Lesbian, Gay, Bisexual And Transgender Populations Research Articles

The influence of minority stress on indicators of suicidality among lesbian, gay, bisexual and transgender adults in Thailand.

INTRODUCTION: A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. To examine rates and predictors of suicidality among Thai LGBT adults (N=411). Data collection was conducted via online and in-person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health-related factors, general and minority-specific stressors and suicidality were completed. Thirty-nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12-month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR=1.12, 1.16, 2.75, and 1.46, p ≤ .05, R2 = 0.327). Past-year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR=1.52, 1.20, 2.34, and 4.89, p<.05, R2 =0.345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use and physical health (OR=1.44, 1.06, 1.59, 1.45 and 0.95, p≤0.05, R2 =0.187). General and minority-specific stressors negatively impacted suicidality among LGBT participants. Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals.

Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin.

There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07–4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64–4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10–7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.

Provider and LGBT Individuals' Perspectives on LGBT Issues in Long-Term Care: A Systematic Review.

Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals' perspectives of LGBT issues in LTSS in the United States. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.

White Paper from a CTSA Workshop Series on Special and Underserved Populations: Enhancing Investigator Readiness to Conduct Research Involving LGBT Populations.

Despite the significant health disparities experienced by lesbian, gay, bisexual and transgender (LGBT) populations, few investigators affiliated with NIH-funded Clinical and Translational Science Award (CTSA) programs are conducting research related to this underserved population. We provide recommendations shared during a half-day workshop aimed at increasing researcher readiness to conduct LGBT research. This workshop was presented as part of a series on conducting research with underserved populations offered by the Recruitment, Retention, and Community Engagement Program of the Center for Clinical and Translational Science at the University of Illinois at Chicago. Six LGBT health research experts provided focused presentations. The workshop presentations included a summary of significant health inequality issues, theoretical models relevant to research on LGBT health, best practices in measuring sexual orientation and gender identity, recommendations for recruitment and retention, a discussion of community engagement, and ethical considerations in conducting LGBT research. We provide a summary of recommendations to guide future research, training, and public policy related to LGBT health. The information can increase capacity among CTSA affiliated researchers in conducting research in this special population.

Do LGBT-Supportive Corporate Policies Improve Credit Ratings?: An Instrumental-Variable Analysis

We investigate the effect of Lesbian, Gay, Bisexual and Transgender (LGBT)-supportive corporate policies on credit ratings. To the extent that LGBT-friendly policies are beneficial to the firm and therefore improve its expected cash flows, credit rating agencies should assign more favorable credit ratings to the firm. To alleviate endogeneity concerns, we exploit the variations in the LGBT populations across the states in the U.S. as our instrument. Our instrumental-variable (IV) analysis reveals that firms that adopt LGBT-supportive corporate policies enjoy significantly better credit ratings, supporting the stakeholder and good management hypothesis. Further analysis using propensity score matching also yields consistent results.

HIV Risk Among Men Who Have Sex With Men, Women Who Have Sex With Women, Lesbian, Gay, Bisexual and Transgender Populations in South Africa: A Mini-Review.

Background:The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. Objectives:This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. Method:Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. Results:In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. Conclusion:Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.

Editorial: HIV Infection and AIDS in Africa - Issues, Lessons Learnt and Next Steps.

Editorial: HIV Infection and AIDS in Africa - Issues, Lessons Learnt and Next Steps.

Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

BackgroundPrior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.MethodologyLBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.ResultsHigher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.ConclusionsThe results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

All inclusive Public Health--what about LGBT populations?

After attending an excellent and well-organized 5th European Public Health Conference with the main theme All inclusive Public Health , it felt appropriate to reflect on what factors are considered when talking about inclusion and exclusion regarding health concerns. During the last day of the conference, we heard some inspiring presentations highlighting the importance of awareness of inequalities based on being small, few or different and the responsibility to manage public health policies to overcome inequality in Europe’s health based on ethnic or social background. Health disparities can be described as differences in incidence, prevalence, mortality, disease burden or other measure of adverse health between minority and majority population groups.1 Awareness of health disparities in specific populations, in particular based on ethnical background, has increased during the past decades. Research on psychosocial factors such as discrimination, context and cultural views of health, which influence health disparities, has begun to increase our understanding of the mechanisms behind such inequalities.1 In addition to ethnicity, disparities based on many other factors such as gender, age, socioeconomic status, geography and disability have been identified. During the past several years, public health policy and research have begun to address the issues of lesbian, gay, bisexual and transgender (LGBT) populations,2 and many official public health agencies call for programmes addressing the specific needs of LGBT individuals. But is attention to LGBT …

At the intersection of marginalised identities: lesbian, gay, bisexual and transgender people's experiences of injecting drug use and hepatitis C seroconversion

Although the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high, we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the well-being of LGBT populations. Although some kinds of drug use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants' understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants' accounts. Drug use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug use. Participants also described feeling afraid to come out about their drug use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the people who inject drugs (PWID) community. Thus, the combination of being LGBT/living with HIV (a gay disease) and injecting drugs/living with HCV (a junkie's disease) left them in a kind of no-man's-land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health-care for LGBT PWID.

