Abuse, mastery, and health among lesbian, bisexual, and two-spirit American Indian and Alaska Native women.

Abstract

American Indian and Alaska Native (AIAN) women have endured a history of colonial oppression in the United States. Current manifestations of colonization include an epidemic of violence toward AIAN women, who often are sexually and physically abused from early on in life. Such violence may erode AIAN women's sense of agency or mastery and contribute to their poor physical and mental health outcomes. AIAN women who identify as lesbian, bisexual, or "two-spirit" appear to experience disproportionate levels of violence and may be particularly vulnerable to disparities in health outcomes. In this study, 152 sexual minority AIAN women were interviewed as part of an investigation addressing the health concerns of two-spirit persons. Participants reported disturbingly high prevalence of both sexual (85%) and physical (78%) assault, both of which were associated with worse overall mental and physical health. These relationships generally were mediated by a diminished sense of control or mastery. The need to indigenize the concept of mastery is discussed, as is the urgency of interventions to work toward decreasing levels of abuse and increasing mastery among sexual minority AIAN women.