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.
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.
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.”
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.
Today, the American College of Physicians called for action to address the entrenched disparities that LGBT people face in the healthcare system. The position paper, published in the Annals of Internal Medicine, asked medical providers, insurers, patients and others to address critical needs for members of the LGBT community, like non-discrimination protections, comprehensive healthcare coverage for transgender people, inclusive visitation policies, and research and training to better address the numerous health disparities LGBT people experience.
Dr. Celia B. Fisher, Director of the Center for Ethics Education
For more information, please visit & “like” RELAY: Resources & Education for LGBT & Allied Youth: www.facebook.com/lgbtrelay
Fordham University Center for Ethics Education Director Dr. Celia B. Fisher and her co-PI Dr. Brian Mustanski (Northwestern University) have received a 4-year grant for $1,918,206.00 from the National Institute on Minority Health Disparities (NIMHD) on Ethics in HIV Prevention Research Involving LGBT Youth (1R01MD009561-01).
