Even though LGBTQ+ Americans have made social and legal gains in recent years, health disparities have persisted and continue to undermine LGBTQ+ well-being. Perhaps most prominent among health disparities is the ever-present shadow of HIV/AIDS across all LGBTQ+ communities, and especially in the lives of LGBTQ+ persons of color and young men. In addition to the risks posed by HIV/AIDS and other STIs, LGBTQ+ people are more likely to attempt or complete suicide; transgender women have the highest rates of suicidal ideation/attempts in the country at around 40%. (APA.org, 2013; James, et al., 2016) From the APA, additional health disparities include:
As stated by the NIH, "eliminating [these and other] LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives." (Healthypeople.gov, 2018) This is particularly necessary, not only to make LGBTQ+ health more equitable, but also because reducing sex/gender stigmatization allows persons who identify as heterosexual and/or cisgender to explore their own sexuality and gender identity without fear of discrimination.
In order to increase equity, the NIH suggests:
The following videos provide additional context ranging from the most basic information to more advanced practice:
As with LGBTQ+ populations as a whole, transgender people continue to experience extreme health and healthcare disparities, even as access and medical services have improved. Transgender people are more likely than any other social group to experience psychological distress leading to suicidal ideation, with 40% having attempted suicide at least once in their lifetime (James, et al., 2016). This is an astoundingly high figure that grows even higher when compounded along intersectional lines; for instance, 54% of transgender people with disabilities report attempting suicide at least once, and 42% report being mistreated by health care providers (James, et al., 2016). Unsurprisingly, transgender people report chronic anxiety and stress, mostly resulting from cultural discrimination and transphobia, but also from experiencing high rates of economic instability and poverty (James, et al., 2016). Transgender people also deal with HIV/AIDS at a higher rate than other LGBTQ+ people; 19% of black transgender women live with HIV, higher than any other social group in the United States (James, et al., 2016).
In many ways, disparities among transgender populations can be combated by dealing with the sociocultural pressures that cause emotional and mental trauma across the lifespan. Additionally, providers should become knowledgeable as to transgender-specific healthcare needs such as: hormone replacement therapy, puberty-blocking hormones, surgeries, and counselling services. Providers should also strive for increased cultural competence, for instance, by finding ways to create electronic healthcare records that allow people to select multiple gender options.
As a biopsychosocial term, Intersex* describes populations with sex characteristics that vary in comparison to binary conceptualizations of female and male bodies (InterACTadvocates.org). Statistically, there are more intersex persons in the global population than transgender people, with roughly 1.7% of persons having intersex characteristics and .33% identifying as transgender (Intersexequality.com, 2013). However, similar to transgender populations, the data is skewed such that we cannot reliably know how many people exhibit intersex characteristics. This is particularly true because intersex anatomies have historically been erased by medical professionals who operated under the assumption that healthy infants should be either female or male in all regards, even if invasive cosmetic surgeries were necessary (UNFE.org). It is still common practice for intersex children to be made subject to invasive, life-altering surgeries for which they can provide no consent, and often resulting in "permanent infertility, pain, incontinence, loss of sexual sensation, and lifelong mental suffering, including depression" (UNFE.org).
The continuation of unnecessary (and dangerous) interventions adds to the number of health and healthcare disparities experienced by intersex persons. Additionally, lack of representation has resulted in poor data collection and a lack of information about psychosocial supports and social determinants. There are studies which suggest that surgery in infancy actually produces negative outcomes (Zhu, et al., 2012, Bennecke, et al., 2017). However, recent studies show that intersex people who receive preventative care relevant to physical or mental health rather than bodily anatomy report a higher QOL (Rapp, et al., 2018).
As such, medical practitioners should focus on combating the disparities and social determinants which result in low QOL. Primarily, these arise from binary conceptualizations about sex identity. However, they also include misconceptions about proper care during immediate neonatal care and care during early life. Researchers and practitioners should work to identify the many ways that sex and anatomy are expressed (not only in reference to internal and external genitalia, but also through brain chemistry, prenatal hormonal balances, postnatal hormone balances, genetics, and chromosomes).
*The MeSH heading for Intersex is Disorders of Sexual Development. Even though this term is widely accepted in biomedical research, it presents intersex characteristics as abormalities which need to be "fixed". In following with the guidelines set by intersex advocacy groups in the United States, this page uses Intersex when possible rather than DSD.
