Trans health and the risks of inappropriate curiosity

BMJ, September 9, 2019

Care providers need to be aware of the damage of inappropriate curiosity when working with people who are transgender, say Adam Shepherd, Benjamin Hanckel, and Andy Guise.

Encountering inappropriate curiosity is a common experience among people who identify as LGBT. This kind of behaviour shouldn’t happen in a healthcare facility, yet recent reports from Stonewall and the government’s Equalities Office confirm that this is a problem in healthcare and that it particularly affects people who are transgender.

What do we mean when we say that a healthcare provider is showing “inappropriate curiosity?” Researchers provided insight into what this is in a study where they describe trans participants being asked intrusive questions about their personal lives and being subjected to invasive physical examinations. Participants felt that these were irrelevant to why they had sought out medical care, and that their only purpose was to satisfy the personal interest of the healthcare practitioner. Imagine, for example, going to your GP for a chronic cough and being asked what genitals you have, or going for a foot X-ray and the radiographer making comments about your breasts.

The Power of Words – Alcohol and Other Drug use

Alcohol & Drug Foundation, 2019

A resource for healthcare and other professionals

There’s power in language. By focusing on people, rather than their use of alcohol and other drugs, and by choosing words that are welcoming and inclusive, professionals working with people who use alcohol and other drugs can reduce the impact of stigma.

Stigma in the form of language and actions can make people who use, or have used alcohol and other drugs, feel unwelcome and unsafe. This can stop them from seeking the services they need, which can negatively impact their health, wellbeing, employment and social outcomes.

How to use this guide

The Power of Words contains evidence-based advice on using non-stigmatising language, and features an easy-to-navigate, colour-coded directory of alternative words and phrases to suit a range of common scenarios.

It’s important that consistent, appropriate language is used when speaking about alcohol and other drug use in all contexts, be it speaking directly to a client or through indirect communication to a broad audience.

Recognising this, the recommendations within Power of Words have been developed to be easily adopted by healthcare professionals as well as anyone working in management, people and culture, education, marketing, the media or social media.

The Power of Words has been produced by the Alcohol and Drug Foundation, Association of Participating Service Users/Self Help Addiction Resource Centre (APSU/SHARC), Department of Health and Human Services, Harm Reduction Victoria and Penington Institute, following an extensive review of evidence-based literature as well as focus groups with people with lived experience and their families.

STIs among transgender men and women attending Australian sexual health clinics

Med J Aust. 2019 Aug 29. doi: 10.5694/mja2.50322. [Epub ahead of print]

Abstract

Objectives

To estimate rates of HIV infection, chlamydia, gonorrhoea, and infectious syphilis in transgender men and women in Australia; to compare these rates with those for cisgender people.

Design

Cross‐sectional, comparative analysis of de‐identified health data.

Setting, participants

We analysed data for 1260 transgender people (404 men, 492 women, 364 unrecorded gender), 78 108 cisgender gay and bisexual men, and 309 740 cisgender heterosexual people who attended 46 sexual health clinics across Australia during 2010–2017.

Main outcome measures

First‐visit test positivity for sexually transmitted infections (STIs), stratified by patient group and year; demographic and behavioural factors associated with having STIs.

Results

14 of 233 transgender men (6.0%) and 34 of 326 transgender women (10%) tested during first clinic visits were chlamydia‐positive; nine transgender men (4%) and 28 transgender women (8.6%) were gonorrhoea‐positive. One of 210 tested transgender men (0.5%) and ten of 324 tested transgender women (3.1%) were diagnosed with infectious syphilis; 14 transgender men (3.5%) and 28 transgender women (5.7%) were HIV‐positive at their first visit. The only significant change in prevalence of an STI among transgender patients during the study period was the increased rate of gonorrhoea among transgender women (from 3.1% to 9.8%). Compared with cisgender gay and bisexual men, transgender men were less likely (adjusted odds ratio [aOR], 0.46; 95% CI, 0.29–0.71; P = 0.001) and transgender women as likely (aOR, 0.98; 95% CI, 0.73–1.32; P = 0.92) to be diagnosed with a bacterial STI; compared with heterosexual patients, transgender men were as likely (aOR, 0.72; 95% CI, 0.46–1.13; P = 0.16) and transgender women more likely (aOR, 1.56; 95% CI, 1.16–2.10; P = 0.003) to receive a first‐visit bacterial STI diagnosis.

