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RepoRt pRepaRed by Somjen FRazeRFoR the empiRe State pRide agenda Foundationand the new yoRk State LeSbian, gay, biSexuaL andtRanSgendeR heaLth and human SeRviceS netwoRk
LgbtheaLth andhuman SeRviceS needSin new yoRk State
“I’vefoundtheexperienceoflookingatschoolsformychildrentobesimilartothe‘comingout’processofmyyouth.Schoolsandchildren’sorganizedactivitiesstilldonothaveauniformapproachto‘alternativefamilies.’Greatereducationoftheprofessionalsinthesearenaswouldbehelpful.Wehaveconsistentlygoneintotheclassroomtoexposetheotherchildrentoourfamilyinanefforttonothaveourchildrenbeputinthepositionofexplainingordefendingourfamily.”“Ihaveapartnerwhohasagoodjobwithhealthinsurance,andyetIamonMedicaidbecausehisjobwon'tgivemebenets.Ihaveaseriouschronicillnessandcan'tworksoIneedmyMedicaid.Ifwehadlegalmarriage,Iwouldnotneedtousepublicassistancetomeetmyhealthcareneeds.”“Inallofmylife,therehasbeenonlyoneprofessionalhealthcareofcethathasanin-takeformthatincludes‘partnered’forLGBTdesignation.Ibelievethatmedicalofcesshouldbeexplicitaboutsupportingpartnersinrelationtolovedones.Nooneunderstandstheisolationandfearsitcauseswhentheydon’t.”“Overtheyears,society,familyandworkhavecausedinternalhomophobiathatIdealwithallthetime.ThefearofbeingtreatedpoorlybecauseIamlesbianisalwayspresent.”“Womenneedspecializedsexeducationaimedatwomenwhohavesexwithwomenthatisnotcondom-based.”“Ifeelpeopleinmyneighborhoodneedgreateraccesstoquality,affordablehealthcare.Often,LGBTaccesstohealthcarehasnothingtodowithqueerspecicissues,butratherwithhowwearetreatedduringroutinemedicalexaminations.Havingwell-informedandsensitivestaffwouldprobablyhelpotherminoritieswithhighincidencesofviolenceorthreat,suchasimmigrants.”“I’madeafperson,andIamagayman.Iliveinagreatcommunity,buttherearesomepeoplewhoarestilluneducatedaboutdeafcultureanddeafpeople’sneeds.WhenIrequesttohaveaninterpreter,somehealthprofessionalsassumeanattitudeof,‘Thisguyisdeafandcan’tspeak.HowdoIcommunicate?’Indthisattitudetoberidiculousontheirparts,becauseIknowhowtoassertmyselfandrequestaninterpreter.”“Mypartnerisatranspersonwhoismaletofemale.Wehaveencounteredalotofissuesrelatedtotranscare.Thelargestissuebeingtheabilityforinsurancecompaniestodenyhealthservicestoatranspersoniftheservicesarethoughtofasfemaleservices,suchasgynecological,uterine,breastandovariancancercare.”“MyconstantconcernishowmypartnerandIcanhavechildrenandhaveoneofustakeevenasmallamountoftimeoffworktocareforthemwhilestillkeepingusallinsuredwithhealthcoverage.ThiswouldbeaHUGEadvantageofmarriage.Evenifwedon’thavechildren,itwouldbeabigloadoffmymindtoknowthatIcouldinsureher(orherinsureme)ifsheeverwantedorneededtostopworkingforanyreason.”“Ihavehadacardiologisttellmehedidnotapproveofme,mypartner,orourlifestylebuthewouldstilltreatme.Needlesstosay,IdidnotfeelverycondentinhiscareandfoundanewdoctorassoonasIcould.”
 
Contents
e Sr
1
ir
2
ml
3
Lgbt pl S  drs
4Population-basedEstimatesofLGBTDemographics4LGBTDemographicsintheNeedsAssessmentSurvey4
Fs
6
InsuranceandSourcesofHealthcare6BarrierstoHealthcareAccess6GeographyandTransportation7MentalIllnessandAccesstoMentalHealthcare8SubstanceAbuse9Housing10SocialSupportandSocialIsolation10Violence11SpecificPopulations12TransgenderandGenderNon-conformingPeople12PeopleofColor13Youth14Seniors15Families16
n Ss
17
wrs c
19
als
19
ThequotesonthefrontandbackcoverofthisdocumentarefromNeedsAssessmentsurveyrespondents’answerstothequestion‘WhatisthemostpressinghealthandhumanserviceneedforLGBTpeopleinNewYorkState?’Thequoteshavebeenlightlyeditedforgrammar,confidentialityanddesign.
