Gay Adults Research Articles

Experiences of informal caregiving among older lesbian and gay adults in Australia.

ObjectiveThis study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving.MethodsInterviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach.ResultsMost participants were caring for a friend or partner and regarded caregiving as a form of love and did not seek external support despite noting several impacts. Some participants found that they too were beginning to require care. For some, formal care was being considered, but with a degree of reluctance.ConclusionsOlder lesbian and gay adult caregivers experience a range of challenges and support needs in relation to their experiences with the caregiving role. This research highlights a need for ensuring that caregiving policies and practices be responsive to the experiences and challenges faced by older lesbian and gay people.

Prevalence and Sociodemographic and Behavioral Correlates of Psychological Distress among Lesbian, Gay, and Bisexual Adults in the United States, 2013-2018

Background: The lesbian, gay, bisexual, and transgender (LGBT) population comprises approximately 5.6% of the total US population. Levels and patterns of psychological distress in the LGBT population are less well known compared with the general population. This study examines the prevalence and sociodemographic and behavioral correlates of psychological distress among lesbian, gay, and bisexual (LGB) adults in the United States. Methods: Using the pooled cross-sectional data from the 2013-2018 National Health Interview Surveys (N=183,020), differentials in serious psychological distress (SPD) and factor-based psychological distress scores were analyzed by multivariate linear and logistic regression. Results: The prevalence of SPD was 8.0% for the LGB population aged ≥18, 7.0% for gay and bisexual males, and 8.9% for LGB females, compared with 3.4% for the total straight/heterosexual population, 2.7% for straight males, and 4.0% for straight females. Mean psychological distress index scores were highest among LGB females (109.8), followed by gay and bisexual males (105.8), straight females (100.6), and straight males (97.7). Compared with the straight population, LGB adults had higher education, unemployment, and poverty levels and were more likely to be non-Hispanic White and single. LGB adults were more likely to smoke and drink alcohol and more likely to be physically active than straight adults. LGB females had higher obesity but gay and bisexual males had lower obesity rates than their straight counterparts. After controlling for covariates, LGB adults had 89% higher odds of SPD and significantly higher distress levels than straight adults. Younger age, lower-income, divorce/separation, lack of health insurance, functional limitation, smoking, physical inactivity, and obesity were significant predictors of SPD and higher psychological distress levels in LGB adults. Conclusion and Implications for Translation: Significant disparities in mental health exist, with LGB adults at substantially increased risk of psychological distress and likely in greater need of appropriate social and mental health services. Health policies aimed at improving the material conditions and social environments may lead to improved mental health outcomes among LGB adults and the general population. Copyright © 2022 Singh, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Chinese Lesbian and Gay Adults’ Self-Reported Experiences of Negative Treatment and Violence From Family of Origin: Evidence From a Larger-Scale Study in China

Lesbian and gay adults’ self-reported experiences of violence from family of origin in adulthood have been less examined in previous research on interpersonal violence from intimate others. In China, while it has been understood that lesbians and gay men face mounting pressure to marry and have children, there is little empirical evidence on their experiences of violence from family of origin. This paper analyzes self-reported experiences of negative treatment and violence from a larger-scale study in China of 11,048 Chinese lesbian and gay cisgender adults. The majority of Chinese lesbians and gay men felt pressure to get married and have children (70.4%), and experienced different forms of negative treatment and violence from their family members based on sexual orientation (54.2%). A significant gender difference was observed. This paper provides novel empirical evidence for the lived experiences of lesbians and gay men in China and bears implications for China’s Anti-domestic Violence Law.

Expectation of Rejection and Its Association with Health Care Avoidance and Delay Among 2175 Korean Lesbian, Gay, and Bisexual Adults: A Nationwide Cross-Sectional Survey.

Purpose: The study examined an association between expectation of rejection and health care avoidance and delay (HAD) among lesbian, gay, and bisexual (LGB) adults in South Korea. Methods: We analyzed data from a nationwide cross-sectional survey of 2175 South Korean LGB adults, which was approved by the Korea University Institutional Review Board. We categorized expectation of rejection into tertiles ("low," "medium," and "high" levels) and investigated its association with past 12-month HAD using multivariate modified Poisson regression. Results: After adjusting for covariates, including experiences of discrimination, participants with high levels of expectation of rejection had 1.38-times (95% confidence interval: 1.16-1.65) higher prevalence of HAD compared with those with low levels. Conclusion: Living in anticipation of rejection can negatively impact LGB adults' health care utilization.