Conclusions

The epidemiology of STIs in transgender people attending Australian sexual health clinics differs from that of cisgender patients. Gender details must be captured by health data systems to facilitate appropriate delivery of sexual health care.

Second HOW2 course announced for 2019

SHINE SA, July 2019

Our first course filled up, and as a result we are pleased to announce a second HOW2 course for this year! The HOW2 CREATE LGBTI INCLUSIVE SERVICES training program is an in-depth, practical program which helps organisations reach their inclusivity goals and potentially achieve accreditation as an inclusive service.

Delivered over 4 separate days, interspersed with time to implement practical improvements to your workplace’s inclusivity, this program will provide immediate benefits to your organisation.

The program is based on a set of 6 national standards developed by Gay and Lesbian Health Victoria (GLHV), in conjunction with QIP (Quality, Innovation & Performance), known as Rainbow Tick Accreditation. SHINE SA was the first South Australian organisation to be awarded Rainbow Tick accreditation for LGBTI inclusive practice and is proud to support other organisations to create safer and more inclusive workplaces and services.

**If you are a not-for-profit or community youth-focused service you may qualify for the Department of Human Services Training subsidy.

DATES (Participants are required to attend all 4 sessions):

First session: Friday 4 October 2019
Second session: Friday 8 November 2019
Third session: Friday 13 December 2019
Final session: Friday 31 January 2020

TIME: 9:30am – 2:30pm

WHERE: SHINE SA @ Woodville

 

 

 

 

 

Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal?

AIDS Res Ther. 2018 Dec 12;15(1):26. doi: 10.1186/s12981-018-0213-z.

Abstract

The World Health Organization estimates that smoking poses one of the greatest global health risks in the general population. Rates of current smoking among people living with HIV (PLHIV) are 2-3 times that of the general population, which contributes to the higher incidence of non-AIDS-related morbidity and mortality in PLHIV.

Given the benefit of smoking cessation, strategies to assist individuals who smoke to quit should be a primary focus in modern HIV care.

Tobacco harm reduction focuses on reducing health risk without necessarily requiring abstinence. However, there remains uncertainty about the safety, policy and familiarity of specific approaches, particularly the use of vaporised nicotine products. Evidence suggests that vaporised nicotine products may help smokers stop smoking and are not associated with any serious side-effects. However, there is the need for further safety and efficacy data surrounding interventions to assist quitting in the general population, as well as in PLHIV specifically.

In addition, official support for vaping as a harm reduction strategy varies by jurisdiction and this determines whether medical practitioners can prescribe vaporised products and whether patients can access vaporised nicotine products. When caring for PLHIV who smoke, healthcare workers should follow general guidelines to assist with smoking cessation.

These include: asking the patient about their smoking status; assessing the patient’s readiness to quit and their nicotine dependence; advising the patient to stop smoking; assisting the patient in their attempt to stop smoking through referral, counselling, pharmacotherapy, self-help resources and/or health education; and arranging follow-up with the patient to evaluate their progress.

New online learning from ASHM tackles stigma and discrimination in healthcare

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), 1 st March 2019

To mark Zero Discrimination Day, today ASHM has launched Removing Barriers, a new online learning tool for addressing stigma and discrimination in healthcare settings against people affected by HIV, hepatitis B or hepatitis C. 

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) received funding from the Australian Government Department of Health to address systemic barriers and stigma and discrimination to increase access to the health system by people at risk of or with hepatitis B, hepatitis C or HIV.

“Removing Barriers makes it everybody’s business to change what we say, change what we do and work together in removing the unacceptable barriers of stigma and discrimination across the health system.”