Health Equity Series:

Responding to LGBT Health Disparities

August 2012
Written by C. Winter
Edited by R. Barker and T. McAulie
MissouriIoundalionforHeaIlhIubIicalion
Table of Contents
Issuc5tatcmcnt
Backgrnund
HeaIlhIquily
SexuaIOrienlalion
GenderIdenlilyandGenderIxression
InlerseclionaIilyofMinorilySlalus
DocumenlingHeaIlhIaclorsandOulcomes
Hca!thFactnrs
AccessloCare
CIinicaICare
CuIluraIIyComelenlCare
Irevenlion
SociaIandIconomicIaclors
HeaIlhehaviors
Hca!thOutcnmcs
Pn!icicsImpactingHca!th
CurrenlIoIicies
RecommendedIoIicies
Cnnc!usinn
Endnntcs
MIHHeaIlhIoIicyIubIicalion
Acknowledgements
TheaulhoroflhisaerexlendsherdeeeslgraliludeloRyanarkerandThomasMcAuIie
forlheiradviceandsuorllhroughoullhevrilingrocessSheaIsovisheslolhankSherriII
WayIandA}ockeImanandDr}aneMcIIroyforsharingIocaIdalaandrovidingguidance
onkeyIileralureloincIudeThanksaIsogoloRyanWeisforhisvorkongrahicsanddesign
and}uIie}ohnsonforheraenlionlodelaiI

MissouriIoundalionforHeaIlhIubIicalion
Issue Statement
LesbiangaybisexuaIandlransgenderLGTindividuaIsexerienceoorerheaIlhoulcomes
lhanlheirhelerosexuaIeers

TheseooroulcomesarearesuIlofdierencesinaccesslo
heaIlhcoverageIimiledavaiIabiIilyofcuIluraIIycomelenlheaIlhcareservicesabsenceof
medicaIseingslhalarearmingandfreeofdiscriminalionscarcilyofmedicaIslalrained
inLGTheaIlhissuesheaIlhbehaviorslhaldonolfoslergoodheaIlhandsociaIandeconomic
syslemslhalhavenolsuorledandrolecledminorilies

ThisaerdravsonresearchfrommuIliIesourceslhereforeavarielyoflermsareusedlo
describesexuaIandgenderminoriliesSGMThebackgroundseclionoflhisaerresenls
denilionsoflhelermsusedasveIIandanexIanalionofvhyoneoverarchinglermvasnol
seIecledIoIIovinglhebackgroundlhisissuebriefexIorescommonexeriencesamongLGT
individuaIslhalimacllheirabiIilyloIeadheaIlhyIivesThisaerconcIudesvilharevievof
currenloIiciesinMissouriandoersoIicyrecommendalionslhalviIIIeadlogrealerheaIlh
equilyandimrovedheaIlhoulcomesforaIIMissourianseIovisaIisloflhedisarilies
highIighledinlhisaer
LGTMissouriansaremorelhanlviceasIikeIylonolreceiveneededmedicaIcareor
surgerycomaredlolhegeneraIouIalion

SexuaIandgenderminoriliesinMissouriarelimesmoreIikeIylobeuninsuredlhanlhe
generaIouIalion

IeverlhanofrimarycarehysiciansinlheslalehaveregisleredasLGT
arminginlheGayandLesbianMedicaIAssocialionsonIinerovidernelvork

LGTMissouriansvhobeIongloraciaIandelhnicminorilygrousexeriencehigherrales
ofnegaliveheaIlhoulcomes

MissourisMedicaidcoverageexIicilIyexcIudeslransgenderlransilioncarebulsurgery
isrequiredforalransgenderersonlochangelhegendermarkeronslaleidenlicalion
documenls

MorelhanonelhirdofgayandIesbianyoungeoIehavenoldiscIosedlheirsexuaI
orienlalionlolheirdoclors

MorelhanlvolhirdsofheaIlhcareorganizalionsdonolrequirelhalhysiciansaend
cuIluraIcomelencylraininglhalincIudesLGTheaIlhissues

TheaveragemedicaIsludenlsendsfeverlhanhoursIearningaboulLGTheaIlhissues
andlhema|orilyoflhallimeisdedicaledloHIVAIDS

LGTfamiIiesinlheUSaremoreIikeIylobeoorunderemIoyedandmuIliraciaIlhan
nonLGTfamiIies

OneinsevenLGTMissouriansreorlsexeriencingdiscriminalioninlhevorkIace

MIHHeaIlhIoIicyIubIicalion
Background
Health Equity
IorlheuroseoflhisaerheaIlhequily
referslolheresenceofraclicesoIicies
andsyslemsromolingheaIlhandequaI
accessloheaIlhcare
ThelermheaIlhdisarilieshasbeen
assignedmuIliIedenilionsinlheasl
years

GeneraIIylhelermdisarily
isusedloreferloanobserveddierence
belveengrousDravingfromlhis
denilionlheNalionaIInslilulesofHeaIlh
hasdenedaheaIlhdisarilyaslhe
dierenceinlheincidencerevaIence
morbidilymorlaIilyandburdenofdiseases
andolheradverseheaIlhcondilions
lhalexislamongsecicouIalion
grous

OverlheIasldecadelhislerm
hasbeenexandedbysomeIlnovrefers
loinequaIiliesinheaIlhoulcomesand
inequiliesinaccessloheaIlhcarelhalare
exeriencedbyminorilygrousincIuding
raciaIandelhnicminorilieseoIeIiving
vilhdisabiIiliesIoverincomeindividuaIs
andfamiIiessexuaIminoriliesruraI
andurbanouIalionsandimmigranl
communilies

Insomecasesdenilions
ofheaIlhdisarilieshavebeenexlendedlo
incIudedelerminanlslhalimaclindividuaI
andcommunilyheaIlh

Someoflhese
delerminanlsincIudeincomeandsociaI
slalussociaIsuorlnelvorkseducalion
emIoymenlsociaIandbuiIlenvironmenls
genelicandbioIogicaIvarialionersonaI
heaIlhraclicesandcoingskiIIsand
heaIlhychiIddeveIomenl

VariousubIicandrivaleenlilieshave
oulIinedlheirdelerminalionsoflhefaclors
lhalconlribulelodierencesinheaIlh
Someagenciessearaledelerminanlsof
heaIlhinlocalegoriessuchasavoidabIe
andunavoidabIeolherscalegorizelhem
asfairversusun|uslinorigin

As
lheseoorheaIlhoulcomeshavebeen
How Many People are Lesbian, Gay,
Bisexual or Transgender (LGBT) in the
United States?
Percent and Number of U.S. Adults who
Identify as LGBT
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
Transgender
Bisexual
Lesbian/Gay
Transgender Men Women
2,648,033
(2.2%)
1,359,801
(1.1%)
1,539,912
(1.4%)
2,491,034
(2.2%)
697,529
(0.3%)
GJ Gates, How Many People are Lesbian, Gay, Bisexual
and Transgender, The Williams Institute, April 2011.
Percent of Adults Who Report Any
Same-Sex Attraction and Behavior
0%
2%
4%
6%
8%
10%
12% Same-Sex Behavior
Same-Sex Attraction
General
Social Survey,
2008
National Survey of
Family Growth,
2006-2008
(Ages 18-44)
11.0%
8.8%
6.9%
GJ Gates, How Many People are Lesbian, Gay, Bisexual
and Transgender, The Williams Institute, April 2011.

MissouriIoundalionforHeaIlhIubIicalion
examinedmorecIoseIyheaIlhrofessionaIscommunilyIeadersandoIicymakershavefound
lhalheaIlhdisariliesoenareassocialedvilhoIiciesandraclicesinlheheaIlhcaresyslem
andolherseclorslhalimaclheaIlh
LGTindividuaIsexerienceoorerheaIlhoulcomeslhanlheirhelerosexuaIeers

TheseoulcomesaredueinarllodierenliaIaccessloheaIlhinsurancecoverageIimiled
avaiIabiIilyofheaIlhcareserviceslhalarecuIluraIIycomelenlandcomassionaleandlhe
imaclofsligmaharassmenlandsyslemicdiscriminalion

IndividuaIsbeIonginglomuIliIe
minorilygroussuchasaLalinogaymanoranAfricanAmericanlransvomanexerience
exonenliaIIyvorseheaIlhcareandheaIlhoulcomescomaredlolheirvhilehelerosexuaI
neighbors

TheCenlersforDiseaseConlroIandIrevenlionhasrecognizedlhesedisarilies
andacknovIedgedLGTcommuniliesasmedicaIIyunderservedouIalionsinHeaIlhyIeoIe

AddilionaIrecognilionoflhesedisariliescameinvhenlheInsliluleofMedicine
IOMreIeasedTncHca|incjIcs|ianGaq
Biscxua|an!Transgcn!crPccp|cBui|!inga
|cun!aiicnjcrBccrUn!crsian!ingvhich
resenledexislingknovIedgeonlheheaIlh
issuesofsexuaIandgenderminorilygrous
andsuggesledresearchgaslobeexIored
forabeerunderslandingoflheheaIlhof
LGTcommunilies

ThelermLGTisusedinscienlicIileralure
andouIarmedialocoIIecliveIyreferlo
muIliIeouIalionsincIudingIesbians
gaymenbisexuaImenandvomen
lransgenderersonsandindividuaIsvho
donolconformlogenderidenlilynorms}uslaseachraciaIandelhnicgrouinlheUSis
uniqueinilsexeriencesandhisloryeachouIalioninLGTcommuniliesresenlsilsovn
uniqueheaIlhconcernsanddislinclexressionsofresiIiencySexuaIminorilygrousandgender
nonconformingersonsIikeolherminorilygrousareoenreferredloasonecommunily
LGTbecauseofcommonexeriencesofre|udiceandinequilyasveIIassharedhisloricaI
viclimizalionsociaIsligmalizalionanddiscriminalion

Inlhefaceofsyslemicdiscriminalion
lhesecommunilieshavecomelogelherloadvocaleforequilabIelrealmenlforLGTindividuaIs
andlheirfamiIies
Sexual Orientation
TheIOMhasdenedsexuaIorienlalionasanenduringaernofordisosilionlo
exeriencesexuaIorromanlicdesiresforandreIalionshisvilheoIeofonessamesex
lheolhersexorbolhsexes

AccordinglolhisdenilionlhelermsIesbiangayandbisexuaI
LGreferlosexuaIorienlalionvhereaslhelermlransgenderreferslogenderidenlily
MuchoflheoriginaIresearchonsexuaIminoriliesfocusedonindividuaIsvhosesexuaI
orienlalionvasnolexcIusiveIyhelerosexuaIlhereforeheaIlhresearchhasIargeIyexcIuded
lransgenderersonsandfocusedonIesbiansgaymenandbisexuaImenandvomen
ResearchaIsohasfocusedonindividuaIsvhohavesexuaIreIalionshisvilheoIeoflhe
samesexbulmaynolidenlifyasIesbiangayorbisexuaI

Insomesludiesresenledinlhis
issuebrieflheseindividuaIsarereferredloasMSMmenvhohavesexvilhmenandWSW
In Missouri, sexual and
gender minorities are more
than twice as likely to not
receive needed medical care
or surgery, compared to the
general population.
5

MIHHeaIlhIoIicyIubIicalion
vomenvhohavesexvilhvomenThese
lvolermshavecomeunderscrulinyin
recenlyearsassomehoIdlhallheyIimil
individuaIsandcanbesligmalizing
Gender Identity and Gender
Expression
WhiIelhelermLGreeclssexuaI
orienlalionlhelermslransgender
andlransareusedcoIIecliveIylorefer
loindividuaIsvhosegenderidenlily
innalesenseofbeingmaIefemaIeor
anolhergenderorgenderexression
reresenlalionofersonaIilyaearance
andbehaviormaynolcorresondvilh
cuIluraIexeclalionsorslereolyesoflhe
sexassignedlolhemalbirlh