Leaving a Mark and Passing the Torch: Intended Legacies of Older Lesbian and Gay Spanish Activists

ABSTRACT Aging paradigms should entail all individuals. More research on older LGBT+ adults is needed since the literature has been mainly built on heteronormative and cisgender standards. The creation and shaping of the kind of legacy an individual would like to leave behind when he/she dies is key in aging well. This study explores the intended legacies of older lesbian and gay adults (50+ years old) who were activists in social movements in Spain. Eighteen participants (12 gay men) participated in a semi-structured interview on their intended legacies. Thematic analysis was used to analyze the interviews. The main findings showed that all participants reported intended legacies: i) personal, to transmit their lived knowledge and to be remembered as good and committed persons; ii) broader, to contribute to LGBT+ rights, and to a better society; iii) composite, the desire that younger generations recognize their contributions, and to know they helped to protect new generations. The participants in this study lived a life of intense involvement in social movements, and currently their intended legacies involve leaving a mark and passing the torch to younger generations. This understanding will help us to develop adequate practices that promote well-being in older LGBT+ adults.

Does coming out matter? A serial mediation model from outness to reduced psychological distress among Chinese gay men

Coming out of the closet refers to the self‐disclosure of one's sexual orientation to other people. A majority of gay men in mainland China are hesitant about coming out. Considerable research in Western contexts has demonstrated that coming out can alleviate gay men's psychological distress. The current study thus aims to understand the psychological impacts of coming out for gay men in mainland China. We employed a serial mediation model to examine the relationship between overall outness and psychological distress, with internalized homonegativity as the first‐order mediator and perceived discrimination based on same‐sex sexual orientation (hereafter “perceived discrimination”) as the second‐order mediator. An online sample of 251 Chinese adult gay men (Mage = 25.25 years, SD = 5.28 years) completed self‐report measures of outness, internalized homonegativity, perceived discrimination, and psychological distress. Results showed that the negative association between overall outness and psychological distress was partially mediated by internalized homonegativity (indirect effect = −0.057, bias‐corrected 95% confidence interval [−0.153, −0.011]), and serially mediated by internalized homonegativity and then perceived discrimination (indirect effect = −0.019, bias‐corrected 95% confidence interval [−0.048, −0.007]), controlling for age. Additionally, we did not find the simple mediating effect of perceived discrimination between overall outness and psychological distress, which may be because coming out reduced oversensitivity and perception bias but increased the probability of actual discriminatory experiences. These results contribute to our understanding of how coming out affects psychological distress among Chinese gay men. Furthermore, this study may illuminate the design of psychological crisis intervention focusing on this group in mainland China.

Intersectional Activism Among Black Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning Young Adults: The Roles of Intragroup Marginalization, Identity, and Community

Research around the importance of activism for positive development has been primarily focused on a single identity, missing the ways in which race and sexual orientation intersect to influence the communities young adults advocate for. The current study assesses how Black lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) young adults’ experiences of discrimination, identity, and community predict involvement in intersectional activism (e.g., activism for LGBTQ communities of color). With a sample of 216 Black LGBTQ young adults from the Social Justice Sexuality project, we used hierarchical linear regression to examine relationships between intragroup marginalization, identity, community involvement, and intersectional activism. While all three constructs explained a significant variance in intersectional activism, only racial marginalization within the LGBTQ community and involvement in LGBTQ communities of color were positively associated with intersectional activism. These findings demonstrate that experiences of intragroup marginalization and connection to communities that center both race and sexual orientation may be important in fostering activism among Black LGBTQ young adults.

COVID-19 Vaccination Coverage and Vaccine Confidence by Sexual Orientation and Gender Identity - United States, August 29-October 30, 2021.

