge and basic skills for qualified practice with the LGBT community. The majority of health care professionals who deal with LGBT individuals and their families lack knowledge about LGBT-related issues (Burkholder & Burbank, 2012, p. 12). At the present times, many organizations reach out to support LGBT basic rights and priorities of related health care. Thus, homosexuality has been removed from the list of disorders by many world associations (Burkholder & Burbank, 2012, p. 13). However, the main problem is the lack of knowledge that is related to this group of population. Therefore, there is a strong need for increasing the number of researches conducted to determine the health experience and basic needs of the LGBT.
There are particular health strategies that can be employed by nurses in order to understand the fundamental health needs of LGBT families, improve their communication, and deliver the highest quality care. Nurses have to understand and recognize biases and change their attitude towards them. Interaction with LGBT individuals is another successful way to provide a favorable attitude towards homosexual people. At the same time, nurses should learn about the regulation and laws on foster care, adoption, and same-sex marriage. It is important to collect necessary information on family composition and distinctive requests.
HIV treatment requires special attention from nurses who work with the LGBT community. A nurse is a kind of link between the patient and the doctor. Working with HIV-infected people, a nurse must possess not only specific professional knowledge but also considerable communication skills to deal with the patient. A significant role is also played by a nurse’s understanding of the importance of non-occupational exposure to HIV. It is recognized that when providing patient care, the nursing staff plays a key role, which is particularly well seen in palliative care. When caring for a patient, it is important to focus on his/her personality and individual needs. Daily care should not become routine or automatic, while care must always be individualized. To accomplish this, a nurse can apply creativity. The person-oriented approach implies orientation on the patient's needs. The patient is treated as an individual with his/her thoughts, fears, and expectations.
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Health Education, Communication Strategies, and Interventions
Health education is an important component of clinical prevention and interventions. The main objective of health education is spreading knowledge and skills and ensuring familiarization with the prevention of diseases. To reduce stigma in regard to sexual behavior health issues, promotion of the positive sides of sexual health can provide multiple benefits. A sexual health approach presents a scope of prevention and fundamental clinical messages. This approach can strengthen communication between patients and health-care professionals. Reframing communication to cover positive sexual health perspectives could help decrease misconceptions and stigma, which surround a number of sexual health issues. “Stigma and misperceptions about sexual health can affect both health-care providers and the patients they serve” (Ford et al., 2013). At the same time, while health care professionals and patients fail to overtly discuss individuals’ issues that are related to sexuality, there is quite a pervasive and sensationalized promotion of physicality in the media.
Sexual health education provides benefits for providers by escalating the effectiveness of visits and developing inclusive and nonjudgmental clinical environments. A wider sexual health focus enhances providing a more comprehensive combination of such related services as HIV screening, counseling, and contraception provision. Effective involvement of the LGBT community is extremely important for the development and adoption of effective measures to combat HIV/AIDS. A long-term serious interaction with the LGBT community leads to the increased capacity of these organizations and their mobilization for self-solving of such problems as a reduction of the spread and impact of the HIV epidemic.
Patients also receive benefits from a deeper understanding of the concepts of sexual health. Patients lack explanation, information, and support from health care providers. According to Ford et al. (2013), “patients can benefit from normalized conversations, nonjudgmental contexts, and efficiency in clinical settings”. Familiarization of patients with some signs of related diseases is necessary to make them seek early medical attention. Limiting or blocking of information regarding sexuality or the use of materials that contain stereotypes and prejudices may contribute to violence and expose LGBT individuals to health risks. Comprehensive sexual education is an integral part of the right to education and can serve as a tool in the fight against discrimination.
Despite certain changes in the perception of LGBT individuals, this group still faces a number of difficulties that are associated with stigma, discrimination, and social inequalities. These health determinants negatively affect the health status of the LGBT community. A number of health information technologies that are aimed at HIV prevention among the LGBT community have proved their effectiveness in prevention interventions. An increasing level of education on the LGBT group among nursing students can help to eliminate negative health outcomes through the improvement of cultural competence. There is a great number of strategies that can be useful for nurses in addressing LGBT families’ needs.