The following is a list of identified conditions that are associated with intersex identity. This list is adopted from the University of Michigan's C.S. Mott Children's Hospital:
We described various health and healthcare disparities for LGBTQ+ people as a whole in the first tab. However, many facets of LGBTQ+ health are intersectional, especially regarding sexuality and gender identity. However, just because sexual orientation and gender identity overlap, they do function as a single phenomenon; rather, the two operate interdependently, and for that reason, LGBTQ+ people are likely to experience a wide range of health disparities that are different for cisgender gay men and transgender gay men (this is only of many possible examples).
Providers should be cognizant to the intersections of LGBTQ+ identity. In order to this, it's important to establish healthcare spaces and services which are recognize the many facets of gender/sexual orientation. Electronic health records should be redesigned to include multiple genders as well as sexual orientations (Grass & Makadon, 2016). Providers, policy makers, and community organizers should also increase awareness towards LGBTQ+ people who do not identify as gay or lesbian. For instance, 39% of bisexual men and 33% of bisexual women report not disclosing their sexual orientation to a provider, as opposed to 13% of gay-identifying men and 10% of gay-identifying women (HRC.org, 2016). For the most part, this discrepancy is due to negative experiences involving lack of understanding as to bisexual identity and deligitimizing stereotypes that erase bisexual people's experience (HRC.org, 2016). The result is a significant portion of LGBTQ+ people who experience chronic stress and anxiety, depression, higher rates of alcohol and tobacco abuse, and unsafe sexual practices. This is especially concerning considering the likelihood that LGBTQ+ people as a whole will experience these and other disparities.These inflated figures are just as likely to occur for people who identify as sexually queer (pansexual, asexual, demisexual, etc.).
Chapter: Treatment of Lesbian, Gay, Bisexual and Transgender Patients; The American Psychiatric Publishing Textbook of Psychiatry by
With its sixth edition, The American Psychiatric Publishing Textbook of Psychiatry, the definitive reference for students, residents, and clinicians, introduces a new generation of textbooks for the field. The only comprehensive psychiatry textbook to integrate all the new DSM-5® criteria, this acclaimed gold standard has been revised, updated, and restructured to serve as a practical, authoritative guide for a new era in psychiatric education and practice. Key features include the following: * The only comprehensive psychiatry textbook to be based on all the new DSM-5® criteria* Serves as a companion book to DSM-5®: DSM-5® readers seeking to learn more about treatment can turn to the Textbook * Part II, which discusses psychiatric disorders, parallels exactly the organizational format of DSM-5®* 17 DSM-5® Task Force and Work Group members are chapter authors* More than 70 new authors, including the leading authorities in their specialties with outstanding expertise in research, education, and treatment* Concise yet comprehensive coverage of the topics most relevant to clinical practice* Six new chapters, including "DSM-5® as a Framework for Psychiatric Diagnosis," "Trauma- and Stressor-Related Disorders," "Neurodevelopmental Disorders," and "Mentalization Therapy"* The latest evidence-based findings and standards of care for assessment and development, psychiatric disorders, treatments, and special populations* "Key Clinical Points" at the end of each chapter* Designed so readers can easily find and acquire information* Streamlined, user-friendly format rich in easy-to-view features* Recommended Web sites and readings for clinicians and patients in every chapter* Ideal for psychiatry board preparation The American Psychiatric Publishing Textbook of Psychiatry, Sixth Edition, continues the tradition of leading the field as the most authoritative, inclusive, relevant, and practical reference available.
Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records by
Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records: Workshop Summary reviews the statement of task set to the committee which required them to collect sexual orientation and gender identity data in electronic health records. This report summarizes the invited presentations and facilitated discussions about current practices around sexual orientation and gender identity data collection, the challenges in collecting these data, and ways in which these challenges can be overcome. Areas of focus for the workshop include the clinical rationale behind collecting these data, standardized questions that can be used to collect these data, mechanisms for supporting providers and patients in the collection of these data, technical specifications involved in creating standards for sexual orientation and gender identity data collection and exchange, and policy considerations related to the health information technology (HIT) Meaningful Use process being overseen by the Department of Health and Human Services. This report summarizes the workshop agenda, select invited speakers and discussants, and moderate the discussions. Invited participants will include lesbian, gay, bisexual, and transgender (LGBT) health care consumer advocates, providers with experience working with LGBT populations, HIT vendors and other HIT specialists, health care administrators, and policy makers.