These
umbreIIalermsincIudelranssexuaIs
crossdresserslransgenderislsbigender
genderqueerandlvosirilindividuaIs

Inlhisissuebriefsomedalaareresenled
forLGTcommuniliesvhiIeolherdala
arereorledsoIeIyforsexuaIminorilies
ieIesbiansgaymenandbisexuaImen
andvomendenoledasLGorgender
minoriliesielransgenderandgender
nonconformingindividuaIsreferredloas
lransgenderorlrans
Intersectionality of Minority Status
AsresearchaboullheheaIlhofsexuaIandgenderminorilieshasbecomemorevideIy
romoledaddilionaIheaIlhdisarilieshavebeenidenliedinsubouIalionsofLGT
communiliesThesedisariliesinheaIlhoulcomes
havebeenarlicuIarIyseriousamongcommunily
membersvhoareaIsomembersofraciaIandelhnic
minorilygrousIiveinruraIcommuniliesorIack
IegaIdocumenlalionofcilizenshiTheinlerseclions
ofraceelhnicilysexuaIorienlalionorgenderidenlily
geograhysocioeconomicslalusageheaIlhIileracyand
immigralionslalushavebeenfoundlohavemuIliIicalive
eeclsonheaIlhoulcomes

Documenting Health Factors and Outcomes

WhiIenumerousdisarilieshavebeendocumenlednalionaIandslaleIeveIdalaforsexuaI
andgenderminorilycommuniliesareIimiledIevheaIlhsurveyshaveincIudedqueslions
onsexuaIorienlalionorgenderidenlilyinlheirdemograhicdala

IederaIIyfundedheaIlh
The Intersection of Multiple Identities
Types of identity:
Lesbian
African-American
Older
Adult
Rural
J Rummens, Conceptualizing Identity and Diversity:
Overlaps, Intersections, and Processes, Canadian Ethnic
Studies, 35, 3, (2003): 10-25.
In Missouri, sexual and gender
minorities are 1.5 times more
likely to be uninsured than the
general population.
5
Sex, gender
Age
Socioeconomic, class
Sexual orientation
Race/ethnicity
Disability
Cultural
Religious
Linguistic
Territorial,
geographical
Indigenous,
newcomer
Below is a depiction of the intersecting identities for
an African-American lesbian who is an older adult
and living in a rural area.

MissouriIoundalionforHeaIlhIubIicalion
researchhasnolhisloricaIIyrequiredlhaldalabecoIIecledonsexuaIorienlalionandgender
idenlilyandlodalenofederaIheaIlhsurveyhasoeredmembersoflheLGTouIaliona
meanslofuIIyidenlifylhemseIvesbyraceelhnicilysexuaIorienlalionandgenderidenlily

SeveraIslaleshaveconducledslalevideheaIlhsurveyslhalincIudedqueslionsonsexuaI
orienlalionandgenderidenlily

AndseveraIIocaIandregionaIheaIlhsurveysinMissourihave
incIudedsexuaIorienlalionandgenderidenlilyullherehasbeennocomrehensiveheaIlh
surveylhalincIudessuchdemograhicinformalionforMissouriasavhoIeIorlheurose
oflhisaerIocaIMissouridalaviIIberovidedvhereavaiIabIeSuorlivedalafromolher
USregionaIsurveysviIIbeusedinareas
vhereslalevideMissouridalahavenolyel
beencoIIecledorubIished
Health Factors
HeaIlhfaclorsarelhecondilionsinan
individuaIsIifelhalfoslerordiscourage
goodheaIlhoulcomesThisaerexIores
heaIlhfaclorsandheaIlhoulcomesIaclors
essenliaIlogoodheaIlhincIude
accessloheaIlhinsuranceandlhecare
incIudedincoverage
quaIilyandreguIarilyofaersons
cIinicaIcare
cuIluraIcomelencyinheaIlhcare
services
accesslorevenlivecare
lhesociaIandeconomicenvironmenlin
vhichanindividuaIIivesvorksand
Iaysand
anindividuaIsheaIlhbehaviors
Access to Care
LGTcommuniliesinMissouriand
lhroughoullhenalionfaceinequaIiliesin
lhereguIarilyandquaIilyoflheirheaIlh
careandinaccessloheaIlhcoverageand
cuIluraIIycomelenlheaIlhservices

ThroughoullheUShelerosexuaIaduIls
aremoreIikeIylobecoveredbyheaIlh
insurancecoveragelhansexuaIand
genderminoriliescoverageforLG
Percent of Adults Delaying or Not
Seeking Health Care
0%
5%
10%
15%
20%
25%
30%
35%
LGB Heterosexual
White Latino/a Asian
or Pacic
Islander
African-
American
21%
29%
22%
28%
31%
12%
13%
21%
J Krehely, How to Close the LGBT Health Disparities Gap:
Disparities by Race and Ethnicity, Center for American
Progress, 2009.
Percent of Missouri Adults Without
Health Coverage
J McElroy & K Everett, Out, Proud and Healthy Project:
SGM Health Behaviors and Access to Care, (PowerPoint
presentation), April 27, 2012.
0% 5% 10% 15% 20% 25% 30% 35%
Transgender Adults
Bisexual Women
Bisexual Men
Gay Men
Lesbians
All Adults 15%
25%
21%
35%
27%
27%

MIHHeaIlhIoIicyIubIicalion
aduIlscoverageforlransaduIls

ThesamelrendsexislamongsexuaIand
genderminoriliesSGMinMissourias
SGMindividuaIsareonaveragelimes
moreIikeIylobeuninsuredlhanlheir
helerosexuaIeers

TheIackofadverlisemenlofLGT
armingrovidersaIsoresenlsbarrierslo
careInlherevererimarycare
hysiciansoeringservicesinMissouris
counliesandSlLouisCily

Iever
lhanoflhesehaveregisleredvilhlhe
GayandLesbianMedicaIAssocialions
LGTarmingonIinerovidernelvork
SixbehavioraIheaIlhrovidersandlvo
aIlernalivemedicinerovidersaIsohave
regisleredasveIcomingenvironmenls
forsexuaIminoriliesinlheslale

AII
oflheseraclicesareIocaledvilhin
miIesofurbanareasSlLouisKansas
CilyCoIumbiaandSringeIdInolhervordsruraIMissouriansvhoseekLGTarming
medicaIcareandbehavioraIheaIlhservicescannolreIyonubIicIyavaiIabIeinformalionlo
idenlifyaveIcomingandlruslvorlhyrovider
TransgenderindividuaIsfaceaddilionaIdisariliesinheaIlhcoverageaslhema|orilyof
heaIlhinsuranceIansdonolcoverlransseciccareandgenderseciccareTranssecic
caremayincIudehormonelrealmenlssexorgenderreassignmenlsurgeryandlransilion
reIaledcareGendersecicroulinecaremayincIudegynecoIogicaIexamsforalransmanor
roslaleexamsforalransvomanDesilelheAmericanMedicaIAssocialionssuorlforlhe
eeclivenessofsexreassignmenlsurgeryforhysicaIlransilionmanyinsurancecomanies
conlinueloreferlolhisrocedureasexerimenlaI

arriersloinsurancecoverageforlransgendereoIeexislinMedicareMedicaidrivale
insuranceandveleransheaIlhcareThroughoullheUSrivaleinsurancecomanieshave
beenfoundlo
denycoverageongendersecicroulinecare
noloerIanslhalrovidecoverageforlransgenderindividuaIsregardIessofcosland
iIIegaIIyre|eclcIaimsforlransgenderindividuaIs
InsomecasesemIoyersIaborunionsandensionfundshavesuccessfuIIyadvocaledfor
incIusiverivaleinsuranceoIiciesMedicareandveleransIansdonolcovermosllransilion
reIaledcareMedicaidcoverageisdelerminedbyeachslaleandcurrenlIyslalesexIicilIy
excIudelransilionreIaledcareincIudingMissouri

Tvenlyeighlslalesdonolhavesecic
excIusionsbulhaverefusedcoverageoflransilionreIaledcaredeemingilexerimenlaI
regardIessofheaIlhrovidersdelerminalionlhalilisnololionaI

Percent of Adults Without Regular

Health Care Source
J Krehely, How to Close the LGBT Health Disparities Gap:
Disparities by Race and Ethnicity, Center for American
Progress, 2009. * Asian or Pacic Islander sample data too
small for reliable result.
9%
12%
14%
23%
26%
9%
12%
0%
5%
10%
15%
20%
25%
30%
LGB
Heterosexual
White Latino/a Asian
or Pacic
Islander
African-
American
*

MissouriIoundalionforHeaIlhIubIicalion
ecauseinsurancecomaniesdonoloer
cerlainlyesofcoveragelransgender
individuaIsoenseekheaIlhcareservices
lhroughunconvenlionaImeanssuch
aslhroughseIfadminisleredhormone
lrealmenlsandsiIiconein|eclions

When
hormonesarelakenvilhoulmedicaI
suervisionindividuaIsrisklaking
loomuchorlooIiIeThiscanIeadlo
heaIlhrisksanduninlendedeeclsSeIf
adminisleredeslrogenandlesloslerone
cancauseseriousheaIlhconsequencesfor
lransgenderindividuaIsincIudingincreased
riskofbIoodcIoinghyerlension
increasedbIoodsugarIeveIsvalerrelenlion
andIiverdamageOlherhormonelrealmenls
suchasanliandrogenscancausedehydralionIovbIoodressureandeIeclroIyledislurbances
ThesehormonereIaledheaIlhrisksvhencombinedvilholherissuessuchaslobaccouse
hyerlensionandobesilymayconlribuleloanincreasedriskforhearlaackorslroke

DierenlcuIluresaccelordiscriminaleagainsllransgenderindividuaIsindierenlvays
CuIlureimaclslhevayveconceluaIizegenderandgenderconformilyInsomenalions
incIudinglheUSgendernonconformilyisalhoIogizedTheAmericanIsychoIogicaI
AssocialionsmoslrecenledilionoflheDiagnoslicandSlalislicaIManuaIofMenlaIDisorders
IVTexlRevisionmainlainslhediagnosisofGenderIdenlilyDisorderGIDAccordinglo
lhedenilionofGIDindividuaIsbornvilhinlersexorhermahrodiliccondilionsarenol
consideredlohaveGIDThelvocrileriaforGIDare
ersislenlandslrongcrossgenderidenlicalionand
disidenlicalionanddiscomforlvilhlheassignedorbirlhgender

AdvocalesdierinlheiraclivismsurroundingGIDSomearguelhalilisinarorialeand
harmfuIandshouIdnolbeseenasaniIInessolhersareconcernedlhalifGIDisnolvieved
asamedicaIcondilionlransgenderersonsvilhincIusiveinsurancecoverageviIInoIonger
quaIifyforhormoneandlransilioncareMoslinsurersdonolcoverlransilioncareregardIess
ofaGIDdiagnosis
Clinical Care
NalionaIIysexuaIandgenderminoriliesexeriencedierencesinlheiraccesslocIinicaIdenlaI
andrevenlivecarecomaredlolheirhelerosexuaIandgenderconformingcounlerarls

WhenseekingcaresexuaIandgenderminoriliesreorldiscriminalionandharassmenl
fromrovidersTheseareexerienceslhalimaclanindividuaIsviIIingnessloseekfulure
medicaIcare

LesbiansgaymenandbisexuaIindividuaIsaremoreIikeIylhanhelerosexuaI
individuaIslodeIayoravoidseekingheaIlhcareandmoreIikeIylodeIayIIingrescrilion
medicines

AsLGTindividuaIsareIessIikeIylhanhelerosexuaIersonslohaveareguIar
sourceforbasicheaIlhcarelheyareaIsomoreIikeIyloreceiveheaIlhcareservicesin
emergencyroomscomaredlo

