Dispari(cid:415) es and Inequali(cid:415) es Lesbian, Gay, Bisexual, Transgender (LGBT) Health in Rural Missouri The acronym LGBT refers to lesbians, gay men, bisexual Factors such as economic and social infl uences have women/men, transgender persons, and individuals who an eff ect on the physical and mental health of LGBT do not conform to gender iden(cid:415) ty norms (LGBT includes individuals. This has the poten(cid:415) al to lead to social these popula(cid:415) on groups but is not exclusive to these isola(cid:415) on, psychological distress, anxiety, depression, low groups). Each individual in the LGBT community presents self-esteem and the physical ailments associated with its own unique health concerns.6 LGBT individuals a poor mental health status. The amount of individuals experience poorer health outcomes than their peers who iden(cid:415) fy as gay or lesbian are twice as likely not to in the general popula(cid:415) on. LGBT health dispari(cid:415) es are a have healthcare coverage in rural Missouri than urban; result of several diff erent factors including the infl uence of transgender individuals in rural areas are threee (cid:415) mes s(cid:415) gma and systema(cid:415) c discrimina(cid:415) on; limited availability more likely not to have coverage (Figure 1).2 Same-sex of culturally profi cient health care access and diff eren(cid:415) al couples are more likely to live below the federal poverty access to health insurance coverage.6 These poor level, specifi cally same-sex couples in rural areas of the outcomes combined with the inadequate health care state (Figure 2).6 access of many rural areas results in signifi cant health inequali(cid:415) es for LGBT individuals in rural Missouri.4,6 Figure 1. Percent of People with No Health Care Coverage by Sexual Orientation/Identity and Geography, 20112 Figure 2. Percent of Poor Households by Sexual Orientation in Urban and Rural Missouri, 20096 2 Transgender Care LGBT and HIV/AIDS • 16.3% percent of transgender people in Missouri • The majority of new HIV cases among males in did not receive needed medical care in rural areas Missouri are a(cid:425) ributed to men who have sex with compared with 10% in urban areas.2 men (MSM).1 • The majority of health insurers do not cover trans- • There were 485 newly diagnosed HIV cases (male and specifi c care; including Medicaid, Medicare and female) in Missouri in 2014. Of those, 404 were men Veteran plans.6 and 301 were reported as MSM.3 • Trans-specifi c care includes hormone treatments, sex • In 2014, 62.1% of all HIV cases (male and female) or gender reassignment surgeries and care related to newly diagnosed in 2014 were transmi(cid:425) ed through the transi(cid:415) on.6 MSM, 3.9% through MSM and injec(cid:415) on drugs, and 2.1% through injec(cid:415) on drugs.3 • Missouri is one of 22 states that explicitly excludes transi(cid:415) on-related care on Medicaid.6 • 74.5% of new male HIV cases in Missouri were transmi(cid:425) ed through MSM, 4.7% from MSM and • As of January 2016, 20% of rural Missourians were injec(cid:415) on drugs, and 2.5% from injec(cid:415) on drugs.3 listed as being on Medicaid.6 • The map in Figure 3 displays the geographical • Without sex reassignment surgery, transgender distribu(cid:415) on of the propor(cid:415) on of men living with HIV individuals in Missouri cannot legally change the that reported MSM as the mode of transmission, gender on their birth cer(cid:415) fi cate or license. 7 2014.3 • Transgender individuals o(cid:332) en a(cid:425) empt unconven(cid:415) onal • The percent of living HIV cases through MSM care due to lack of coverage, increasing the chances of transmission by race/ethnicity and geographical area addi(cid:415) onal health concerns.6 is depicted in Figure 4.1. Figure 3. Proportion of Men Living with HIV that Reported MSM as Mode of Transmission, 20143 *Excludes persons most recently diagnosed in Missouri correc(cid:415) onal facili(cid:415) es 3 Figure 4. Living HIV Cases in Men who Have Sex with Men, by Race/ Ethnicity and Geographic Area, 2014 1 LGBT Health & Patient Rights • LGBT status is signifi cantly underreported in Missouri, • LGBTs in Missouri are more than twice as likely to do limi(cid:415) ng available data; especially when comparing without surgery or medical care when needed for rural vs urban areas of the state.6,2 fear of bias and discrimina(cid:415) on.6 • The percent of LGBT individuals who did not receive • Informing providers of one’s sexual orienta(cid:415) on needed medical care due to cost or lack of insurance and/or gender iden(cid:415) ty can assist in diagnosis and was higher in rural areas compared with urban.2 treatment of certain illnesses.6 4 Sources 1Missouri Department of Health and Senior Services. 2014 Epidemiological Profi les of HIV, STD, and Hepa(cid:415) (cid:415) s in Missouri. Accessed March 16, 2016 at h(cid:425) p://health.mo.gov/data/hivstdaids/pdf/MOHIVSTD2014.pdf. 2Missouri Department of Health and Senior Services. 2011 County Level Study. Special Report; Arthur Pashi DHSS. 3Missouri Department of Health and Senior Services. Bureau of Reportable Disease Informa(cid:415) cs: enhanced HIV/AIDS Repor(cid:415) ng System (eHARS). Reported February 28, 2015. 4Missouri Department of Health and Senior Services. Health in Rural Missouri: Biennial Report, 2014-2015. Accesses March 15, 2016. 5Missouri Department of Health and Senior Services. MICA: Medicaid Records. Accessed March 17, 2016 at h(cid:425) p:// health.mo.gov/data/mica/MICA/. 6Missouri Founda(cid:415) on for Health . Health Equity Series: Responding to LGBT Health Dispari(cid:415) es, August 2012. Accessed Match 15, 2016 at h(cid:425) ps://www.m(cid:301) .org/mm/fi les/LGBTHealthEquityReport.pdf. 7Na(cid:415) onal Center for Transgender Equality. Missouri. Accessed April 4, 2016 at h(cid:425) p://www.transequality.org/documents/ state/missouri. 8PROMO. LGBT Health. Accessed April 4, 2016 at h(cid:425) ps://promoonline.org/lgbt-health.html. MMiissssoouurrii OOffifficcee ooff PPrriimmaarryy CCaarree && RRuurraall HHeeaalltthh OOrraall HHeeaalltthh RRuurraall HHeeaalltthh PPrriimmaarryy CCaarree Missouri Department of Health and Senior Services Offi ce of Primary Care and Rural Health P. O. Box 570 Jeff erson City, MO 65102-0570 573.751.6219 health.mo.gov Alternate forms of this publica(cid:415) on for persons with disabili(cid:415) es may be obtained by contac(cid:415) ng the Missouri Department of Health and Senior Services, Offi ce of Primary Care and Rural Health, P.O. Box 570, Jeff erson City, MO 65102, 573.751.6219. Hearing- and speech-impaired ci(cid:415) zens can dial 711. AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis. 5