Discussing her NIH-funded research on ethical issues in research involving LGBT youth, Dr. Fisher discussed the “interfamilial, regulatory and ethical tensions” that emerge in HIV prevention studies striving to recruit sexual and gender minority adolescents under 18 years of age.
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.
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.
For LGBT resources, please visit: RELAY – Research and Education for LGBT and Allied Youth is a project of the Fordham University Center for Ethics Education which looks to advance the conversation about health for lesbian, gay, bisexual, and especially trans youth.
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.”
The movement of the World Health Organization (WHO) to declassify transgender identity as a mental disorder is simultaneously a step forward in affirming the personhood of gender minority individuals, and a step backward in diagnoses that adequately reflect their health needs. The solutions posited by the WHO reveal the systemic influence of health insurance policies in defining not only medical disorders, but also social categories.
Currently, in the United States and abroad, in order to qualify for health insurance coverage for gender affirming surgery or hormone replacement therapy (HRT), mentally healthy transgender individuals must receive a diagnosis indicating a gender-related mental disorder based on either the WHO classification or the “gender dysphoria” diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the hopes of fostering greater acceptance while still satisfying insurers, after 25 years, the WHO is considering a new diagnostic category: “Conditions related to sexual health.”
According to Dr. Celia B. Fisher, Director of the Center for Ethics Education and Professor of Psychology at Fordham University, the new terminology, while well-intentioned, “runs the risk of perpetuating stereotypes that conflate gender identity and sexual orientation and lead to continued misclassification of transgender personhood as a sexual problem.”
Following a White House report released in October condemning the use of conversion therapy, Senators Cory Booker (D-NJ) and Patty Murray (D-WA) have introduced legislation to end the harmful practice.
The Therapeutic Fraud Prevention Act would empower the Federal Trade Commission to crack down on so-called “conversion therapy” that falsely claims to change a person’s sexual orientation or gender identity, according to a press release from Senator Booker’s office.
Fisher and Mustanski describe this problem in their article, “HIV Rates Are Increasing in Gay/Bisexual Teens: IRB Barriers to Research Must Be Resolved to Bend the Curve,” to be published by the American Journal of Preventative Medicine.