Lesbian, gay, bisexual, and transgender (LGBT) populations have higher prevalences of health conditions associated with severe COVID-19 illness compared with non-LGBT populations (1). The potential for low vaccine confidence and coverage among LGBT populations is of concern because these persons historically experience challenges accessing, trusting, and receiving health care services (2). Data on COVID-19 vaccination among LGBT persons are limited, in part because of the lack of routine data collection on sexual orientation and gender identity at the national and state levels. During August 29-October 30, 2021, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed to assess COVID-19 vaccination coverage and confidence in COVID-19 vaccines among LGBT adults aged ≥18 years. By sexual orientation, gay or lesbian adults reported higher vaccination coverage overall (85.4%) than did heterosexual adults (76.3%). By race/ethnicity, adult gay or lesbian non-Hispanic White men (94.1%) and women (88.5%), and Hispanic men (82.5%) reported higher vaccination coverage than that reported by non-Hispanic White heterosexual men (74.2%) and women (78. 6%). Among non-Hispanic Black adults, vaccination coverage was lower among gay or lesbian women (57.9%) and bisexual women (62.1%) than among heterosexual women (75.6%). Vaccination coverage was lowest among non-Hispanic Black LGBT persons across all categories of sexual orientation and gender identity. Among gay or lesbian adults and bisexual adults, vaccination coverage was lower among women (80.5% and 74.2%, respectively) than among men (88.9% and 81.7%, respectively). By gender identity, similar percentages of adults who identified as transgender or nonbinary and those who did not identify as transgender or nonbinary were vaccinated. Gay or lesbian adults and bisexual adults were more confident than were heterosexual adults in COVID-19 vaccine safety and protection; transgender or nonbinary adults were more confident in COVID-19 vaccine protection, but not safety, than were adults who did not identify as transgender or nonbinary. To prevent serious illness and death, it is important that all persons in the United States, including those in the LGBT community, stay up to date with recommended COVID-19 vaccinations.

Aging LGBT Adults’ Access to Social Resources According to LGBT Identity and Sociodemographics

Research suggests that social resources positively influence the health and well-being of lesbian, gay, bisexual, and transgender (LGBT) aging adults, but their access to social resources may vary according to LGBT identity. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N=2,536), multivariate models tested how access to social resources varied by LGBT identity and whether the effect of LGBT identity showed additional variations by sociodemographic characteristics (i.e., age and education) among aging LGBT adults. Lesbian respondents had larger social networks than gay respondents, while gay respondents had smaller networks than transgender respondents. Lesbian respondents had more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay respondents and bisexual male respondents reported less community belonging than gay respondents. Education and age moderated the association between LGBT identity and social support. Findings highlight the importance of considering social support separately from social network size with the understanding that large social networks do not necessarily provide ample social support and this distinction was particularly relevant for transgender respondents who had larger social networks, but less social support than gay respondents. Results also suggest that feelings of LGBT community belonging vary among LGBT identity groups. Health and human service professionals should not only consider the sexual and gender identity of their aging LGBT clients, but also consider the clients’ additional sociodemographic characteristics when assessing their access to social resources.

We Should Have Talked About Hospice: Transforming Communication With Bereaved LGB Aging Women

Because of historical discrimination, discomfort disclosing information, and differing definitions of family, lesbian, gay, bisexual, and transgender (LGBT) older adults with serious illness need both improved palliative and end-of-life (EOL) care communication with clinicians and recognized inclusion of spouses/partners. Communicating about palliative and EOL care may improve the care goals and emotional trajectory for patients and significant others. Using a descriptive qualitative approach, this study’s aim was to analyze the communication experiences during a spouse’s/partner’s EOL care for bereaved LGB women (n=16) 60 and older. Drawing on queer gerontology, issues relating to access to resources and information and the systemic silencing of older LGB women illuminate areas where policy and practice may be improved. Semi-structured, one-on-one interviews were used to provide deep and meaningful information about palliative and EOL care communication between participants, their spouse or partner, and clinicians. While results reflect certain outcomes found in prior studies with non-LGBT adults, thematic analysis revealed three main findings with evidence specific to this population: 1) avoiding deep discussions about EOL; 2) lack of understanding about palliative or EOL care; and 3) limited communication with clinicians. Findings illuminate the need for better understanding among clinicians regarding palliative and EOL communication with LGBT dyads as well as communication strategies based on recognition and acceptance. Further dyadic communication research may improve care goals for LGBT older adults. Understanding couples’ interactions and examining different communication behaviors may lead to improved palliative and EOL care goals for older LGBT adults with serious illness and their spouses/partners.

