When LGBTQ + people seek medical help, they face challenges beyond just questions of diagnosis or waiting time. The nuances of their sexual or gender identity mean that they are more likely to receive lower quality care: health workers may mistake them, misunderstand their family relationships and not understand how hormone therapy will interact with other prescriptions.
The results could be detrimental, said Dr. Annesa Flentier, an associate professor at the UCSF School of Nursing and director of the Center for Sexual and Gender Minority Health at UC San Francisco. “Patients are very vulnerable when they go to a healthcare provider,” she said. “If they are abused in this situation, it can be a really disturbing experience and can discourage them from returning and getting the health care they need.
“We know that there is a lack of LGBTQ + curriculum and training hours mainly in the whole field, not just UCSF,” said Matthew Beld, MPH, who identifies as non-dual. “This means that students receive very minimal training on LGBTQ + health – and even on the basics of LGBTQ + identity: What is considered sexual orientation?” What is gender identity? What is gender expression? And why are pronouns important, especially in the test room or the research room?
We wanted to improve care at UCSF as a whole to make sure staff were able to receive the training they needed to make sure that clinical spaces and educational spaces were truly inclusive for LGBTQ + people.
According to an upcoming study, about 30% to 42% of people in the sexual or sexual minority (SGM) report being discriminated against in healthcare facilities, Flentje said, and these experiences can lead to hesitation in receiving medical care, which can to have all kinds of long-term negative effects, such as higher levels of cardiovascular disease and smoking, as well as delayed examinations. All this is especially relevant now that the hesitation about vaccines has contributed to the ongoing crisis with COVID-19.
Overcoming this disconnect between health care providers and SGM communities inspired Flentje to develop the LGBTQ + health certification program through the Center. The certification program is based on UCSF’s pioneering work in LGBTQ + healthcare and is open to all UCSF staff, faculty, students, associates and residents. The program has one cohort of individuals and one entire clinic to date, with plans to enroll an additional cohort once it receives additional funding.
“The health certificate is really designed to be a way for people who want advanced training in LGBTQ + health,” she said. “We wanted to improve care at UCSF in general to make sure staff are able to receive the training they need to make sure that clinical spaces and educational spaces are truly inclusive for LGBTQ + people.
Flentje and Beld spent a year hosting discussions and focus groups, “to learn what people really want to know and what their level of knowledge is,” Beld said, and from those discussions they developed the certificate.
Participants in the program from different disciplines complete four hours of class work together and then immerse themselves more deeply in focused learning. “The idea was to build a truly personalized certificate so that there could be a standard level of training plus specialization in the specific area of focus,” Flentje said.
This focus ends with a project proposal to promote change throughout the institution. For example, recognizing that LGBTQ + patients may have unpleasant experiences when receiving with partners who are not sexual or ignored, clinical staff may suggest a project to see how to improve this admission process, Flentier said. This adaptive approach allows for more targeted interventions precisely at those points where healthcare is most likely to fail LGBTQ + people.
Working against decades of stress
The certificate program was born from Flentje’s own research on minority stress. “We have a pretty good body of evidence that shows that many of these differences in mental health, and even some of the differences in physical health that were found among LGBTQ + populations, have a direct bearing on stigma and discrimination – what I consider to be minority stress, “she said.
Her study, led by her colleague Nicholas Livingston of the National Center for Post-Traumatic Stress Disorder, found, among other things, a link between mistreatment and the likelihood of subsequent substance abuse and other adverse outcomes.
“In our clinical trials testing stress reduction interventions for minorities, we will see that people change their behavior based on the experience they had 20 years ago, doing things like never holding hands with a partner in a particular block in the city because they were once called there and it felt very dangerous. That was 20 years ago – we’ve been dealing with this type of stress for 20 years, “she said. “We know that stress can have a really strong effect on the body and affect the development of diseases and a whole range of biological processes.
In the last few years, it has become clear that these stresses are not only individual burdens, but also create “unfavorable results” at the population level. As vaccine hesitation is a factor in hospitalizations and deaths from COVID-19, the Center hosted discussions earlier this year on how LGBTQ + people might view the COVID-19 vaccine.
“We discussed the barriers to getting the vaccine and personal experience with friends who are LGBTQ + who just don’t necessarily trust medical institutions,” Beld said, “and the work we’ve done to try to convince them. that the vaccine is safe – you really have to get it. “
Area of the bay and beyond
The first cohort of the program was 29 people: 13 students, 13 employees and three teachers. “And they come from almost every field at UCSF: we had representation in medicine, nurses, pharmacy and physiotherapy,” Beld said.
While other LGBTQ +-focused programs in the United States focus on clinicians, the UCSF program integrates students, staff, and faculty and can be adapted to different health care environments, Beld said. “Rural clinics, training hospitals, research groups that are interested in including LGBTQ + populations and their research. Our goal is to expand that. ”
“We have built a certificate program that is flexible enough that a full professor who has been in academia forever can complete it, but also a security guard can complete it, a new medical student can complete it,” Flentje said. “So we tried to make it flexible enough so that it could be personalized to really improve everyone’s knowledge and meet them where they are.”