Percent of Transgender Adults Delaying

or Not Seeking Care Due to Cost
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.
0% 20% 40% 60% 80% 100%
Uninsured (86%)
Public Insurance (46%)
Private Insurance (37%)

MIHHeaIlhIoIicyIubIicalion
InMissourisexuaIandgenderminoriliesaremorelhanlviceasIikeIylodovilhoulmedicaI
careorsurgeryvhenilisneeded

Thesedierencesinaccesslocareareexaggeraledvhenrace
andelhnicilyareaIsoexaminedTheIikeIihoodforLGTindividuaIslohaveareguIarsource
ofheaIlhcareisonaveragelhreeercenlIesslhanlheirhelerosexuaIcounlerarlsineachraciaI
andelhnicsubgrouvilhLGTLalinoaduIlsbeingIeaslIikeIyofaIIgrousexaminedlohave
areguIarsourceofcarehavenoreguIarsource

ThisdisarilyincIinicaIcareersisls
amongoIderLGTaduIlsageyearsandabovedesilelheirquaIicalionforMedicare

AccordinglolheNalionaITransgenderDiscriminalionSurvey

lheIargeslreresenlalive
surveyoflransgenderandgendernonconformingindividuaIsinlheUSlransgender
individuaIsreorldeIayingoravoidingneededandrevenlivemedicaIcareduelobolh
coslanddiscriminalionInfaclnearIyhaIfoflransgenderindividuaIssurveyedreorl
deIayingcareduelocoslvhenlheyaresickorin|uredTheercenloflransgenderindividuaIs
deIayingrevenlivecareduelocoslisevenhigherTransgenderindividuaIsvilhoul
insurancecoveragearemuchmoreIikeIylodeIayneededcareduelocosllhanlhosevilh
ubIicinsuranceorrivaleinsurance

DiscriminalioninmedicaIseingsaIso
IaysasignicanlroIeinlransgender
individuaIsdecisionlodeIayoravoid
heaIlhcare

Morelhanoneinfour
lransgenderalienlsreorlexeriencing
verbaIharassmenlindoclorsoces
emergencydearlmenlsandmedicaI
seingsSimiIarIymorelhanonequarlerof
lransgenderindividuaIsdeIayneeded
careduelodiscriminalionIrevenlive
careisdeIayedalanevengrealerrale
vilhoneinlhreelransgenderindividuaIs
deIayingornolseekingrevenlive
careduelodiscriminalionTvoercenl
oflransgenderindividuaIsreorlbeing
hysicaIIyassauIledoraackedina
doclorsoceorhosilaICerlaingrousof
lransgenderindividuaIsreorlhigherrales
ofbeinghysicaIIyaackedinadoclorsoceincIudingAfricanAmericansindividuaIs
vhohaveIosllheir|obslhoseinvoIvedinsexvorkdrugsaIesorlheunderground
economyyoungaduIlsvholransilionedriorloageandundocumenlednon
cilizensIlisnoluncommonforlransgenderindividuaIslobedeniedcarebymedicaI
rovidersasnearIyoneinvereorlbeingrefusedcareTheseralesdieraccordinglo
lhelyeofservicerovidervilhercenloflransgenderersonsreorlingrefusaIofcare
fromadoclorTransgenderindividuaIsaIsoreorlbeingdeniedcarebyemergencyrooms
menlaIheaIlhcIinicsemergencymedicaIlechniciansanddruglrealmenlrograms

WhiIe
deIiberalediscriminalionofsexuaIminoriliesisIesscommoninmedicaIseingslhanin
schooIorvorkseingslhedireclconsequencesofbeingdeniedarorialemedicaIcarecan
beseriousTheIuIsesurveyinKansasCilyfoundlhalercenlofresondenlsvho
hadsamesexreIalionshishadexerienceddiscriminalioninheaIlhcareseings

Among
Percent of Transgender Adults Refused
Care According to Medical Setting
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.
0% 5% 10% 15% 20% 25%
Doctor's Oce (24%)
Emergency Room (13%)
Mental Health Clinic (11%)
EMT (5%)
Drug Treatment Program (3%)

MissouriIoundalionforHeaIlhIubIicalion
lransgenderalienlsoneinfouroflhose
surveyedhadbeenharassedinadoclors
oceorhosilaI

Culturally Competent Care

TheabsenceofcuIluraIIycomelenl
andcomassionalecarekeessome
individuaIsfromaccessingheaIlhservices
CrealingaveIcomingandcuIluraIIy
comelenlracliceaIIovsalienlslofeeI
safelodiscusslheirsexuaIilyThiscan
imrovelrealmenlandenhanceroviders
abiIilylocareforlhevhoIeersonand
beerunderslandlheouIalionslhey
areservingSludieshavedelermined
lhalhesilancylodiscIoseonessexuaI
orienlalionisreIaledloroviderbias
lovardIesbianandgayouIalions

ThisbiasrangesfromarovidersIack
ofcomforlorlraininginroviding
arorialeandcuIluraIIycomelenlcarelohosliIilyandrefusaIlolrealgayandIesbian
alienlsInmorelhaningayandIesbianyoungaduIlsdidnoldiscIoselheir
sexuaIorienlalionlolheirdoclors

AalienlsdecisionlonoldiscIoselhisinformalioncan
resuIlindeIayedlrealmenlIackofrevenlivecareandIesscareforchroniccondilions

TrainingincuIluraIcomelencyaIIovsheaIlhcarerovidersloexaminelheirovnbiasesand
beerconlroIanybiaseslhalmayimacllhecarelheyrovideThesecanbeunconsciousIy
communicaledcrealinganuninlenlionaIIy
hosliIeorconfusingenvironmenlfor
alienlsUninlendednegaliveaclionsand
communicalionslemmingfromrovider
biasareknovnasmicroaggressions

OveraeriodoflimelheseaclsresuIl
inanenvironmenllhalishosliIeand
confusingforlheindividuaIvhois
largelediasre|udiceandslereolyes
inheaIlhcareseingsfoslerunveIcoming
andunsafeenvironmenlslhalcankee
individuaIsfromrelurningforfulure
careMicroaggressioninamenlaIheaIlh
careseingcanincIudeoveremhasis
ofanindividuaIssexuaIorienlalionand
genderidenlily

Whenaraclilioner
cilesanindividuaIssexuaIorienlalionas
lheroolcauseofaIIsymlomslhisisan
examIeofmicroaggressionInconlrasl
vhenaraclilionerrefusesloacknovIedge
Percent of Missouri Adults Not
Receiving Needed Medical Care
J McElroy & K Everett, Out, Proud and Healthy Project:
SGM Health Behaviors and Access to Care, (PowerPoint
presentation), April 27, 2012.
7%
0%
5%
10%
15%
20%
Sexual and Gender Minorities
General Population
Adults >65 years All Adults
17%
5%
11%
Percent of Health Professionals
Required to Complete Training Within
Organizations Oering LGBT-Inclusive
Cultural Competency Trainings
A DelPercio, (Edited by E Kahn & T Sullivan), Healthcare
Equality Index Survey 2011: Creating a National Standard
for Equal Treatment of Lesbian, Gay, Bisexual and
Transgender Patients and Their Families, Human Rights
Campaign Family Foundation Project, 2011.
47.9%
0% 10% 20% 30% 40% 50%
Medical Assistants & Technicians
Administrative Personnel
Allied Health Professionals
Nurses
Physicians 31.6%
45.0%
45.7%
45.0%

MIHHeaIlhIoIicyIubIicalion
lheroIesexuaIorienlalionmayIayinaersonsIifelhisIackofrecognilionisaIsoa
resuIlofbias

WeIImeaningmedicaIraclilionersmayuninlenlionaIIyromoleahosliIe
environmenlbyassuminghelerosexuaIilyofaIIalienlsresenlingmaleriaIsandbrochures
lhalonIydeiclheleronormalivefamiIiesfaiIingloincIudesexuaIorienlalionandgender
idenlilyoninlakeformsandmakingslereolyicaIassumlionsaboulalienlsvhochooselo
comeoullolheirroviders
NearIyaIImedicaIassocialionsinlheUSsuorlelhicaIslandardslhalrohibildiscriminalion
againslLGTeoIeinlheracliceofmedicineInaneorllosuorlalienlsheaIlhmany
oflheseassocialionslogelhervilhlheIOM}oinlCommissionandDearlmenlofHeaIlh
andHumanServicesDHHSarerecognizinglheimorlanceofcuIluraIcomelencyamong
rovidersinimrovingalienlsheaIlhoulcomesThe}oinlCommissionanaccrediling
organizalionlhalcerlieslhequaIilyerformanceofmorelhanheaIlhcareorganizalions
lhroughoul
lheUSurges
hosilaIsandheaIlh
rovidersloavoid
discriminalion
andlakelhe
Ieadincrealing
communicalive
veIcoming
environmenlsfor
aIIalienlsThe
}oinlCommission
recognizeslhallheIeadersofheaIlhorganizalionsmusldirecllheseinilialivesandensurelhal
lheneedsofsexuaIminorilyalienlsandfamiIiesareconsideredinlheIanningdeIiveryand
evaIualionofaIIheaIlhcareservices

InaddilionloencouraginggrealercuIluraIcomelency
lhroughIeadershilhe}oinlCommissionaIsorovidesguideIinesforcuIluraIcomelency
inlherovisionofcarelrealmenlandservicesvorkforcedeveIomenldalacoIIeclionand
useandalienlfamiIyandcommunilyengagemenlIrovidingcheckIislsloensureeeclive
communicalionandcuIluraIcomelencylhe}oinlCommissionhasoeredhosilaIsandheaIlh
careorganizalionsausefuIlooIloensurecomIianceandfosleramorecuIluraIIycomelenl
alienlcenleredmedicaIenvironmenl

TheHeaIlhcareIquaIilyIndexHIISurvey

conducledbylheHumanRighlsCommissionis
anolherlooIusedbyheaIlhcareorganizalionsloevaIualelheincIusivenessoflheiroIiciesfor
alienlsandslaandlhebreadlhoflheircuIluraIcomelencylrainingsHosilaIsandheaIlh
careroviderscanarlicialeinlhissurveylorecordlheirrogressaslheyslrivelomake
lheirfaciIiliesmorecuIluraIIycomelenlandalienlcenleredAcrosslhenalionheaIlhcare
organizalionsarlicialedinlhesurveyreresenlingfaciIiliesNalionaIIylheHIISurvey
idenliedlhalfeverlhanhaIfoflheagenciesrovidingLGTincIusivecuIluraIcomelency
lrainingsloslamembersacluaIIyrequirearlicialionAndfeverlhanonelhirdof
lheorganizalionsrequirelheirhysicianslocomIelelhem

InMissourilvoorganizalions
reresenlingfaciIiliesarlicialedinlhesurveyGrealerarlicialionisneededfrom
MissourisheaIlhcareorganizalionsinorderlobeerunderslandhovlheslalecomareslo
nalionaIlrendsinLGTincIusiveoIiciesandrocedures
Most physicians are not required to complete cultural
competency training that includes LGBT health issues. In
fact, more than two thirds of health care organizations
oering cultural competency trainings on LGBT issues do
not require physicians to attend.
11

MissouriIoundalionforHeaIlhIubIicalion
IxaminingchangesinheaIlhimaclandalienlsalisfaclionralesreIaledlocuIluraI
comelencylrainingscanbechaIIengingvhenlrainingsareolionaIIndividuaIsservedin
heaIlhcareorganizalionsvilholionaIcuIluraIcomelencylrainingsmayhavedierenl
exeriencesandoulcomesvhenslamembersarelrained
dierenlIyvilhinlhesameorganizalionThesedierencesmay
maskcuIluraIcomelencylrainingsimaclonalienlsalisfaclion
reorlsandheaIlhoulcomes
ManymedicaIschooIsandubIicheaIlhlrainingrograms
donolrequirelheincIusionofinformaliononsexuaIminorily
ouIalionsDalaIimilalionsoenareciledaslhereasonfor
medicaIschooIsIimiledcoverageofLGTheaIlhissuesand
cuIluraIcomelencyMorelhanhaIfofmedicaIschooIcurricuIa
donolconlainanyinformalionongayandIesbianouIalions

