The National Transgender Study is a Start – But More is Needed to Protect the Sexual Health of Transgender Teens

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On Thursday, December 9th, the largest survey of transgender people ever conducted was published by The National Center for Transgender Equality. The anonymous online survey had nearly 28,000 participants and found transgender people are twice as likely to live in poverty and three times more likely to be unemployed, according to an article in TIME Magazine. Other findings included that one-third of respondents reported issues in finding healthcare and 42%  reported higher rates of mistreatment by health care providers.

Fordham University Center for Ethics Education Director, Celia B. Fisher, Ph.D., lauded the recent national study highlighting the healthcare needs of transgender people in the United States. “More is needed on the health care experiences of transgender adolescents, especially their experiences with family physicians who often do not have the training to provide necessary gender affirming care,” she noted.

Fisher’s research with colleagues from Northwestern University, supported by the National Institute on Minority Health and Health Disparities (NIMHD), has highlighted the critical need for physicians who are trained and open to providing gender minority youth with not only transitioning information, but also gender and sexual orientation specific sexual health information and services to prevent HIV and related STIs.

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Fordham Study Addresses Health Care of Bisexual Adolescent Girls

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For bisexual female adolescents,  proper sexual healthcare is difficult to obtain due to healthcare providers’ judgmental attitudes and assumptions of patient heterosexuality, and lack of opportunities for HIV and sexually transmitted infections (STI) testing. Additionally, youth openness with healthcare providers is restricted due to stigma experienced within families of bisexual teen girls and concerns of confidentiality. These findings were published in LGBT Health, a Mary Ann Liebert, Inc. publication

Principle investigators of this NIH-funded study, Dr. Celia B. Fisher, Director of the Fordham University Center for Ethics Education and Dr. Brian Mustanski, Director of the Institute for Sexual and Gender Minority Health and Wellbeing, along with Drs. Miriam Arbeit and Kathryn Macapagal, describe these health care disparities in the article, Bisexual Invisibility and the Sexual Health Needs of Adolescent GirlsThe study analyzed bisexual female adolescents’ perspectives on their access to health information and services provided by health care professionals.

In addition to attitudes and assumptions of healthcare providers and stigma within families, the findings also included limited school-based sexual health education as an important factor contributing to insufficient health care for bisexual adolescent girls.

“The findings from our study are consistent with the unfortunate fact that sexual health care of adolescent girls has largely been absent or focused primarily on birth control tools that do not prevent risk of HIV and other STI – especially if male partners refuse to use condoms,” notes Fisher, Director of Fordham Center for Ethics Education, “and this problem is exacerbated for bisexual girls who may be unprepared for sexual experiences with male partners or who engage in such experiences to avoid social stigma.”

The researchers concluded that practitioners must improve standard sexual health practices involving female youth by integrating nonjudgmental questions regarding bisexuality. According to Fisher, the study “underscores the need for additional training of family physicians and gynecologists to engage in patient centered discussions that help to overcome bisexual invisibility and fears of medical discrimination that are barriers to bisexual girls sexual health.” In a recent article about the study, William Byne, MD, PhD of LGBT Health, adds, “Knowledge of a patient’s sexuality is essential to the biopsychosocial model of clinical practice.”

According to the study, other forms of support of bisexual health among adolescent girls include addressing stigma, increasing sensitivity to privacy and expansion of school-based sexual health education.

Read more about this research in the News Medical Life Sciences article as well as in LGBT Health.

Ethics & Society Newsfeed: October 14, 2016

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Health Care and Bioethics

DNA database highlights need for new medical privacy protections
Creation of a national repository of genetic information is seen by some as crucial to reducing medical costs and improving people’s healthcare.

‘Big data’ could mean big problems for people’s healthcare privacy
Public and private insurers are spending millions of dollars on systems that can predict people’s future healthcare needs.

Colorado Wrestles With Ethics Of Aid In Dying As Vote Looms
Colorado man says he would like the option to end his life rather than face a painful death and advocates for Colorado’s Proposition 106  or “death with dignity.”

The NIH needs to review the ethics of research on primates
Congress asked the National Institutes of Health to review “its ethical policies and processes” on nonhuman primate research “to ensure it has appropriate justification for animal research protocols.”

Breast Cancer Death Rates Are Down, But Racial Disparities Persist
Women are less likely to die of breast cancer than they were a decade ago, but not all women are benefiting from that trend.

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Medical Training for Transgender Patients Needs to Include Sensitivity to Social Stigmas for both Gender and Sexual Orientation

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The recently published article on doctor’s lack of expertise in treating transgender patients in The Guardian is an important step forward in highlighting current disparities in healthcare services for this population.  The study, based on interviews with sample of 23 physicians and psychologists who chose to work with transgender patients, focused on current challenges in providing gender affirming care for individuals who are seeking medically supported transitioning treatments, such as hormonal replacement therapies (HRT).

A recently completed study by Celia B. Fisher, Ph.D. and her colleagues, funded by the National Institute for Minority Health and Health Disparities (NIMHD) confirms the need for greater medical training, based on the reports of 228 transgender males, females and gender non-conforming youth ages 14 – 21.  “Fear of stigmatization is a significant barrier to healthcare among these youth,” notes Fisher, Director of Fordham University’s Center for Ethics Education, “and in our study, 51% reported they did not discuss their transgender identity with their primary health care providers out of fear that the provider would not be accepting.”

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The Affordable Care Act and Distributive Justice: Is it Ethical to Exclude Undocumented Immigrants?

By Ken Ochs

Immigration reform and healthcare reform are two of the most polarizing ongoing political debates in recent American history. In the absence of federal immigration reform and in the presence of a new federal healthcare system – the Affordable Care Act (ACA) – which requires legal status to obtain health insurance, there is now opportunity for everyone’s healthcare situations to improve except those of the undocumented immigrant. What are the ethical implications of excluding this large segment of the population from the prospect of improving their healthcare situations?

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Are the Workers Alright? Moral Distress Among Mental Health Researchers

By Adam L. Fried, Ph.D.

Psychologists and psychiatrists have devoted increased attention to their own self-care in response to high levels of stress in treating individuals with serious mental health conditions. Little attention, however, has been paid to those conducting research with these populations and the unique moral dilemmas encountered by researchers on the front lines.  This is especially true for the graduate students, research assistants, and other research staff who are out in the field or in hospitals providing research-related clinical assessments and interventions, as well as other more traditional research tasks, such as participant recruitment and enrollment, with individuals with high levels of anxiety, depression, and trauma.

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