 
1
T
hisassessmentofLGBTHealthandHumanServiceNeedsinNewYorkState(“theNeedsAssessment”)wasdesignedtoexamineexistingdatasources,identifygapsindataandcollectoriginaldatainordertoestablishthemostpressingneedsandgapsforlesbian,gay,bisexualandtransgender(LGBT)non-HIVhealthandhumanservicesinNewYorkState.Tothatend,NewYorkStateDepartmentofHealthandNewYorkCityDepartmentofHealthandMentalHygienesurveyswereanalyzed,60expertsinLGBThealthandhumanserviceswereinterviewed(individuallyoringroups)andnearly3,500LGBTpeopletookanonlineorpapersurveyabouttheirhealthandhumanserviceneeds.Herearesomekeyfindings:About4.1%ofthegeneralpopulationself-identifies
aslesbian,gayorbisexualongovernment-funded,population-basedsurveys.Lessisknownabouttransgenderidentity;however,onesurveyestimatesabout300,000self-identifiedtransgenderpeopleliveinNewYorkState.Lesbian,gay,bisexualandtransgender(LGBT)people
havepooraccesstohealthcarebecauseoflowerratesofinsuranceandutilizationofprimarycare.Forexample,theNewYorkCityDepartmentofHealthandMentalHygiene’sCommunityHealthSurvey(2007)estimatesthat20.6%oflesbianandgayand23.5%ofbisexualpeoplelackinsurance,whileonly14.9%ofheterosexualpeopledo.Lackofculturallycompetentprovidersisamajor
barriertohealthcareforLGBTpeople,withnearly40%ofpeopleintheNeedsAssessmentsurveysayingtherewerenotenoughhealthprofessionalswhoareadequatelytrainedandcompetenttodeliverhealthcaretoLGBTpeople.GeographicisolationisalsosignificantbarriertohealthcareforLGBTpeoplelivingoutsidemajorurbanareas.LGBTpeoplefacehomophobiaandtransphobiain
theireverydaylives,andaremorelikelytoexperiencedepressionandlackofaccesstoadequatementalhealthcare.Youth,transgenderandgendernon-conformingpeopleandBlackandHispanicLGBTpeoplewerethemorelikelytobedepressedandlesslikelytohaveadequateaccesstomentalhealthcare.Homelessnessandinadequatehousingaresignificant
barrierstohealthandwelfareforLGBTpeople.Nearly14%ofrespondentswerecurrentlyorformerlyhomeless.Lonelinessandsocialisolationwereparticular
problemsforLGBTpeoplewhodidnotliveorworkinManhattan.Socialisolationhasnegativehealthoutcomes,andthosewhoattendedeventsatLGBTcenterswerelesslikelytobelonely.HateviolenceisanimportantproblemintheLGBT
community,with13%reportingtheyhadexperiencedanti-LGBTsexualassaultorviolenceseriousenoughtosendthemtothehospital.Transgenderandgendernon-conformingpeople
aremorelikelytoexperiencebarrierstohealthcare,homelessness,violenceandothernegativehealthoutcomes.Peopleofcolorneedculturallysensitiveservices
bothwithintheLGBTcommunityandinmainstreamsettings.Theyreportedlowerincomes,morebarrierstohealthcareandmoredepressionandlonelinessthanwhitepeople.LGBTyoutharemorelikelythannon-
LGBTyouthtoexperiencenegativehealthoutcomessuchassmoking,substanceabuse,violenceandriskbehavior,aswellassuicide.ManyLGBTseniorsareresilient,whileothersareat
riskforsocialisolation.LGBTseniorsareparticularlyvulnerabletofinancialexploitationandneglect.LGBTpeoplebuildfamiliesinavarietyofways,and
thesefamiliesneedsupportandrecognition.
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