WhensexuaIminorilyheaIlhissuesarediscussedmedicaI
schooIcurricuIaoenIimillheirleachingloHIVAIDSinlheLGTcommunilyAsurvey
foundlhalmedicaIschooIssenlanaverageofhoursoverayeareriodleachingon
LGTheaIlhloics

ymedicaIschooIsreorledsendinganaverageofhourson
lheseissues

AnemhasisonHIVAIDSremainsinmedicaIeducalionbulisdueinarllo
researchfocusingondiseaseralherlhan
onLGTouIalionheaIlhexeriences
osiliveheaIlhoulcomesandresiIiency

LackofcuIluraIcomelencyandsensilivily
invorkingvilhlransalienlsremainsa
concernandlheseissuesusuaIIyarenol
addressedinUSmedicaIschooIs
SimiIarIylhema|orilyofUSubIicheaIlh
schooIsdonolincIudecoursevorkaboul
LGTheaIlhdisariliesandlhoselhal
dofocusrimariIyonHIVAIDSAmong
ubIicheaIlhrogramssurveyed
feverlhanercenlhadoeredacourse
coveringLGTheaIlhloicsbeyondHIVAIDS

OflhosesameschooIsercenlIanned
looersuchacourseinlhenexllhreeyearsAndvhiIelhema|orilyoflheseschooIs
oerednondiscriminaloryheaIlhinsurancecoverageforsexuaIorienlalioninemIoymenland
educalionmosldidnoloerheaIlhinsurancefordomeslicarlnersoffacuIlyorslaor
domeslicarlnersofsludenls

Prevention
MembersoflheLGTcommunilyareIessIikeIyloreceiverevenlivecaresuchascancer
screenings

WhencouIedvilholherIimilalionsinaccessandbehaviorlhishasresuIledin
IesbianshavinglhehigheslriskfaclorsforbreaslcancerofaIIvomenvorIdvide

Dalafrom
lheCaIiforniaHeaIlhInlervievSurveyreveaIedlhalvhiIesexuaIminorilyvomenand
helerosexuaIvomenhaddieringmammogramralesoverlhereviouslvoyearslhese
dierencesgrevdramalicaIIyvhensubouIalionsvereexaminedbasedonraceandelhnicily
Fewer than 10 percent of
public health programs
oer courses covering
LGBT health topics
beyond HIV/AIDS.
31
During 4 years of education,
the average medical student
spends about 5 hours learning
about LGBT health issues, the
majority of which is focused
on HIV/AIDS.
12

MIHHeaIlhIoIicyIubIicalion
LesbiansareaIsoalincreasedriskforsomegynecoIogicaIcancers

andaresignicanlIyIess
IikeIyloreorlreceivingIasmearsinlhereviousmonlhsofIesbianscomared
vilhofhelerosexuaIandofbisexuaIvomen

DalafromKansasCilyMissouri
indicalelhalercenlofIocaIWSWoveragehadalIeasloneIasmeareachyear

AccordinglolheIuIseercenlofWSWreorledhavinglherecommendedagearoriale
screeningsforbreaslandcervicaIcancersThesamesurveyfoundlhalonIyercenlof
WSWhadreceivedrecommendedagearorialescreeningsforcoIoreclaIcancerThese
dalarovideaIookinloralesofcancerscreeningsaccordingloagebullheydonolrovide
screeningralesaccordingloraceandelhnicily
InlheUSdisariliesinrevenlivecareandcancerscreeningsaIsoexislforgaymenAsgay
menhavehigherralesofanaIcancersandanaIaiIIomalhanhelerosexuaImenilisimorlanl
lhalgaymenreceiveHIVscreeningsbeginningalageandcancerscreenings

TheIuIse
foundlhalercenlofgaymenoveragehadbeenscreenedforanaIcancerusinglheIa
smearAmongKansasCilyMSMageoroIderercenlhadreceivedarorialeroslale
cancerscreeningbulmorelhanhaIfhadnolreceivedcoIoreclaIcancerscreening

Higher
ralesofHIVAIDSamonggaymenhavemolivaledmanyindividuaIsinlheLGTcommunily
lobereguIarIy
lesledforHIV
ReguIarHIV
leslingamonggay
mendemonslrales
lheimacllhal
ubIicheaIlh
camaignscan
haveandshovslhe
resiIienceofLGT
communilies
WhiIeslaleIeveI
dalaonrevenlive
careamongsexuaI
minoriliesdo
nolyelexislin
MissouriseveraI
IocaIsurveysrovidevaIuabIeinformalionfromsamIeouIalionsacrosslheslaleTheIuIse
foundlhalmorelhanhaIfofMSMcomIelinglhesurveyhadbeenlesledforHIVinlhe
aslyearTheIuIseaIsofoundlhalMSMvereIessIikeIyloreorlreguIarhysicaIexamsand
receivedenlaIexamslhanWSWvilhercenlandercenlreorlinglhallheyhadnever
receiveddenlaIcareresecliveIy

TransgenderindividuaIsexerienceIoverralesofcancerscreeningsandlhereforeexerience
ooreroulcomesanddeIayeddiagnoses

ThisisarlicuIarIylrueforcancerinreroduclive
organs

SomerovidersrefuselolrealcancersinlransgenderindividuaIsvhosereroduclive
organsdierfromlheirgenderidenlily

Transmenremainalriskforulerineovarianand
breaslcancervhiIelransvomenremainalriskforroslalecancer

Percent of Women Receiving a Mammogram in Past Two Years

Krehely, J. How to Close the LGBT Health Disparities Gap: Disparities by Race and Ethnicity.
Center for American Progress. 2009.
0% 10% 20% 30% 40% 50% 60% 70% 80%
African-American
Asian or
Pacic Islander
Latina
White
L
G
B
H
e
t
e
r
o
s
e
x
u
a
l
68%
53%
56%
69%
60%
51%
71%
35%

MissouriIoundalionforHeaIlhIubIicalion
Social and Economic Factors
HeaIlhrofessionaIsareincreasingIyrecognizinglhecrilicaIroIelhalonessociaIandeconomic
environmenlsIayinonesheaIlhAccordinglolheCounlyHeaIlhRankingsaersons
sociaIandeconomicenvironmenlscombineloimaclanindividuaIsheaIlhmorelhanaccess
loheaIlhinsuranceorlhequaIilyandreguIarilyofcIinicaIcare

LessaccessloemIoyer
sonsoredheaIlhcoveragehasbeenidenliedasaconlribulorlooorerheaIlhoulcomesand
feverheaIlhcarevisilsamongsexuaIandgenderminorilies

Disariliesindomeslicarlner
insurancecoverageimaclLGTcouIesandfamiIiesabiIilyloaccessheaIlhcare

SexuaI
minoriliesreceivingarlnerbenelsfromemIoyersonsoredheaIlhcoveragearelaxedon
lhesebenelsaslhoughlheyareincome

ThisaddilionaIlaxonincomecanrovearlicuIarIy
burdensomebecauseilcomoundslhenanciaIinequaIiliesexeriencedbysexuaIandgender
minoriliesLGTindividuaIsfacehigherralesofunemIoymenlandunderemIoymenland
IoverincomeslhanlheirhelerosexuaIeers

TransgenderindividuaIsexeriencelvice
lheralesofunemIoymenlandoverlylhanlhegeneraIouIalion

Amonglransgender
individuaIsofcoIoroverlyralesaresignicanlIyhigherIoverlyralesareercenlfor
lhegeneraIouIalionercenlforaIIlransgenderindividuaIsercenlformuIliraciaI
lransgenderersonsercenlforLalinolransgenderersonsandercenlforbIack
lransgenderindividuaIs

Table 1. Percent of U.S. Poor Children in Coupled Families by Household Type, by Race,
Ethnicity, and Age of Child
Married Dierent-Sex Male Couples Female Couples
All
Householder & Partner 9.4 20.9* 19.7*
Race
White 6.8 15.9* 13.8*
Black 13.1 27.9* 31.6*
Native American/Alaskan 21.5 41.1* 29.4
Asian/Pacic Islander 14.1 23.2 16.3
Other Race 21.4 23 24.7
Ethnicity
Hispanic 23.8 26.9 31.9*
Non-Hispanic 6.6 17.8* 16.6*
Age
0-5 10.5 22.9* 21.1*
6-13 9.2 19.5* 19.4*
14-18 8 19.7* 17.2*
Abelda, R., Lee Badgett, M. V., Schneebaum, A., and Gates, G. J. Poverty in the Lesbian, Gay, and Bisexual Community. The Williams
Institute. 2009. Tabulations from 5% Public Use Microdata Sample (PUMS) Files, U.S. Decennial Census, 2000. *Dierence from married
dierent-sex is statistically signicant at the 5% level.

MIHHeaIlhIoIicyIubIicalion
ConlraryloslereolyesromolinglhalsexuaIminoriliesonIyresideinurbanareasandare
moreauenllhanlheirhelerosexuaIeersLGfamiIiesvilhchiIdrenIiveinercenlof
UScounliesandaremoreIikeIylobeIivinginlheSoulh

InMissouriercenlof
counlieshavesamesexcouIesdescribinglhemseIvesassousesorunmarriedarlners

MuIliIesludieshavedelerminedlhalsamesexcouIesareasIikeIyormoreIikeIylobe
IivinginoverlylhandierenlsexcouIes

CIoserexaminalionoflhesesludiesreveaIs
videreconomicdisariliesforsamesexcouIesvhenlheyaregrouedaccordinglolheir
geograhicaIIocalionmelrooIilanslalusandraciaIandelhnicbackground

Accordinglo
lheNalionaISurveyofIamiIyGrovlhLGmenandvomenveremoreIikeIylobeoor
IivinginafamiIyvilhanincomebeIovlhefederaIoverlyIeveIlhanhelerosexuaImenand
vomenInarlicuIarIesbianandbisexuaIvomenaresignicanlIymoreIikeIylobeoorlhan
helerosexuaIvomenandresecliveIy

LesbianandbisexuaIvomenarelvice
asIikeIyloreceivefoodslamsvhencomaredlohelerosexuaIvomenand
resecliveIyIconomicdisariliesincreasefurlheramongfamiIiesvilhchiIdrenIivinginlhe
homeaschiIdrenofLGfamiIiesarelviceasIikeIylobeoorlhanchiIdreninhelerosexuaI
famiIies

IoverlyralesarearlicuIarIyhighamongyoungchiIdrenvilhsamesexarenls
vhoareIackNaliveAmericanAIaskanorHisanicAsLGfamiIiesaremoreIikeIylobe
muIliraciaIlhanhelerosexuaIfamiIiessamesexarenlsandlheirchiIdrenmayencounler
discriminalionandre|udicebecauseoflheirraciaIandelhnicbackgroundsandlheirsexuaI
orienlalionandgenderidenlilies

Wnrkp!accdiscriminatinn
DiscriminaliononlhebasisofonessexuaIorienlalionorgenderidenlilycanoccurinavariely
ofvaysincIuding

beingred
beingdeniedemIoymenlorromolion
beingoverIookedforaddedresonsibiIilies
Percent of Poor Householders and Partners in Coupled Families by Metropolitan Status
13
0%
2%
4%
6%
8%
10%
12%
Female Same-Sex Couples Male Same-Sex Couples Dierent-Sex Married
Non Metro (Rural) Small Metro Med Metro Big Metro
5%
3%
6%
5%
4%
7%
5%
6%
8%
7%
9%
12%
R Abelda et al., Poverty in the Lesbian, Gay, and Bisexual Community, The Williams Institute, 2009.

