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Archive for the ‘LGBTQ’ Category

Throughout 20 Days of ACA, we have discussed many ways the Affordable Care Act (ACA, or health reform) prioritizes the prevention of disease and illness. We have discussed the creation of the National Prevention Council and National Prevention Strategy as well as no co-pays for a wide range preventive care services including cervical cancer screening, pregnancy-related care, STI/HIV testing, and maternity and newborn coverage in the state insurance “exchanges.”

Today, we discuss another preventive health service that will be offered with no co-pay: domestic violence screening.

Starting on August 1, 2012 new health insurance plans must begin to cover this important service at no additional cost to patients. This important provision was included thanks to the Women’s Health Amendment (WHA).

How does domestic violence or inter-partner violence (IPV) impact Latinas?

According to year 2000 estimates, nearly 1 in 4 (23.4%) Latinas face domestic violence over the course of their lifetime. This violence comes in many forms including but not limited to verbal abuse, physical assault, and sexual assault. Abusive partners also cut off access to support systems and money (even partners’ earned wages.) Increasingly,  reproductive coercion – including sabotaging birth control methods, threatening to leave a women if she does not become pregnant, forcing contraception or abortion, and forcing partners to use recreational drugs to enhance arousal - is being used a form of violence against partners.

And while more data is needed, we know that immigrant Latinas are  overrepresented among IVP-related homicide victims and they face more barriers to leaving abusers due to lesser developed support systems, ineligibility for public benefits, and limited English proficiency among others. We also know a pregnant woman has a 35% increased chance of experiencing IPV compared to non-pregnant women and that IPV in LGBTQ communities occurs, but is often ignored.

To add to the challenges, states like Arizona and Alabama have enacted a series of dangerous immigration policies that only  decrease Latinas’ confidence in law enforcement, break apart families through incarceration, detention and deportation, and create an “anti-immigrant” culture.  Despite the creation of the U-Visa in 2000 to protect immigrants who assist law enforcement, these egregious state immigration policies threaten public safety and health by making it more difficult for Latina immigrants of IPV to leave their abusers.

Why is no co-pay for domestic violence screening and counseling important for Latinas?

Much needs to be done in this country to end domestic violence, address domestic violence in LGBTQ communities, and elevate the status of those who identify as women. For starters, NLIRH called for comprehensive immigration reform and condemned Arizona-like immigration policies.

The Affordable Care Act make a small but necessary contribution to the health of women who face domestic violence. By requiring no co-pays for domestic violence screening, the health care law removes a barrier for women whose wages and access to money have been cut off by abusers.

Health reform recognizes that women face unique barriers to health care that men do not face. From no co-pays for women’s-specific preventive care to non-discrimination protection, the ACA hopes to reduce health disparities faced by women, and particularly women of color by improving women’s access to health care insurance and public health services. And as Latinas have disproportionately been excluded from health services, they stand poised to gain from the reforms under the ACA.

There are only a few more posts in 20 Days of ACA — stay tuned throughout this week!

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It’s LGBT health awareness week, and today we’d like to spend some time talking about a few of the ways the Affordable Care Act will affect LGBTQ Latin@s. Shall we?

Medicaid expansion: We’ve already talked about this some before, but it’s important to mention here that the ACA will expand Medicaid eligibility dramatically, and will cover U.S. citizens and eligible immigrants up to 133% of the federal poverty line. This is absolutely crucial to LGBTQ Latin@s. People of color are disproportionately poor, and most available data suggests that LGBTQ folks are disproportionately poor as well. The data that we have that looks at both, such as the data from the Latin@ subset of the Trans Discrimination Survey, suggest extreme levels of poverty. What this means is that LGBTQ Latin@s and people of color stand to benefit greatly from a Medicaid expansion, and that it will bring health care to many LGBTQ folks that did not have it before. Not included in this expansion, unfortunately, are undocumented immigrants and legal permanent residents who have had that status for less than five years, many of whom are undoubtedly LGBTQ-identified. We’ve gotta keep fighting the good fight to get these folks covered.

Data Collection: One of the provisions of the Affordable Care Act is geared toward improving data collection, and we were incredibly pleased to see that last year, Health and Human Services Secretary Kathleen Sebelius announced a plan to expand data collection on Lesbian, Gay, Bisexual, and Transgender populations. The plan calls for the integration of sexual orientation and  gender identity questions into national health data collection surveys, and will not only bring to light important issues on LGBT health and health disparities, but having these numbers also will facilitate the funding needed to create and implement relevant public health interventions.

The end of pre-existing conditions exclusions: Again, this is something we’ve already talked about, but it is worth mentioning again here. This obviously applies to any LGBTQ-identified person who may be diabetic, has had a c-section, or any number of common health issues (i.e. lots of people), but this is especially important for transgender Latin@s. Under many private plans, simply being transgender is a “pre-existing condition” and reason for exclusion. This means that folks could get denied insurance on these grounds, or that if they were insured that any ongoing care relating to gender re-alignment (including every day care such as hormones) would not be covered. This is clearly unacceptable, and we’re really glad to see it go.

We were also excited to hear that the exchanges may not discriminate on the basis of sexual orientation and gender identity in their activities, and insurance plans offered within them must include a list of essential health benefits including preventive and mental health services.

Stay tuned for more on how our communities stand to benefit from the Affordable Care act in 20 Days of ACA!