The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health by
This new 2nd edition of The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health reflects clinical and social changes since the publication of the first edition. Written by leading experts in the field of LGBT health in conjunction with The Fenway Institute at Fenway Health, one of the most trusted and respected community-based research, education, and care centers, this edition continues to present the important issues facing patients and practitioners, including: Principles for taking an LGBT-inclusive health history Caring for LGBTQ youth, families, and older adults Behavioral Health Care: coming out, intimate partner violence, drug, alcohol, and tobacco use Understanding health care needs of transgender people Development of gender identity in children and adolescents Sexual health and HIV prevention Policy and legal issues The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, Second Edition is a must-have resource for clinicians, students, and researchers working in hospitals, clinics, universities, libraries, and private practices in every community.
Global HIV/AIDS Politics, Policy, and Activism by
An international team of specialists in politics, policy, and activism provide an indispensable guide to the persistent challenges and emerging issues posed by the global HIV/AIDS epidemic, now in its fourth decade.
Health Care Disparities and the LGBT Population by
Health Care Disparities and the LGBT Population addresses a people whose lack of health care access, including mistreatment and refusal of services, are often omitted from discussions about health care and insurance reform. Research suggests that LGBT people experience worse health outcomes than their heterosexual counterparts. Low rates of health insurance coverage, high rates of stress due to systematic harassment, stigma, discrimination, and lack of cultural competency in the health care system frequently manifest in negative health-related behaviors. The dearth of data collection on sexual orientation and identity in state and federal health care surveys has led to inadequate information about LGBT populations, and has impeded the establishment of health programs and public policies that benefit them. With its diverse perspectives, this book will not only benefit LGBT people, but will also more broadly improve the lives of entire communities, medical care, and prevention programs and services. This research provides a better understanding of the social and structural inequalities that LGBT populations experience. Improvements to our country's health care system should go beyond just providing universal insurance and should ensure equitable health care for all.
The Health of Lesbian, Gay, Bisexual, and Transgender People by
At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.
Intersexuality and the Law by
Winner of the 2013 Bullough Award presented by the Foundation for the Scientific Study of Sexuality The term "intersex" evokes diverse images, typically of people who are both male and female or neither male nor female. Neither vision is accurate. The millions of people with an intersex condition, or DSD (disorder of sex development), are men or women whose sex chromosomes, gonads, or sex anatomy do not fit clearly into the male/female binary norm. Until recently, intersex conditions were shrouded in shame and secrecy: many adults were unaware that they had been born with an intersex condition and those who did know were advised to hide the truth. Current medical protocols and societal treatment of people with an intersex condition are based upon false stereotypes about sex, gender, sexual orientation, gender identity, and disability, which create unique challenges to framing effective legal claims and building a strong cohesive movement. InIntersexuality and the Law, Julie A. Greenberg examines the role that legal institutions can play in protecting the rights of people with an intersex condition. She also explores the relationship between the intersex movement and other social justice movements that have effectively utilized legal strategies to challenge similar discriminatory practices. She discusses the feasibility of forming effective alliances and developing mutually beneficial legal arguments with feminists, LGBT organizations, and disability rights advocates to eradicate the discrimination suffered by these marginalized groups.
Lesbian, Gay, Bisexual, and Transgender Aging by
Lesbian, Gay, Bisexual, and Transgender Aging brings together cutting-edge research, practical information, and innovative thinking regarding the characteristics and processes of aging among lesbian, gay, bisexual, and transgender individuals. Written by experts in the field, the book covers a range of subjects and provides a comprehensive knowledge base for practitioners, students, and researchers. Contributors address topics such as sexuality, relationships, legal issues, retirement planning, physical and mental health, substance abuse, community needs, gay and lesbian grandparents, and a model agency dedicated to delivering services to the senior LGBT population. Their writing takes a gay-affirmative approach that focuses on resilience, coping, and successful adaptation to aging and is sensitive to the importance of historical oppression in the lives of older members of sexual minorities. The authors also pay close attention to ethnic and cultural issues and identify where further research is needed. Lesbian, Gay, Bisexual, and Transgender Aging is a groundbreaking collection of some of the most significant voices in this area of research today. Gerontologists and those who serve the LGBT community are in great need of the information contained in this singular and definitive resource.
Making Sense of Intersex by
Putting the ethical tools of philosophy to work, Ellen K. Feder seeks to clarify how we should understand "the problem" of intersex. Adults often report that medical interventions they underwent as children to "correct" atypical sex anatomies caused them physical and psychological harm. Proposing a philosophical framework for the treatment of children with intersex conditions--one that acknowledges the intertwined identities of parents, children, and their doctors--Feder presents a persuasive moral argument for collective responsibility to these children and their families.