MissouriIoundalionforHeaIlhIubIicalion
verbaIandhysicaIharassmenl
verbaIhysicaIorsexuaIabuse
vandaIizedvorksaceand
unequaIayorbenels
DiscriminalionandsligmalizalioninlhevorkIaceandheaIlhcareseingsnegaliveIyimacl
lheheaIlhofsexuaIandgenderminorilies

WhiIeaGaIIuoIIreorledlhalercenl
ofAmericansbeIieveLGindividuaIsshouIdhaveequaI|oboorlunilies

vorkIace
discriminalionagainslsexuaIandgenderminoriliesersislsSludiesexaminingvorkIace
discriminalionhavefoundlhalbelveenandercenlofLGmenandvomenreorl
havingbeendiscriminaledagainslbecauseoflheirsexuaIorienlalion

TheIuIsefoundlhalercenlofsexuaIminoriliesreorleddiscriminalioninlhevorkIace

InlhissurveyralesofvorkIace
discriminalionverehigheslamong
MSMvhovereoveryearsoIdand
WSWagesloyears

Ralesof
emIoymenldiscriminalionareaIsohigh
amonggenderminorilieslransgender
individuaIsforexamIeexeriencedoubIe
lheunemIoymenlraleoflhegeneraI
ouIalionNalionaIIynearIyhaIfof
lransgendereoIeexressedbeingred
nolhiredordeniedaromolionbecause
ofnonconformancelogendernorms

AddilionaIIyercenloflransgender
individuaIsreorledbeingharassedor
mislrealedvhiIeonlhe|oborhavinglohide
lheirgenderidenlilyloavoidharassmenl

Morelhanoneinfourlransgender
individuaIsreorlbeingredduelogender
idenlilyandhaIfofgendernonconforming
individuaIsreorlbeingharassed

WhenindividuaIsareredforgender
idenlilylheirunemIoymenlIaces
lhemalincreasedriskofnegaliveheaIlh
oulcomesandfaclorsTheseincIude
becominghomeIessconlraclingHIV
andmisusingsubslanceslocoevilhmislrealmenlAccordinglolheNalionaITransgender
DiscriminalionsludysurveyarlicianlsvhohadIosllheir|obsbecauseofbiasexerienced
fourlimeslheraleofhomeIessnessercenlmorecurrenldrinkingormisuseofdrugslo
coevilhmislrealmenlercenlmoreincarceralionmorelhandoubIelheralevorkingin
lheundergroundeconomyandmorelhandoubIelheHIVinfeclionralecomaredlolhose
vhodidnolIosea|obduelobias

Harassment, Assault, and Discrimination

of Trans Students in K-12 Settings
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Expelled Sexually
Assaulted
Physically
Assaulted
Harassed
78%
35%
12%
6%

MIHHeaIlhIoIicyIubIicalion
5chnn!5cings
SociaIsligmadiscriminalionandisoIalionfromfamiIyandeersaIsoconlribulelonegalive
heaIlhoulcomesamongsexuaIandgenderminoriliesincIudingincreasedriskforcancer
higherralesofmenlaIandhysicaIiIInessesandhigherriskforsychoIogicaIdislress

AmonglhegeneraIouIalionercenlofsludenlsreorlbeingbuIIiedonlheirschooI
camusesfourercenlofsludenlsagesreorlbeingviclimized

inlherevious
sixmonlhsandIesslhanlvoercenlofsludenlsagesreorlexeriencingvioIenl
viclimizalion

orseriousvioIenlviclimizalion

vhichincIudehysicaIandsexuaIassauIl

In
lheNalionaISchooICIimaleSurveyfoundlhalnearIynineinlenLGTsludenls
reorledbeingharassedalschooIforlheirsexuaIorienlalion

Missourisludenlsexeriencehigherrales
ofhysicaIassauIlinschooIbecauseof
acluaIorerceivedsexuaIorienlalion
andgenderidenlilycomaredlonalionaI
averages

AhighIeveIofviclimizalion
andharassmenlexeriencedbyLGT
youlhinschooIsisassocialedvilhhigher
IeveIsofderessionanxielyandIovseIf
esleem

TransgenderindividuaIsvho
exressedlheirgenderidenlilyduringlheir
youlhreorlexeriencinghigherralesof
harassmenlhysicaIassauIl
andsexuaIvioIenceinKschooI
seingsvhencomaredvilhlhegeneraI
ouIalion

TheNalionaITransgender
DiscriminalionSurveyfoundlhal
sludenlsvhohadbeenbuIIiedharassed
orassauIledvhiIealschooIexerienced
higherralesofsuicideaemlsdrugand
aIcohoIusehomeIessnessandHIVlhan
lransgendersludenlsvhohadnolbeen
viclimizedalschooINolabIysludenlsvho
hadbeenharassedorassauIledbyleachers
alschooIexeriencedlhehigheslralesofaemledsuicideAemlsverenoledamong
ercenloflranssludenlsvhohadbeenharassedbyleachersercenloflranssludenls
vhohadbeensexuaIIyassauIledbyleachersandercenloflranssludenlsvhohadbeen
hysicaIIyassauIledbyleachers

TransgendersludenlsvhodroedoulofschooIbecauseof
lheinlensilyofharassmenlandassauIlaIsohadhigherIeveIsofsuicideaemls

NalionaIIyLGTsecondarysludenlsverefourlimesmoreIikeIylohavemissedalIeaslone
dayofschooIinlhereviousmonlhbecauseoffeeIingunsafeoruncomforlabIeofLGT
sludenlscomaredlooflhegeneraIsludenlouIalion

SchooIbuIIyingharassmenl
andassauIlimaclsludenlsIearningandhavebeenassocialedvilhoorermenlaIand
WhereviclimizalioniscalegorizedaslhevioIenlviclimizalionandseriousvioIenlviclimizalion
WherevioIenlviclimizalionincIudesseriousvioIenlcrimesandsimIeassauIl
WhereseriousvioIenlviclimizalionincIudesraesexuaIassauIlrobberyandaggravaledassauIl
Comparison of Missouri and U.S. Reports
of Physical Assault of Students at School
(Based on Actual or Perceived Identity)
JG Kosciw et al., The 2009 National School Climate Survey:
The Experiences of Lesbian, Gay, Bisexual and Transgender
Youth in our Nations Schools, GLSEN, 2010.
GLSEN, School Climate in Missouri, GLSEN, 2011.
0% 5% 10% 15% 20%
U.S. Students
Missouri Students
Sexual
Orientation
Gender
Identity
Gender
Religion
Race/
Ethnicity
Disability
3.0%
3.3%
2.0%
4.2%
7%
5.2%
7%
7.8%
14%
12.5%
20.0%
18.8%

MissouriIoundalionforHeaIlhIubIicalion
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TherearesignicanldierencesbelveenlheheaIlhrisksofsludenlsvho
exerienceIovIeveIsofleenageviclimizalionandlhoseexeriencinghighIeveIsSludenls
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limesmoreIikeIyloreorlHIVriskasayoungaduIl

LGBTYnuth
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comingoulorverbaIizinglheirsexuaI
orienlalionandgenderidenlilylolheir
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agelhalindividuaIschoselocomeoul
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andnegalivereaclionsaboulonessexuaI
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Asurveyofmorelhanleensfoundlhalfeverlhan
haIfofLGTleensreorledhavingalIeasloneaduIlfamiIymemberlolurnloforheI
vhiIeercenlofnonLGTleensreorledlhesame

LGTyoulharedisroorlionaleIyreresenledamonghomeIessouIalionsInilvas
eslimaledlhalbelveenmiIIionandmiIIionyoulhagesyearsverehomeIessin
lheUS

WhiIeloercenlofaIIyoulhidenlifyasLGTeslimalessuggesllhallo
Youth Descriptions of the Most Important Problems They are Currently Facing
Most Important Problems
Identied by LGBT Youth
50
Most Important Problems
Identied by Non-LGBT Youth
50
Non-accepting families (26%)
1
Class/exams/grades (25%)
School/bullying problems (21%)
2
College/career (14%)
Fear of being out or open (18%)
3
Financial pressures related to college or job (11%)
Human Rights Campaign, Growing Up LGBT in America: HRC Youth Survey Report Key Findings, HRC, June 2012.
LGBT youth who have
experienced high levels of
family rejection are 8 times
more likely to attempt
suicide than LGBT peers not
experiencing family rejection.
48

MIHHeaIlhIoIicyIubIicalion
ercenlofhomeIessyoulhidenlify
asLGTAmongsludieslhalincIuded
homeIessyoulhfromMissouri
ercenloflhehomeIessyoulhsurveyed
idenliedasLGT

IamiIyre|eclionand
isoIalionareassocialedvilhlheincreased
riskofhomeIessnessamongLGTyoulh
TheyareaIsodisroorlionaleIyyoulhof
coIorNalionaIIyercenlofhomeIess
LGTyoulhareIackandercenlare
HisanicThisdisarilyisevengrealer
amonglransgenderhomeIessyoulh
IackHisanic

HomeIessLGTyoulharemoreIikeIyloaemlsuicidebecomeviclimsofsexuaIvioIence
besoIiciledforsexinexchangeforfoodcIolhingorsheIlerandhaveITSDlhanlheir
helerosexuaIhomeIesseers

Oen
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oulcomesThesefaclorsincIudechaIIengesinaccessingubIiceducalionduringhousing
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ageyearsandabovereorlhighralesofIifelimeviclimizalionInanalionaIsurveyofmore
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anddiscriminalionreorledbyLGTeIders

hysicaIassauIl
roerlydamage
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lhrealofbeingouled
harassmenlbyoIice
Individuals with families who
accept them are less likely to
engage in negative health
behaviors, and less likely to
experience negative health
outcomes.
26
Homeless Youths Who Have Been
Sexually Assaulted
58%
33%
0% 10% 20% 30% 40% 50% 60%
LGBT
Non LGBT
NS Quintana, J Rosenthal, & J Krehely, On the Streets:
The Federal Response to Gay and Transgender Homeless
Youth, Center for American Progress, June 2010.

MissouriIoundalionforHeaIlhIubIicalion
lhrealofhysicaIvioIenceand
verbaIassauIl
WhiIelhema|orilyofLGTeIdersareoullofamiIyandcommunilymemberslheyareaIso
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lohaveaarlnerorbemarriedlhannonLGTeIdersNearIyoneinlhreeLGTeIders
reorllhallheydonolhavesomeoneinlheirIivesloIovelhemandmakelhemfeeIvanled

ThecomanyofaarlnerorsouseaordsseniorssociaIsuorlandrovidesnanciaI
securilyandassislancevilhhousingcoslsLackingsociaIsuorlisassocialedvilhdecreased
menlaIandhysicaIheaIlhremalurechronicdiseasesandremaluredealhDesile
discriminalionandisoIalionsludieshavefoundlhalLGTeIdersmainlainosilivilyand
resiIiencyasinLGTeIdersreorlfeeIinggoodaboulbeIonginglolheircommunilies

Health Behaviors
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negalivecanbeusedlocoevilhslressTheGayandLesbianMedicaIAssocialionGLMA
hasvarnedlhallheexerienceofslressandanxielycausedbydiscriminalioncanIeadlo
increasedriskforhearldiseaseforsexuaIminoriliesinlheUS

Higherralesofsmoking
andobesilyincreaselheriskofhearldiseaseamongsexuaIminorilies

SmokingandaIcohoI
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InMissouriSGMhavesignicanlIyhigherralesofsmokinglhanlheirnonLGTeers
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SexuaIandgenderminoriliesaIsoreorlhigher
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surveyinMassachusesfoundlhalsexuaIminoriliesveremoreIikeIyloreorldaylension
orvorrydruguseandcurrenlsmokinglhanhelerosexuaIs

Aslalevidesurveyconducled
bylheCoIoradoDearlmenlofIubIicHeaIlhandInvironmenlfoundlhalsomeIesbiangay
andbisexuaIindividuaIsvereusingsmokingandsubslanceabuselodeaIvilhvorkIaceand
socielaIdiscriminalionfamiIyandsociaIre|eclionandminorilyslressThesludyfoundlrends
simiIarlolhoseinnalionaIsurveysvhichshovedlhalbingedrinkingvasmorecommon
amongIesbianandgayresondenlsandbisexuaIresondenlslhanhelerosexuaI
individuaIsThissamesludyfound
lhalIesbianandgayindividuaIsreorled
lvicelheraleofunemIoymenlformore
lhanoneyearcomaredlooflhe
generaIouIalion

SomeindividuaIscoevilhdiscriminalion
andlraumabyengaginginhighrisk
behaviorsOlherscoelhroughveIIness
acliviliessociaIevenlsandhysicaI
lnessWhiIeeachersonexeriences
uniqueslressorsandraclicesindividuaI
Percent of Adults Reporting Excellent or
Very Good Health
0% 20% 40% 60% 80% 100%
Transgender
LGB
Heterosexual
67%
77%
83%
J Krehely, How to Close the LGBT Health Disparities Gap,
Center for American Progress, 2009.