Assessing Knowledge, Attitudes, and Beliefs of Nurses About LGBTQ Older Adults Using a Documentary Video

Statistics reveal that lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience health disparities and barriers to accessing healthcare because of discrimination and fear of disclosing sexual orientation. Nurses receive limited education regarding care for LGBTQ older adults. This study exposed nurses to the documentary, Gen Silent, which details LGBTQ older adult experiences. The objective of the study was to increase participants’ understanding of LGBTQ health disparities. A one-group pre-/post-test design was conducted to test the effect of the documentary on knowledge and attitudes about LGBTQ health. A total of 379 nurses participated in the study. A questionnaire including a 16-item standardized scale and an open-ended question asking how participants would change their practice was administered before and after the intervention. Findings revealed statistically significant increases in LGBTQ knowledge and inclusive attitudes. This research supports the use of a documentary as an educational method related to LGBTQ older adults.

Evidence-based Recommendations to Inform Best Practices for LGBTQ Older Adults in Long-term Care Settings

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are more likely to live alone and have less familial support, which disproportionately contributes to a reliance on long-term care facilities as they age. Best-practice guidelines supported by scholarly literature to care for LGBTQ older adults in long-term care settings do not exist. This review synthesizes literature about LGBTQ older adults in long-term care facilities and provides recommendations for best practice guideline development. Four electronic databases were searched in June 2019 for studies conducted between 2000 – 2019 related to caring for LGBTQ older adults in long-term care settings. An integrative literature review was completed on the twenty eligible studies. Findings showed that LGBTQ participants fear discrimination in long-term care leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. Long-term care staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. They experience training deficits and have a need for more expansive training modalities. The recommendations offered by both LGBTQ participants and long-term care staff are to revise policies and forms as well as provide widespread training and education. LGBTQ participants recommend that their unique identities be recognized within long-term care while long-term care staff recommend leadership involvement to change culture and practice. This review provides evidence-based recommendations to promote equitable healthcare to the LGBTQ older adult population and calls to attention the need for long-term care settings to uniformly follow best-practices.

LGBTQIA+ Caregiving and Care Needs of Persons Living With Alzheimer’s Disease and Related Dementias

Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual (LGBTQIA+) older adults are a growing population. LGBTQIA+ persons living with Alzheimer’s disease and related dementias (ADRD) face unique challenges in terms of accessing care and support compared with their non-LGBTQIA+ counterparts. The care challenges faced by LGBTQIA+ people living with ADRD may be compounded by the fact they are more likely to be single, more likely to live alone, and less likely to have children. Several studies have started to explore the unique needs of LGBTQIA+ caregivers and persons living with ADRD. In this symposium, we highlight current research addressing the psychosocial and health-related needs of LGBTQIA+ caregivers and persons living with ADRD. Two presentations address psychosocial factors and health among LGBTQIA+ caregivers of persons with ADRD. Krystal Kittle will present analyses using population-based data on LGBTQIA+ caregivers in terms of caregiving burden and mental health. Shana Stites will present results from the Health and Retirement Study highlighting differences among same-sex spouses in terms of caregiving patterns and research participation. Next, Ethan Cicero will present prevalence estimates of care needs and challenges among diverse transgender adults living with memory problems. Finally, we will highlight a promising intervention for LGBTQIA+ caregivers of persons with ADRD. Jason Flatt will describe the adaptation and feasibility of the Savvy Caregiver program for LGBTQIA+ caregivers. Joel Anderson, an expert in LGBTQIA+ caregiving for persons with ADRD, will facilitate a conversation about these results and place them in the context of current LGBTQIA+ and ADRD research.

LGBTQ&A: Development of a needs assessment to define access, needs, and barriers to health care services among LGBTQ older adults

While health-related research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has grown, more research is necessary to understand this population. Howard Brown Health (HBH) conducted a mixed-method needs assessment in Cook County, IL. The purpose of this article is to describe the development of the community survey, focus group guidebook, and study protocol. HBH created the needs assessment to increase knowledge about access to and need for services and barriers to care among LGBTQ aging patients. Furthermore, the study explored how subgroups based on sexual orientation, gender identity, race, ethnicity, and veteran status differed in access, need, and barriers to care. Study participants were 50 years and older, self-identified as LGBTQ, and resided in Cook County. With this knowledge, HBH plans to launch culturally competent wellness programs to improve the quality of life of its LGBTQ older adult patients.