Sexual Orientation and Gender Expression in Social Work Practice by
This volume offers an invaluable resource for both social work educators and practitioners working with gay, lesbian, bisexual, and transgender (GLBT) clients and their families. It is the first such work to specifically address issues affecting bisexual and transgender people as well as the larger concerns of the GLBT community. Contributors present specific, practical suggestions for effective knowledge-based and skills-based practice with GLBT clients. Topics include heterosexism and homophobia, identity development, coming out, GLBT adolescents and older adults, health-care concerns, relationships and families, workplace issues, the history of the GLBT civil rights movement, sex reassignment, AIDS, and the role of spirituality in the lives of GLBT individuals. The contributors also consider intragroup issues of race, ethnicity, age, and socioeconomic status.
Trans/Portraits by
Although transgender people are increasingly represented in academic studies and popular culture, they rarely have the opportunity to add their own voices to the conversation. In this remarkable book, Jackson Shultz records the stories of more than thirty Americans who identify as transgender. They range in age from fifteen to seventy-two; come from twenty-five different states and a wide array of racial, religious, and socioeconomic backgrounds; and identify across a vast spectrum of genders and sexualities. Giving voice to a diverse group of individuals, the book raises questions about gender, acceptance, and unconditional love. From historical descriptions of activism to personal stories of discrimination, love, and community, these touching accounts of gender transition shed light on the uncharted territories that lie beyond the gender binary. Despite encounters with familial rejection, drug addiction, and medical malpractice, each account is imbued with optimism and humor, providing a thoughtful look at the daily joys and struggles of transgender life. With an introduction and explanations from the author, this work will appeal to transgender individuals, their significant others, friends, family, and allies; health-care providers, educators, and legal professionals; and anyone questioning their own gender, considering transition, or setting out on their own transition journey.
Understanding Asexuality by
Asexuality can be defined as an enduring lack of sexual attraction. Thus, asexual individuals do not find (and perhaps never have) others sexually appealing. Some consider "asexuality" as a fourth category of sexual orientation, distinct from heterosexuality, homosexuality, or bisexuality. However, there is also recent evidence that the label "asexual" may be used in a broader way than merely as "a lack of sexual attraction." People who say they have sexual attraction to others, but indicate little or no desire for sexual activity are also self-identifying as asexual. Distinct from celibacy, which refers to sexual abstinence by choice where sexual attraction and desire may still be present, asexuality is experienced by those having a lack or sexual attraction or a lack of sexual desire. More and more, those who identify as asexual are "coming out," joining up, and forging a common identity. The time is right for a better understanding of this sexual orientation, written by an expert in the field who has conducted studies on asexuality and who has provided important contributions to understanding asexuality. This timely resource will be one of the first books written on the topic for general readers, and the first to look at the historical, biological, and social aspects of asexuality. It includes firsthand accounts throughout from people who identify as asexual. The study of asexuality, as it contrasts so clearly with sexuality, also holds up a lens and reveals clues to the mystery of sexuality.
Women and Bisexuality by
Get a global perspective on bisexuality from a women's viewpoint Women and Bisexuality: A Global Perspective reflects the growing contribution bisexuals, and especially bisexual women, make to queer culture on an international level. This unique book presents a collection of thoughtful essays, studies, and reviews that combine to help develop a language that reflects the reality of bisexuality from a feminine/feminist viewpoint. Authors map the inroads made by bisexual studies into conventional disciplines, including anthropology, sociology, health, literature, film, history, and biography, and analyze the situations of bisexual women in areas as diverse as France, North America, Germany, Australia, and Africa. The rich and varied contributions to Women and Bisexuality: A Global Perspective track the spread of bisexuality from the urban and metropolitan centers of gay culture to more peripheral areas as the movement becomes more and more hospitable to transnational and transcultural people. The book's main themes--bisexuality's ability to disrupt categories and the resulting feeling of alienation many bisexuals experience--are manifested in approaches that include critical theory, deconstruction, textual analysis, cognitive psychology, personal essay, review essay, reportage, and qualitative study. Topics addressed include: the impact of feminism and women's communities on the appearance of bisexual women multi-sexual relationships as border existence in Australia a South African perspective on bisexuality understanding bisexuality's invisibility Lillian Hellmann's bisexual fantasies and much more Women and Bisexuality: A Global Perspective follows bisexuality to the crossroads of academics and activism, presenting a wide scope of refreshing and insightful thought that reflects more than an identity or practice. The diverse mix of ideas is an essential read for anyone interested in literature on sexuality.