MIHHeaIlhIoIicyIubIicalion
slressreIievingacliviliesidenlifyinglrendsamongsubgrousoflheouIalioncanbe
heIfuIinidenlifyingeecliveslralegiesloromoleheaIlhycoingskiIIsandimroveheaIlh
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aclivilyLGToIderaduIlsaIsohavehigherralesofsmokingcigareesanddrinkingaIcohoI
SlalevideandIocaIsurveysconrmlheselrendsInaMassachusesslalevidesurveygay
menverelimesmoreIikeIylouseiIIicildrugslhanlheirhelerosexuaIcounlerarls

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menvereequaIIyIikeIylo
engageinbingedrinking
Lesbiansverelviceas
IikeIylouseiIIicildrugs
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louseiIIicildrugslhan
helerosexuaIvomen
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andonehof
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helerosexuaIvomen

ResuIlsfromlheNalionaITransgenderDiscriminalionSurveyfound
lhalvhiIenearIyoneinlhreelransgenderindividuaIsreorledsmokingdaiIylhese
ercenlagesincreasedamonglransindividuaIsvhohadbeenviclimsofhysicaIassauIl
andsexuaIassauIlduelobias

GayandbisexuaImenreorlhigherralesofsexuaIrisklakinglhanlheirhelerosexuaIeers
OnesurveyinMissourifoundlhalercenlofmenhavingsexvilhmenreorledneverusing
acondomvhiIeercenlofMSMreorledneverusingacondomfororaIsexMSMaIso
reorlmorefrequenlHIVleslingbulHIVleslingvasfoundnollocorreIalelolhenumber
ofsexuaIarlnersamanhadinlhereviousyearAddilionaIIyercenlofMSMreorled
neverhavinghadananaIcancerscreeningorHIVscreening

Researchhasfoundlhallhe
morecomorbidmenlaIheaIlhrobIemsexeriencedbyanindividuaIlhegrealerlheoddsof
sexuaIriskbehaviorsegunrolecledsexnumberofarlnersIackofSTIleslingHighIeveIs
ofneighborhoodhomohobiaanddiscriminalionaIsohavebeenfoundloinuencesexuaIrisk
behaviorsashavenegalivecuIluraIandsocielaImessagesaboulhomosexuaIilyInconlrasl
sociaIsuorlresiIiencyandosiliveinlimalereIalionshishavebeenfoundlodecrease
sexuaIriskbehaviorsandsubslanceuse
Health Outcomes
WhenresearchersmeasureheaIlhoulcomeslheyaremeasuringindividuaIshysicaI
heaIlhandmenlaIheaIlhandhovveIIlheyfeeITheseareknovnasmorbidilymeasures
IndividuaIandouIalionheaIlhoulcomesaIsoaremeasuredbyhovIongeoIeIiveand
vhelherdealhsareremalureorrevenlabIeTheseareknovnasmorlaIilymeasures

Nearly one in three transgender

individuals currently smoke, but this
number increases exponentially for those
who have been victims of physical and
sexual assault due to bias.
26

MissouriIoundalionforHeaIlhIubIicalion
Gay Men
Heterosexual Men
Percent of Men who are Underweight
**
0.6%
1.7%
Bisexual
Lesbian
Heterosexual
Percent of Women who are Obese
17.4%
26.4%
19.6%
LGB
Heterosexual
Percent of Adults with Cancer Diagnosis
*
6.0%
9.0%
Gay
Heterosexual
Percent of Men with Heart Disease
**
2.5%
3.2%
Bisexual
LG
Heterosexual
Percent of Adults with Asthma
**
20.5%
20.2%
15.0%
Bisexual
LG
Heterosexual
Percent of Adults Living with
Activity Limitation Caused by Disability
**
33.8%
20.5%
14.9%
**
TheIOMreorlonLGTheaIlhdrev
aenlionlolhedisariliesinmorbidily
andmorlaIilyexeriencedbysexuaI
andgenderminoriliesasveIIaslhe
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idenliedbylheUSDHHSandGLMA
asariskfaclorforolherheaIlhreIaled
concerns

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overveighlorobeseOIderLGTaduIlsaIso
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higherralesofHIVandSTIs

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lhanoneercenloflhegeneraI
USouIalionisIivingvilhHIVvhiIe
Disparities in Health Outcomes
* J Krehely, How to Close the LGBT Health Disparities
Gap, Center for American Progress, 2009.
** KJ Conron, MJ Mimiaga & SJ Landers, A Population-
Based Study of Sexual Orientation Identity and Gender
Dierences in Adult Health, American Journal of Public
Health, 100, 10, (2010):1953-1960.

MIHHeaIlhIoIicyIubIicalion
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areIivingvilhHIV

Whenlransgender
individuaIsresonsesverecalegorized
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LalinoandAmericanIndianlransgender
individuaIsreorledhigherralesofHIV
andresecliveIy

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ercenlareIivingvilhHIVThissame
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haveSTIs

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lolherevasaercenlincrease
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redominanlIyamongyoungMSM
andmoslnolabIyamongyoungAfrican
AmericanMSM

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SexuaIminoriliesreorlhigherralesof
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increasesonesriskofIiverdamage

HeaIlhfaclorssuchassociaIandeconomicinuenceshavebeenfoundloimaclbolh
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suicidebulexeriencesofsligmaanddiscriminalionareassocialedvilhderessionand
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eersaccordingloasludy

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AmericansaremoslIikeIyloexeriencesychoIogicaIdislressandresecliveIy

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lhanLGcommunilymembersandnonLGTindividuaIs

Asludy
foundlhalercenlofgaymenhadaemledsuicidecomaredloercenloflheir
helerosexuaIcounlerarlsAddilionaIIyercenlofgaymenhadmadeasuicideIan
HIV Infection Among Trans Population,
By Race, Compared to U.S. General
Population
26
0.60%
0% 5% 10% 15% 20% 25%
Multiracial
White
Latino/a
Black
Asian
American Indian
U.S. General Population
2.64%
7.04%
24.90%
10.92%
0.78%
3.52%
JM Grant et al., Injustice at Every Turn: A Report of the
National Transgender Discrimination Survey, National
Center for Transgender Equality & National Gay and
Lesbian Task Force, 2011.

MissouriIoundalionforHeaIlhIubIicalion
accordinglolhesamesludy

RiskofsuicideishigheslamongyoulharlicuIarIyvhenlhey
idenlifyasgayIesbianorbisexuaIyelremaincIoseledlofamiIyorfriends
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unvanledorunaordabIeTheserequiremenlscanbeburdensomeandrevenllransgender
individuaIsfromhavingdocumenlslhalcorresondlolheirgenderidenliliesIdenlicalion
documenlsarerequiredlooenabankaccounlbeginanev|oblraveIandinsomecasesvole

MissouriIoundalionforHeaIlhIubIicalion
andurchasecoIdmedicineInaccuraleidenlicaliondocumenlscanmakeindividuaIsmore
vuInerabIelodiscriminalioninheaIlhcareandemIoymenlseings

asedonrecommendalions
fromlheWorIdIrofessionaIAssocialionforTransgenderHeaIlhlheUSDearlmenlofSlale
announcedinlhalsexuaIreassignmenlsurgeryvouIdnoIongerbearequiremenlfor
changinglhegendermarkeronaUSassorl

InIaceoflhesurgeryrequiremenlindividuaIs
seekinglochangelhegendermarkermuslresenlcerlicalionfromahysicianslalinglhallhe
ersonhascomIeledcIinicaIlrealmenlforgenderlransilionIflheindividuaIisinlherocessof
lransilioningarequeslmaybemadeforaIimiledvaIidilyassorl

VictimizatinnandDiscriminatinnLaws
ThirleenslalesandlheDislriclofCoIumbiahavehalecrimeIavslhalcoversexuaIorienlalion
andgenderidenlilyMissouriisoneoflhoseslalesWhiIeLGTindividuaIsareincIudedin
halecrimeroleclionslheyarenolrolecledfromdiscriminalioninhousingemIoymenland
ubIicservicesInMissourinoIavroleclsindividuaIsfromIosinga|obbecauselheyidenlify
asLGTorareerceivedlobeLGTSevenciliesinMissourihavelheirovnIocaIordinances
loroleclSGMfromemIoymenlandhousingdiscriminalion

Law covers sexual orientation and gender

identity
Law covers only sexual orientation
Law does not cover sexual orientation and
gender identity
No law
Movement Advancement Project, 2012.
Hate Crime Laws Employment Non-Discrimination Laws
Housing Non-Discrimination Laws

MIHHeaIlhIoIicyIubIicalion
5aIc5chnn!sLaws
IneducalionaIseingsLGTsludenlsarenolIisled
asagrourolecledfrombuIIyingMissouriLGT
sludenlslhoughlheyexeriencehigherlhannalionaI
averageralesofhysicaIassauIlbecauseofacluaI
orerceivedsexuaIorienlalioncannolexecllobe
rolecledinschooIseings

Infaclinrecenlyears
someslalebiIIshavebeenroosedlocurbleachers
abiIilylosuorlorseakaboulsexuaIorienlalion
sexuaIilyorgenderidenlilyinanyscenariooulside
helerosexuaIrocrealionSuchabiIIvasinlroducedin
MissouriHroosinglobananyinslruclion
maleriaIsorexlracurricuIaraclivilieslhaldiscuss
sexuaIorienlalionMorelhanercenlofLGTyoulh
reorledschooIbuIIyingaslhegrealeslrobIemin
lheirIivesandanolherercenlofyoulhexressed
lhalnonaccelingfamiIiesverelhemosllroubIing
robIemfacinglhem

Lavslhalrohibilleachersfrom
discussingsexuaIorienlalionvhenasludenlisbuIIied
andlhalbansuorliveexlracurricuIaraclivilies
mayremoveroleclivefaclorslhalromolesludenls
menlaIandhysicaIheaIlh
MarriagcandRc!atinnshipRccngnitinn
SamesexcouIescannolIegaIIymarryinMissouri
Iurlhermorelheslaledoesnolrecognizesamesex
marriagesfromolher|urisdiclionsInMissouriassedaslalulesecifyinglhalil
vouIdrecognizeonIymarriagesbelveenamanandavomanslalingexIicilIylhalildoes
nolrecognizemarriagebelveenersonsoflhesamesexTheMissouriconslilulionvas
amendedinloslalelhesame

WhiIelhereisnoslaleviderecognilionofsamesex
couIesreIalionshisseveraIcilieshaveassedIocaIdomeslicarlnerregislrieslhalaIIov
samesexcouIesloregislerinorderloquaIifyforcerlainbenelssuchasdomeslicarlner
heaIlhcoverage