Effects of harassment on psychological inflexibility/experiential avoidance among Taiwanese emergent adult gay and bisexual men

Gay and bisexual men are at a higher risk of mental and physical health problems than heterosexual men, reporting higher frequencies of harassment and discrimination in both housing and employment domains. Psychological inflexibility/experiential avoidance (PI/EA) refers to behaviors that are rigidly guided by psychological reactions rather than direct contingencies or personal values; PI/EA referring to a key psychopathology behavior related to greater mental illness. The objective of the study was to examine the association of various types of harassment with PI/EA and the effects of multiple types and site harassment on PI/EA among Taiwanese emergent adult gay and bisexual men. A total of 305 gay and bisexual men aged between 20 and 25 years were recruited into this study. The level of PI/EA and types of harassment were evaluated and further analysis the effect of harassment on PI/EA. Findings indicated that various types of harassment exerted significant effects on PI/EA in emergent adult gay and bisexual men; furthermore, the effect was cumulative. The result also revealed that victims of verbal ridicule and relational exclusion, victims of physical aggression and theft of belongings, and victims of cyber harassment had significantly higher PI/EA. Harassment experiences appeared to be significantly associated with PI/EA, and the effects could be cumulative. It would be beneficial to construct a friendly world for emergent adult gay and bisexual men. Evaluation and intervention with PI/EA improvement should be considered for emergent adult gay and bisexual men with traditional and cyber harassment experiences.

Troops and Tribes: Masculinity, Playing Indian, and the Social Politics of Ernest Thompson Seton's Expulsion from the Boy Scouts of America

Troops and Tribes: Masculinity, Playing Indian, and the Social Politics of Ernest Thompson Seton's Expulsion from the Boy Scouts of America

Assessing the combined effect of ageism and sexuality-related stigma on the mental health and well-being of older lesbian and gay adults

Objective Relatively little research has examined ageism among older lesbian and gay adults. In this study, we investigated how ageism, as well as sexuality-related stigma, relate to mental health and well-being in these groups. Method Six hundred and thirteen lesbian women and gay men aged 60+ in Australia completed a nationwide survey. We investigated how experiences of ageism, concerns about having one’s sexual orientation accepted by others (as one broad indicator of sexuality-related stigma), and their interactions, predict psychological distress, positive mental health, and resilience. Results Among the lesbian women, experiences of ageism predicted greater psychological distress and lower positive mental health, while sexuality acceptance concerns predicted poorer outcomes on all three well-being measures. Among the gay men, experiences of ageism and sexuality acceptance concerns predicted poorer outcomes on all the well-being measures. In addition, the gay men who were higher on sexuality acceptance concerns had higher psychological distress and lower resilience, but only when they also had greater experiences of ageism. Conclusion Findings suggest that those concerned with the well-being of lesbian and gay people should account for not only the potential impact of sexuality acceptance concerns but also ageism, and how these two factors may interact.

Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men.

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

Abuse and Violence Experienced by Gay Men living in Pakistani cultural context: An interpretative phenomenology analysis

This study was conducted using Interpretative Phenomenological Analysis to explore and understand psychosocial issues of the gay community living in the Pakistani cultural context. Six adult gay men, aged 20–40 years, were interviewed using semi-structured interviews at their preferred locations. Thorough and in-depth analysis of the transcripts revealed two superordinate themes: (1) The experience of verbal harassment and associated emotional disturbance was universal, (2) The experience of sexual violence was universal. These themes describe participants’ experience of verbal harassment with followed emotional reaction, and experiences of different forms of sexual violence. This study helps in understanding what it means to be a gay man in Pakistan.

Wild Child: Intensive Parenting and Posthumanist EthicsLegally Straight: Sexuality, Childhood, and the Cultural Value of Marriage

Wild Child: Intensive Parenting and Posthumanist EthicsLegally Straight: Sexuality, Childhood, and the Cultural Value of Marriage