"When most health care practitioners think about lesbian, gay, bisexual or transgender health, they immediately conjure up images of HIV and AIDS."
At the beginning of the Oscar-nominated movie TransAmerica, Bree Osbourne, a transgender woman, eagerly awaits the sex change surgery that will make her a complete woman and allow her to live a more fulfilled life. However, a few days before the scheduled surgery, Bree is contacted by a son she never knew she had. Her therapist, concerned that this unresolved issue may disrupt Bree's ability to successfully integrate into a new life, refuses to sign off on the sex-change operation until Bree travels to meet her son.
Although the therapist portrayed in TransAmerica is highly competent in dealing with Bree's transgender conundrum, in real life the majority of health care professionals are completely unprepared to address these types of issues, according to Michael D. Shankle, M.P.H., a research specialist at the University of Pittsburgh Graduate School of Public Health (GSPH), department of infectious diseases and microbiology and editor of the newly published The Handbook of Lesbian, Gay, Bisexual, and Transgender Public Health: A Practitioner's Guide to Service.
"When most health care practitioners think about lesbian, gay, bisexual or transgender health, they immediately conjure up images of HIV and AIDS. However, the public health landscape for sexual minorities is much larger and significantly more complicated than just sexually transmitted diseases. That is why there is a great need for this handbook," he explained.
Mr. Shankle said that the lack of in-depth knowledge about lesbian, gay, bisexual and transgender, or LGBT, issues by practitioners often leads to less-than-optimal delivery of health care and other public services. For example, many lesbian and bisexual women may not undergo routine reproductive examinations. Therefore, they tend to be diagnosed with reproductive cancers at a significantly later stage then their heterosexual counterparts.
"Unfortunately, many health care providers don't emphasize the additional need for extra screening among this patient population," he said.
To overcome such problems, the Handbook, which is published by Harrington Park Press in New York, covers a wide range of issues that practitioners who serve LGBT communities often encounter, including the inequities in health care services available to sexual minorities; the overt prejudice they often face as well as discrimination, disdain, or outright denial of services; the assumption by health professionals of risk factors based on sexual or gender orientation rather than individual behaviors and health history; the higher incidence of reproductive cancers; the confidentiality of medical records; and employment issues, to name just a few.
"For a health care practitioner who is not a researcher, this type of information is extremely difficult to track down," explained Mr. Shankle. "That is why we assembled the best and brightest people in public health to help us pull together the handbook from the available research." Mr. Shankle hopes that the breadth and scope of research in the Handbook will give practitioners the confidence – and competence – to give real-life Bree Osbournes and members of other sexual minorities the evidence-based help they need.
Mr. Shankle served as chair of the LGBT Caucus of Public Health Workers, in official relations with the American Public Health Association, from 2001 to 2003, and his research interests include LGBT health issues, HIV prevention in young adults and public health technology integration. He also is a founding board member of Lesbian, Gay, Bisexual, and Transgender Health, Education and Research Trust, Inc., and is a member of GSPH's Center for Research on Health and Sexual Orientation.
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