Defining Equity NASTAD

Everyone engaged in public health, from front desk assistants to chief medical officers, play a crucial role in reducing health disparities that exist among Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA) communities. To ensure patient populations receive high-quality, culturally responsive care in and outside of clinical settings, providers must both develop and sustain systems that affirm their sexual orientation and gender identities. Such systems require data. By developing data collection systems and tools, particularly through electronic health records, our healthcare community can begin to open the doors to honest and holistic conversations about sexual health and overall wellness with LGBTQIA patients. Rosy Galvan (previously with the New York State Department of Health AIDS Institute and now with NASTAD) and Cecilia Gentili (New York State Department of Health AIDS Institute) discuss the New York State health department’s efforts to implement SOGI data collection practices among their providers and how their work also served as a catalyst to supporting transgender and gender-expansive people in HIV prevention and care.

As the Deputy Commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, Demetre C. Daskalakis uses his clinical and public health background to develop efficacious systemic and community-level interventions across the city. In this podcast, Dr. Daskalakis discusses the health department’s approach to delivering comprehensive Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) sexual health education and programming. Recognizing that public health approaches can be highly variable among jurisdictions, he presents replicable strategies that can improve the health care of LGBTQ people. Among these are the development of a jurisdictional LGBTQ Health Care Bill of Rights, the launch of the Bare It All campaign and the dissemination of city health information bulletins for providers. Dr. Daskalakis joins others in the field who are humanizing conversations about health and working to bridge the disconnect between health departments and the communities they serve in their effort to achieve health equity for all.

For Kip Castner, former Chief of HIV/STI Integration and Capacity at the Maryland Department of Health, HIV care and prevention interventions that consider behavioral and mental health are integral components of the HIV response. In this podcast, Kip discusses various external forces that produce health inequities including lack of behavioral and mental health clinicians, unaffordability of treatment services, stigma, and prevailing cultural norms that hinder access to care. While systems-level changes such as the Affordable Care Act and Medicaid Expansion have attempted to address these issues, oppression can also have a devastating impact on populations over time, leading to mental health outcomes such as depression, anxiety and isolation. By providing clients with strategies that interrupt negative scripts about communities, they can better navigate through systems and improve health outcomes. Kip currently works at the Health Resources Administration Bureau focusing on workforce development and issues related to the opioid epidemic.

Why aren’t more queer and bisexual women getting pap smears and mammograms? Do we need to change the way we ask questions? These are one of the many topics Tanekwah Hinds, Women’s Health Program Coordinator at Fenway Health, delves into on the first podcast of the Defining Equity series, which focuses on the health of bisexual and queer women, including people of color. Hinds explains how smoking, substance use, high body mass index, and intimate partner violence can increase morbidity , while also disentangling the role of racism, biphobia, stigma, discrimination, and other social determinants in perpetuating these health disparities. Hinds further identifies the unique, systemic barriers to care Black transgender women confront including unemployment, bullying, violence, and homelessness. Our healthcare community is uniquely positioned to address these disparities; Hinds offers us strategies to create affirming environments based on her work.