Marriage equality for same-sex couples

Comprehensive civil union or domestic
partnership law
Out-of-state marriages recognized, but
same-sex couples may not marry in-state
Limited relationship recognitionlaw
No legal recognition for same-sex couples
Movement Advancement Project, 2012.
Local Nondiscrimination
Policies
Missouri cities and counties with
nondiscrimination ordinances
covering employment, housing and
public accommodations for LGBT
individuals:
Clayton
Columbia
Kansas City
Kirksville (housing only)
Olivette
Richmond Heights
St. Louis City
Unincorporated Jackson County
University City
Missouri cities with domestic partner
registries:
Clayton
Columbia
Kansas City
Olivette
St. Louis City
University City
PROMO, 2012
Relationship Recognition Laws

MissouriIoundalionforHeaIlhIubIicalion
AdnptinnLaws
SingIeLGTaduIlsareermiedloadol
chiIdreninMissouriasslaleIavsecies
lhalanyaduIlcanelilionloadolSame
sexcouIeshoveverarenolermied
underslaleIavlo|oinlIyadol
Recommended Policies
ThisseclionviIIrevievfederaIslaleand
IocaIoIicyrecommendalionslhalcan
romoleheaIlhequily
5ncia!andEcnnnmicFactnrs
LackofaccessloheaIlhcoverageandcare
oorercIinicaIcareandIimiledrevenlion
rogramsareaIIimacledbysociaIand
economicfaclorsMembersofLGT
communilieshaveoorerheaIlhoulcomes
duelominorilyslressfromsyslemic
discriminalionTheidenliliesandrighls
ofSGMarereguIarIydebaledinIegisIalive
sessionsYoungeoIereorlhearing
frequenldiscriminaloryremarksinschooIs
SGMexeriencehighralesofvioIenceand
viclimizalionbasedonlheiridenlilies
IquaImarriagerighlsequaIemIoymenl
oorluniliesandequaIhousingoIicies
arenonexislenlinmanyslalesandregions
ThesefaclorsgrealIyimacllhemenlaI
andhysicaIheaIlhofLGTindividuaIs
IoIicyolionslhalcanimroveheaIlh
andreducedisariliesfacedbyLGT
communiliesincIudesociaIandeconomic
faclorssuchasreIalionshirecognilionand
nondiscriminalionroleclionsTheseare
inexlricabIyIinkedloheaIlhoulcomes
AcccsstnCarc
WhenindividuaIsdonolhaveaccesslo
heaIlhinsurancelheyaremoreIikeIylo
deIayneededrevenlionandcareThe
AordabIeCareAclACAaIIovsslales
loexandMedicaidaccessloindividuaIs
vilhincomesalorbeIovercenlof
lhefederaIoverlyIineAddilionaIIymosl
eoIeinlheUSviIIberequiredin
lohaveheaIlhinsuranceorayaenaIly
Recommended Policies
Access to Care
Public insurance programs
include transition-related care.
Public insurance programs
reach out to enroll LGBT
Missourians.
Legal recognition of same-sex
relationships.
Employer recognition of same-
sex relationships.
Employer non-discrimination
policies include sexual orientation
and gender identity.
Domestic partner insurance
coverage required of employers
oering health insurance plans.
End taxation of domestic
partner insurance coverage.

MIHHeaIlhIoIicyIubIicalion
TheexansionofheaIlhcoveragehaslhe
olenliaIloimaclMissouriansheaIlhin
osilivevaysbuladdilionaIoIicychanges
areneededlomakeheaIlhinsuranceaccess
moreequilabIeforLGTcommunilies
IubIicinsurancerogramsandmoslrivale
insurersdonolcoverlransilionreIaledcare
forlransgenderindividuaIsWhiIemany
lransgenderAmericansmayquaIifyfor
ubIicinsurancelheseindividuaIssliIIhave
loayoulofockelcoslsfornecessary
lransilioncareIncIudinglransilioncare
inubIicinsuranceIansandcomIeling
oulreachloindividuaIsvhoareeIigibIefor
MedicaidandMedicareviIIheIloensure
lhalLGTAmericanshavelhecoverageand
carelheyneed
MoslAmericanshaveheaIlhcoverage
lhroughemIoyersonsoredinsurance
LGTAmericansareIessIikeIylobe
insured

andmoreIikeIyloquaIifyfor
ubIicinsurance

WilhoulemIoymenl
roleclionsforsexuaIorienlalionand
genderidenlilyLGTAmericansand
lhosevilhnonslandardgenderexression
regardIessofsexuaIorienlalionexerience
higherralesofunemIoymenland
underemIoymenl

UnemIoymenland
underemIoymenlimaclanindividuaIs
abiIilyloaccessnecessaryheaIlhservices
ToeIiminaledisariliesinaccessand
coveragebusinessesmuslroleclvorkers
basedonsexuaIorienlaliongenderidenlily
andgenderexression
IquaImarriagerighlsandIegaIrecognilion
ofdomeslicarlnerreIalionshislhrough
domeslicarlnerregislriesareimorlanl
slesingainingaccessloemIoyer
sonsoredheaIlhcoverageforLGT
MissouriansandlheirarlnersIighlynine
ercenlofIorlunecomaniesoer
domeslicarlnerheaIlhinsuranceand
ercenloerlransgenderincIusiveheaIlh
coverageIans

InasurveyoflheIargesl
Recommended Policies
Clinical Care
Patients Bill of Rights include
sexual orientation, gender
identity, and gender expression.
Non-discrimination policies
include sexual orientation, gender
identity, and gender expression.
Visitation policies explicitly
include same-sex couples and
parents in denition of family.
Cultural Competency trainings
offered to staff and medical
students include LGBT health
care issues.
Intake forms include sexual
orientation and gender identity.
Oce environments are LGBT
inclusive and arming.

MissouriIoundalionforHeaIlhIubIicalion
IorlunecomaniesandIargesl
federaIgovernmenlconlraclorsercenl
slaledlhaldiversilyoIiciesandgenerous
benelackagesveregoodforlheir
businessesMorelhanhaIfoflhose
surveyedslaledlhallheirboomIinesvere
imrovedbyrohibilingdiscriminalion
basedonsexuaIorienlalionandgender
idenlilyandbyoeringdomeslicarlner
benelslolheiremIoyees

UnderlheACAsmaIIbusinessesareabIe
lhroughalaxcredillooeremIoyer
sonsoredheaIlhcoveragelolheir
emIoyeesAsmoresmaIIbusinessesare
oeringcoverageilisimorlanllhallhey
exlendlherighllocoverageloaIIemIoyees
andlheirfamiIiesincIudinglhosevilh
domeslicarlners
CurrenlIyemIoyeesvilhinsuranceIans
coveringadomeslicarlnerarelaxedon
lhevaIueoflhecoverageIanmeaning
lhalsamesexcouIesearnIessincome
aerlaxeslhanhelerosexuaIcouIes
Thislaxcanbeadisincenlivelohaving
domeslicarlnercoverageIndinglhelax
ondomeslicarlnerinsurancecoverageviII
aIIovmoreMissouriansaccessloemIoyer
basedheaIlhcoverage
C!inica!Carc
DiscriminalioninheaIlhseingsdiscourages
alienlsfromseekingcareIoIIoving
discriminalionoruonIearningaboul
olhersnegaliveexeriencesLGTalienls
mayfearreealeddiscriminalionandrefrain
fromdiscussinglheirsexuaIorienlalionor
genderidenlilyvilhlheirmedicaIroviders
DeIayingcarecanhavenegaliveheaIlh
consequencesforLGTMissourians
MedicaIrovidersandheaIlhorganizalions
canrevenldiscriminalionbyimIemenling
incIusivenondiscriminalionoIicies
androvidingslalrainingoncuIluraI
comelencyandorganizalionaIoIicies
InorderforaIIMissouriansloreceive
Recommended Policies
Prevention
HIV prevention programs focus
on the whole person.
HIV treatment through
Medicaid is available prior to
disability from AIDS.
Recommended Policies
Health Behaviors
State and federally funded
programs are LGBT arming,
including substance abuse
treatment facilities, mental health
facilities, foster and juvenile justice
facilities, and homeless and
domestic violence shelters.
Health and human service
organizations implement non-
discrimination policies protecting
LGBT clients and sta.
Support clean air and tobacco
control policies.

MIHHeaIlhIoIicyIubIicalion
alienlcenleredcuIluraIIycomelenl
carenondiscriminalionoIiciesmusl
incIudesexuaIorienlaliongenderidenlily
andgenderexression
On}anuaryand}uIyequaI
visilalionrighlsforLGTfamiIiesvenlinlo
eeclinhosilaIsarlicialinginMedicaid
andMedicareandlhoseaccrediledbylhe
}oinlCommissionresecliveIyAccording
lolhesereguIalionshosilaIsareexecled
loaIIovalienlsloseIecllheirvisilors
AddilionaIIyvisilaliondiscriminalion
basedonsexuaIorienlalionandgender
idenlilyisnolermied
InaneorllodecreasevariabiIilyinhov
slamembersinlerrelrequiremenls
hosilaIsareeIeclingloamendlheir
visilalionoIiciesloexIicilIyincIudesame
sexcouIesandarenlsinlhedenilion
offamiIyVisilalionoIicieslhalexIicilIy
incIudesamesexfamiIiesdecreaselhe
IikeIihoodlhalslabiasesviIIimacl
famiIiesrighlslovisillheirIovedones
receivingcare
InsuringlhalslamembersarecuIluraIIy
comelenlinlheirraclicesiscrilicaIlo
reducingdisariliesincIinicaIcarefor
LGTcommunilymembersThiscanbe
accomIishedbyrequiringlhalaIIsla
arlicialeincuIluraIcomelencylrainings
lhalincIudeLGTheaIlhcareissues
ToheIalienlsfeeIveIcomedinmedicaI
seingsilisimorlanllhalocemaleriaIs
anddisIaysincIudeindividuaIsand
famiIiesfromdiversebackgrounds
incIudingSGMInlakeformslhalincIude
sexuaIorienlalionandgenderidenlily
areaIsoimorlanlinensuringlhaloce
environmenlsarearmingandincIusive
loaIIalienls
Prcvcntinn
IubIicheaIlhrevenlionslralegieslargeling
behavioraIchangecanIayasignicanl
Recommended Policies
Health Outcomes
Collect demographic data for
LGBT populations.
Voluntary HIV/AIDS and STI
screenings are mandatory
services covered by Medicaid for
ages 13+.
Employment non-discrimination
policies include sexual orientation
and gender identity.
School anti-bullying policies
protect against bullying based on
sexual orientation, gender identity,
and gender expression.
School district anti-harassment
and non-discrimination
policies protect LGBT students,
teachers, and their allies.
Domestic partner relationships
are granted equal marriage
rights and legal recognition.
Housing non-discrimination
policies protect on the basis
of sexual orientation, gender
identity, and gender expression.