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This blog is part of the #HERVotes blog carnival to support VAWA reauthorization.

In 1994, the Violence Against Women Act (VAWA) passed Congress with bipartisan support, providing funding for studies of intimate partner violence (IPV), the creation of necessary trainings and other materials responding to the issue, and the development of resources that help individuals exit dangerous and abusive situations. VAWA has been reauthorized twice—in 2000 and 2005—and is currently up for reauthorization again. This time, though, the bill faces challenges in getting through Congress, and proposed adjustments the Act’s funding threaten VAWA’s integrity. Ensuring that VAWA passes should be on everyone’s minds, since IPV occurs in all of our communities. But immigrant communities—especially immigrant women—may be particularly affected by any changes to VAWA.

IPV is a wide-reaching issue, with over two million injuries from IPV per year. But while male-on-female violence in heterosexual relationships is the stereotypical image of an abusive relationship, it is important to recognize that IPV also occurs in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community and that men and women alike may be subject to IPV.

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It’s hard to ignore the numerous ways in which our system of immigration incarceration harms our communities: on a daily basis, tens of thousands of people are warehoused in jails, many of them far from their families, separated from children and other loved ones, and unable to access legal assistance. To our horror, immigration detention produces story after story of even more extreme abuse, including denial of adequate healthcare, refusal of appropriate housing facilities, and unpunished sexual abuse of immigration detainees. We hope that shedding more light on the reality of abuse in immigration detention will help improve the transparency of the system; force recognition of its over-expansion, under-regulation, and general inefficacy for addressing immigration infractions; and, ultimately, bring about the end of our reliance on incarcerating immigrants. (more…)

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The National Center for Transgender Equality has put up a blog for Cervical Health month, recognizing the importance of this issue for trans, genderqueer, and gender non-conforming people:

Anyone with a cervix can contract cervical cancer, so this means that lots of trans men and genderqueer/gender nonconforming people are at risk. But because trans people face widespread discrimination from health care providers and insurance plans, they often avoid seeking or cannot access preventive care.

The post lists ways to prevent cervical cancer among trans men and gender non-conforming people, including tips to keep your own cervix healthy and advocacy items to ensure access to care. Check it out!

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When talking about bringing the number of cervical cancer deaths to zero, it is crucial not to forget about LGBTQ people’s distinct experiences accessing health care. We know cervical cancer is completely preventable, and that regular pap smears are designed to catch any changes in the cervix that may lead to cancer later on. Just as with many other Latinas, however, preventing cervical cancer for LGBTQ Latin@s becomes a matter of access – to affordable exams, to providers who are culturally competent, and to providers who are trained to deal with LGBTQ patients. Unfortunately, for many LGBTQ Latin@s, affordable preventive care with properly trained clinicians is simply not accessible.

One of the most pressing issues for LGBTQ access to care is discrimination and bias. Homophobia at the doctor’s office is unfortunately common, and a great detractor to queer women seeking care. This then affects access to preventive care – women who have sex with women are at risk for cervical cancer, and research suggests that queer women who report positive attitudes about their providers are more likely to have had a recent pap. Transphobia is also a concern, and especially for highly gendered health services such as Pap smears, a huge barrier to access. In fact, in a recent survey about the experiences of transgender people with discrimination, nearly a quarter of trans Latin@s reported having been denied medical services due to their gender identity, and 36% reported delaying needed medicals services for fear of bias.

Discrimination at the doctor’s office is only part of the problem, however. While person-to-person discrimination is an issue, the systematic oppression and marginalization of LGBTQ communities plays a role in LGBTQ Latin@s’ ability to afford care, research and knowledge about LGBTQ health, and clinicians’ training on treating LGBTQ patients. Existing research suggests that LGBTQ communities are disproportionately poor, and the Latin@ respondents of the Transgender Discrimination Survey reported high rates of both unemployment and harassment at work due to gender identity. This means that health care is often out of reach for these communities, especially non-emergency and preventive care such as Pap smears. But even if LGBTQ people are able to afford care, most physicians are woefully unprepared to treat LGBTQ patients due to a lack of training on relevant issues.

We are seeing progress, however. Reproductive justice activism is incorporating the needs of LGBTQ communities, and the LGBTQ advocates are beginning to consider reproductive rights issues as ones that are relevant to their base. Every day we are seeing research on LGBTQ health grow. And last November, in a historic move, the American College of Obstetricians and Gynecologists released a statement urging their members to be prepared to treat transgender patients. It’s a long road ahead, but as long as we don’t forget our LGBTQ herman@s in the fight to bring down cervical cancer deaths to zero, we are moving forward.

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If you’ve ever read or seen a TV program about our penal incarceration system, you know that what goes on in jails and prisons is the stuff of nightmares. And it is increasingly coming to light that what goes on in immigration detention is not so different. In a sense, this revelation may not be very shocking considering that in 2009, about half of immigration detainees were held in detention centers operated by private entities—typically those that focus on criminal corrections “solutions”—while the other half was actually housed in jails or prisons. But despite the increasingly clear similarities between our criminal and immigration detention systems, including an awareness that sexual abuse in immigration detention is a widespread phenomenon that continues to occur, largely with impunity, there is resistance from various quarters to applying the Prison Rape Elimination Act (PREA) to immigration detainees. Women and LGBTQ detainees, in particular, will continue to pay with their dignity so long as PREA’s application to immigration detention is not ensured.

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