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Equal Care for Equal Lives

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Billy Thomas, MD, MPH, Vice Chancellor for Diversity & Professor of Pediatrics

Last month I attended the 3rd Annual Equal Care for Equal Lives: An LGBTQ- Inclusive Health Care Conference. The theme this year was LGTBQ throughout the Ages. The conference took a Life-course approach in examining the specific needs of LGTBQ people of all ages – childhood/adolescence, early/middle adulthood and later adulthood (IOM report). It was very well organized thanks to the excellent leadership of Kendra Johnson who, unfortunately, will be leaving to take the position of Executive Director of Equality NC in Raleigh, North Carolina. Given the very recent issues in North Carolina, along with the passage of House Bill 2, it will be a challenge but I’m sure she is equal to the task.

This year’s conference felt different. Not only was it well attended but the atmosphere was warm, collegial, inclusive, friendly and informative. It was just plain fun.  Walking around, I recognized many familiar faces but there were several new faces in the crowd. The only thing I regret is, I was unable to attend every session. One of the more optimistic and promising sessions was on HIV and Pre-exposure prophylaxis or PrEP targeting patients at high risk for HIV. Basically patients take a daily combination (Truvada) of two HIV medications to reduce their chances of getting infected. Based on data presented in the workshop and a very brief look at the literature, when used as prescribed PrEP is very effective in preventing HIV. However, as is the case with many therapies, awareness, availability and access to medication is an issue. In addition a PrEP Provider Tool Kit was also introduced during the workshop. The toolkit is designed and produced by the Human Rights Campaign (HRC). The overall intent is to educate patients and providers about the availability and effectiveness of PrEP.  It not only contains a very clear treatment algorithm but also billing and coding information for PrEP visits. It is a very promising therapy and has the potential to greatly reduce the overall HIV infection rates in high risk populations.

One of the keynote speakers was Dr. Joycelyn Elders, former US Surgeon General.  Although I have heard her speak on many occasions, I’m still in awe.  She never ceases to amaze me. Her talks are always fresh, on point, filled with data, sincere and humorous. The title of her talk was “The Quest for Inclusive Sexual Education in the Age of Health Equity”. In holding true to the format of the conference she took a Life Course approach. As I listened to her discuss normal sexual development including masturbation, the need for early sexual education, teen pregnancy and condom use and the high rate of HIV infection in the older patient population, my thoughts were, I can only hope to be half as sharp, clear and enthusiastic as I age. The data she presented was up to date and told the story of an LGBTQ population that makes up about 4-5% of the US population of 333 million.  She highlighted the very high incidence of health disparities across the entire life course of LGBTQ people. Part of her closing statement was “we are all sexual beings and remain so until we die”. This is true and highlights the need for early intervention and education on normal sexual development and healthy sex. This will go a long way towards reducing health disparities in marginalized population like LGBTQ people. She also stated that many people report having their best sex after age 70. So, I have a lot to look forward to!

Lastly I think the only part of the conference that bothers me is the low number of sponsors. Although we have made significant progress over the past 7 or 8 years we still have a long way to go. UAMS is now a Health Equity Index Leader and we have a solid Transgender Clinic that is expanding. My disappointment extends beyond UAMS to the community. As mentioned about 4-5% (probably an underestimation) of the US population identify as LGBTQ. That is a significant number. As highlighted in the IOM report, LGBTQ people suffer the worse health and health care disparities in the US. A recurring theme throughout the entire conference was the extremely important role of support systems in the LGBTQ community as one comes out or transitions.  We not only need the support of families but also local businesses, community organization, foundations, members of the academe, academic institutions, local churches and a legislature that recognizes the social, moral and economic benefit of a universally healthy population. We cannot simply ignore such a large segment of the population. We must be inclusive and provide targeted health care to a population that continuously faces marginalization, isolation, discrimination, physical and mental abuse. All lives are interconnected and the lives of LGBTQ people are interwoven throughout society.

Best wishes to Kendra Johnson!

 

The Health of Lesbian, Gay, Bisexual, and Transgender People. Building a Foundation for Better Understanding. Institute of Medicine. National Academies Press. National academy of Sciences. 2011.