MissouriIoundalionforHeaIlhIubIicalion
roIeineducalingLGTcommunilymembersabouldisariliesinsmokingandsubslanceuse
anddisariliesinriskybehaviorsIducalioncanIayaroIeinrevenlionhovevervilhoul
largelingslrucluraIinequaIiliesandsyslemicdiscriminalionLGTcommuniliesviIIconlinue
lofacedisaraleIeveIsofiIInessresuIlingfromslressandunheaIlhycoingbehaviors
CIiniciansinHIVrevenlionhavefoundlhalvhenrevenlioneorlsfocussoIeIyonnegalive
behaviorsegfaiIurelousecondomsfaiIurelolesllheyIimillheiraudienceandare
Iesseeclive

SlralegieslhalromiselobemoreeeclivefocusonindividuaIsslrenglhs
IromolingmorelhanHIVrevenlionlheseslrenglhbasedaroachesemhasizelhe
imorlanceofinlimacyandheaIlhysexuaIreIalionshisTheyfocusonlhevhoIeerson
ralherlhanonlhedisease
SomeHIVrevenlionrogramsareIimiledinlheiraroachesduelofederaIrequiremenls
lhalnosexuaIorienlalionorbehaviorberomoledinHIVrevenlionrogramslhalreceive
federaIfundingLavslhalIimilHIVeducalionlodiseasecenlricnegalivebehaviorfocused
melhodsaIsoIimilrogramsabiIilyloreseclindividuaIsandcrealeIaslingchangeIor
revenlionrogramslobemosleeclivelheymuslbeermiedloemhasizelhevhoIe
ersonaddressreIalionshisandinlimacyandromoleheaIlhysexuaIily
IoIiciesromolingearIylrealmenlcoverageofHIVheIloIoverviraIIoadslherebyreducing
lhenumberofnevinfeclionsandimrovinglhequaIilyofIifeforeoIeaIreadyIivingvilh
HIVCurrenlIyMedicaidcoverageisnolavaiIabIeforchiIdIessaduIlsIivingvilhHIVunliIlhey
quaIifyforSuIemenlaISecurilyIncomevhichisgranledlolhoseIivingvilhdisabiIilies

WhenchiIdIessaduIlsvhohaveHIVbulhavenolyelrogressedloAIDSaregivenaccess
loMedicaidforlrealmenlilaIIovslheseindividuaIsearIieraccessloinlervenlionIarIier
inlervenlionsincreasesavingsandslrelchIimiledresourcesenabIingmoreaduIlsIivingvilh
HIVAIDSloreceivecare
Hca!thBchavinrs
DisariliesreIaledlosmokingandsubslanceusedisorderedealingandsuicidaIidealion
havebeenIinkedloslresscausedbysyslemicdiscriminalionandslrucluraIinequaIiliesin
asocielyIndividuaIsIookingloaIlerlheirbehaviorssomelimesarereferredlosubslance
abuselrealmenlormenlaIheaIlhfaciIiliesIaciIilieslhalaremeanllobelheraeulicsafe
andrehabiIilalivecanbeunsafeIacesforSGMWhenlherearenooIiciesandrocedures
ensuringlhalorganizalionsroleclLGTersonsindividuaIsseekingsuorlandlrealmenl
mayfacediscriminalionandviclimizalionfromolhercIienlsandslaHeaIlhandhuman
serviceorganizalionscanheIensurelhallheirfaciIiliesarearmingbyimIemenlingnon
discriminalionoIiciesrequiringslalrainingincuIluraIcomelencyvilhLGTouIalions
andcrealingveIcomingenvironmenlsforaIIcIienls
Hca!thOutcnmcs
WhiIeIocaIandnalionaIsurveyshavedocumenleddisaraleheaIlhoulcomesforLGT
individuaIsaddilionaIresearchisneededlobeercommunicalelheheaIlhneedsand
resiIienciesofLGTindividuaIsacrosslhecounlryTodalenonalionaIIyreresenlalive
randomsurveyhasbeenconducledloexamineLGTheaIlhdisariliesallhenalionaIIeveI
ToincreaseunderslandingofandfundingforLGTheaIlhequilyheaIlhsurveysandheaIlh
rovidersmuslbeginlocoIIecldemograhicdalaonsexuaIorienlaliongenderidenlilyrace
andelhnicilygeograhicIocalionandsocioeconomicslalusvhenconduclingheaIlhsurveys

MIHHeaIlhIoIicyIubIicalion
ThehigheslincreasesinHIVinfeclionralesareamongyoungAfricanAmericangayand
bisexuaImenandlransgendervomenofcoIorThisisarlicuIarIylrueamongyoungaduIls
agesyearsSomeoIicieslodecreasedisariliesinHIVlransmissionamongyounggay
andbisexuaImaIesrecommendlhalvoIunlaryscreeningsforHIVAIDSandolherSTIsshouId
becoveredbyMedicaidforaIIaduIlsagesandoIder

IoorheaIlhoulcomesresuIlingfromre|udiceunequaIaccesslocareemIoymenlandhousing
discriminalionandincomeinequaIiliescanbeaddressedlhroughsociaIandeconomicoIicies
lhalromoleequaIrighlsandroleclionsforSGMIquaIroleclionsfromdiscriminalion
harassmenlandbuIIyingareneededinMissourisschooIsbusinesseshousingandubIic
sacesTherighllomarryandlherighlloIegaIrecognilionofdomeslicarlnerreIalionshis
romiseloimrovemenlaIheaIlhoulcomesandreducedisarilies
Conclusion
AsLGTheaIlhresearchrogresseslheevidenceofdisaraleheaIlhoulcomesamongLGT
communilymembersisconvincingIxislingsludiesdemonslralelhalLGTheaIlhdisarilies
slemfrom
dierencesinaccessloheaIlhcoverage
aIackofcuIluraIcomelence
Iimiledaccessloanduseofrevenlivecare
unheaIlhybehaviorsand
sociaIandeconomicsyslemslhaldonolsuorlandroleclindividuaIs
OorluniliesexislforoIicieslobeerroleclandromolelheheaIlhandveIIbeingofaII
MissouriansregardIessoflheirsexuaIorienlalionorgenderidenlilyThisaerrecommends
oIiciesloaddresslhedelerminingfaclorsofheaIlhdisariliesalmuIliIeIeveIsThechaIIenge
remainsforschooIsmedicaIrovidersemIoyersandubIicagenciesloacknovIedge
lheresenceofLGTindividuaIsinourcommuniliesandloaddresslhefaclorslhalare
conlribulinglolheirheaIlhneeds

MissouriIoundalionforHeaIlhIubIicalion
Endnotes
}KreheIyHovloCIoselheLGTHeaIlhDisariliesGaCenlerforAmericanIrogress
K}ConronM}MimiagaS}LandersAIouIalionasedSludyofSexuaIOrienlalionIdenlilyandGenderDierencesin
AduIlHeaIlhAmerican}ournaIofIubIicHeaIlh
InsliluleofMedicineIOMTheHeaIlhofLesbianGayisexuaIandTransgenderIeoIeuiIdingaIoundalionforeer
UnderslandingTheNalionaIAcademiesIress
MarkerGayandLesbianHeaIlhDisariliesIvidenceandRecommendalionsforIIiminalion}ournaIofHeaIlh
DisariliesResearchandIraclice
}McIIroyKIvereOulIroudandHeaIlhyIro|eclSGMHeaIlhehaviorsandAccessloCareIoverIoinl
resenlalionAriI
RoberlGrahamCenlerIoIicySludiesinIamiIyMedicineandIrimaryCareIrimaryCareIhysiciansbySlaleRoberl
GrahamCenlerSelember
GLMAIroviderDirecloryMissouriAvaiIabIealhsgImaimaknelvorkalscommembersonIinenevmembers
dirrovideras
SnasholAdvancingTransgenderIquaIilyMAI
ISGehiGArkIesUnraveIingIn|usliceRaceandCIassImaclofMedicaidIxcIusionsofTransilionReIaledHeaIlhCare
forTransgenderIeoIeSexuaIilyResearchandSociaIIoIicy}ournaIofNSRCDecember
TheHenry}KaiserIamiIyIoundalionInsideOUTAReorlonlheIxeriencesofLesbiansGaysandisexuaIsin
AmericaandlheIubIicsVievsonIssuesandIoIiciesReIaledloSexuaIOrienlalion
ADeIIercioIdiledbyIKahnTSuIIivanHeaIlhcareIquaIilyIndexSurveyCrealingaNalionaISlandardfor
IquaITrealmenlofLesbianGayisexuaIandTransgenderIalienlsandTheirIamiIiesHumanRighlsCamaignIamiIy
IoundalionIro|ecl
}ObedinMaIiverelaILesbianGayisexuaIandTransgenderReIaledConlenlinUndergradualeMedicaIIducalion
}AMAThe}ournaIoflheAmericanMedicaIAssocialion
RAbeIdaelaIIoverlyinlheLesbianGayandisexuaICommunilyTheWiIIiamsInslilule
CenlerforAmericanIrogressIamiIyIquaIilyCounciIMovemenlAdvancemenlIro|eclAIIChiIdrenMaerHov
LegaIandSociaIInequaIiliesHurlLGTIamiIiesIxeculiveSummaryOclober
GayandLesbianMedicaIAssocialionGLMAToTenThingsTransgenderIersonsShouIdDiscussvilhlheirHeaIlhcare
Irovider
TheIULSILGTCommunilyHeaIlhAssessmenlKansasCilyMissouriCilyofKansasCily
VGThomasIxIainingHeaIlhDisarilieselveenAfricanAmericanandWhileIouIalionsWhereDoWeGoIrom
Here}ournaIoflheNalionaIMedicaIAssocialion
USDearlmenlofHeaIlhandHumanServicesDHHSIIiminalingHeaIlhDisariliesSlrenglheningDalaonRace
IlhnicilyandIrimaryLanguageinlheUniledSlalesDHHSNovember
HeaIlhIoIicyriefAchievingIquilyinHeaIlhHeaIlhAairsRoberlWood}ohnsonIoundalionOclober
OCarlerIokrasCaquelWhalisaHeaIlhDisarilyIubIicHeaIlhReorlsSelemberOclober
}KreheIyHovloCIoselheLGTHeaIlhDisariliesGaDisariliesbyRaceandIlhnicilyCenlerforAmerican
Irogress
DHHSNegolialedRuIemakingCommieeonlheDesignalionofMedicaIIyUnderservedIouIalionsandHeaIlh
IrofessionaIShorlageAreasDHHSOclober
SSSicerHeaIlhcareneedsoflhelransgenderhomeIessouIalion}ournaIofGayLesbianMenlaIHeaIlh

AmericanIsychialricAssocialionDiagnoslicandslalislicaImanuaIofmenlaIdisorderslhedlexlrev
CV}ohnsonM}Mimiaga}radfordHeaIlhcareissuesamongIesbiangaybisexuaIlransgenderandinlersexLGTI
ouIalionsinlheUniledSlalesInlroduclion}ournaIofHomosexuaIily

MIHHeaIlhIoIicyIubIicalion
}MGranlelaIIn|uslicealIveryTurnAReorloflheNalionaITransgenderDiscriminalionSurveyNalionaICenlerfor
TransgenderIquaIilyNalionaIGayandLesbianTaskIorce
KSheIlonIADeIgadoRomeroSexuaIOrienlalionMicroaggressionsTheIxerienceofLesbianGayisexuaIand
QueerCIienlsinIsycholheray}ournaIofCounseIingIsychoIogy
}LubsenMenlaIHeaIlhDisariliesImaclinglheLGTCommunilyIoverIoinlresenlalionIebruary
The}oinlCommissionAdvancingIecliveCommunicalionCuIluraIComelenceandIalienlandIamiIyCenleredCare
forlheLesbianGayisexuaIandTransgenderLGTCommunilyAIieIdGuideOclober
LKeIIeyelaIACrilicaIInlervenlioninLesbianGayisexuaIandTransgenderHeaIlhKnovIedgeandAilude
OulcomesamongSecondYearMedicaISludenlsTeachingandLearninginMedicine
HLCorIissMDShankIeMMoyerResearchCurricuIaandResourcesReIaledloLesbianGayisexuaIand
TransgenderHeaIlhinUSSchooIsofIubIicHeaIlhAmerican}ournaIofIubIicHeaIlh
GLMAToTenThingsLesbiansShouIdDiscussvilhlheirHeaIlhcareIrovider
HeaIlhResourcesandServicesAdminislralionMalernaIandChiIdHeaIlhureauWomensHeaIlhUSADHHS

GLMAToTenThingsGayMenShouIdDiscussvilhlheirHeaIlhcareIrovider
RoberlWood}ohnsonIoundalionRW}ICounlyHeaIlhRankingsandRoadmas
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