Gay, Lesbian, Bisexual and Transgender Aging: Challenges in Research, Practice and Policy

This text book offers a valuable contribution to the developing literature concerned with Lesbian, Gay, Bisexual and Transgender (LGBT) ageing. For many years, there has been a relative dearth of texts specifically focused on LGBT ageing issues, and it is therefore encouraging that two similar texts are published in the same year, one focusing specifically on the US context and the other from UK research and practice (Ward et al., 2012). This text is focused specifically on the US context of LGBT ageing and starts with the premise that LGBT populations face unique challenges as they age. The text combines both biological and social science research, and includes case studies to illustrate particular issues. The book attempts to produce a comprehensive overview of issues related to different ageing perspectives, including gay, lesbian, bisexual, transgendered and intersex ageing experiences. However, as the book is written in terms of US policy and practice, some of the content has limited applicability to global contexts of LGBT ageing policy and practice. For example, in the UK, Civil Partnership legislation affords legal recognition in a way not available within some US states.

Gender Identity: A Culture with Unique Nutrition Concerns

Lesbian, Gay, Bisexual and Transgender (LGBT) individuals encompass all races and ethnicities, religions, and social classes. It is estimated that between 7 and 10 percent of Canadians and 3.8 percent of Americans gender identify themselves as LGBT. Members of the LGBT culture experience a number of unique health disparities. Healthy People 2020 has considered this problem pressing enough to include LGBT as an area of concern in its latest edition. For example, lesbians and bisexual females are more likely to be overweight or obese which may contribute to an increased risk of heart disease, diabetes, certain cancers, and other health problems. Gay and bisexual males have a higher rate of eating disorders and body dissatisfaction. Transgender individuals undergoing hormone therapy are at higher risk of developing cardiovascular disease and decreased bone density. Theymay also experience impaired glucosemetabolism and often gain abdominalweight due to this therapy thus requiring specialized nutrition counseling. LGBT populations have the highest rates of substance abuse for tobacco, alcohol, andother drugs, all ofwhichmay affect their nutrition status. If a person discloses their gender identity during nutrition counseling the dietitian needs to ask additional screening questions to assesswhether the client has unique nutritional needs. Dietitiansmay need to address weight management issues for transgender patients undergoing hormonal therapy. In general, healthcare provider’s need tomake themselves more aware of the special nutrition needs of members of the LGBT community.

Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities.

BackgroundThis article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada.MethodsA critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives.ResultsA continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse.ConclusionsThe analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions about, and ideological commitments to, sexual and gender diversity and health services access and equity. Thus, the continuum of discourses may serve as an important element of a health care organization's access and equity framework for the evaluation of access to good quality care for diverse LGBT populations. More specfically, the analysis offers four important points of consideration in relation to the development of a health services access and equity framework.

Unmet priority population needs in tobacco control: large disparities--little Master Settlement Agreement dollars.

his section of the journal explores variousapproaches and the failure of the Master Settle-ment Agreement (MSA) to meet tobacco controlneeds of priority populations. Many factors make thesepopulations particularly vulnerable. Some groups haveexperienced an extraordinary growth in the past 10years, namely, Hispanic/Latino and Asian and PacificIslanders (U.S. Bureau of the Census, 2000), increasingtheirpurchasing powerandbecomingmoreattractivetothe tobacco industry. Others experience high preva-lence rates sometimes double that of the generalpopulation, such as American Indians, Vietnamese,gay/lesbian/bisexual/transgender (Joint Ethnic TobaccoEducation Networks [JETEN], 2003; Ryan, Wortley,Easton, Pederson, & Greenwood, 2001) and low socio-economic status (SES) communities (U.S. Departmentof Health and Human Services [USDHHS], 1998). Oth-ers suffer a disproportionate burden of tobacco-relateddiseases, such as African Americans, lesbian/gay/bisexual and transgender (LGBT) community, andAmerican Indians, experiencing premature death, lostproductivity (Max, Rice, Zhang, Sung, & Miller, 2002;USDHHS, 1998), higher rates of lung cancer mortality,cardiovascular disease, and asthma (JETEN, 2003).However, they benefit less because of lack of fundingfrom the MSA and other health care dollars going spe-cifically to these groups.The current financial crisis of many states has fueleda controversial debate on how to best spend MSA andother tobacco funds (Givel & Glantz, 2002; Schultz,2002). The public believes a significant proportion ofdollars should go toward tobacco control (Batra, Patkar,Weibel, Pincock, & Leone, 2002). However, at its best in2000, tobacco prevention allocations were limited toonly 9.2% of the revenues obtained from the settlement(Bergman, 2003). In most states, tobacco control needsof priority populations have been chronicallyneglected. Tightening of state budgets with the elimina-tion of tobacco control and other health programs sig-nals a potentially severe health crisis. The NCSLreported that only 3% of MSA moneys would be allo-cated in 2004 for tobacco prevention (Bergman, 2003).Thisisnotenoughtomeetoveralltobaccocontrolneedsin the future. Priority populations maywell be the hard-est hit. The cost of treating smoking-related diseasesand the lost productivity from smoking-related deathsis calculated at approximately U.S.$15.8 billion annu-ally, in California alone (Max et al., 2002), a state withhigh protection against smoking. The costs to the nationare anticipated at well over $100 billion dollars a year.At a time when foundations have also eliminated orlargely reduced their tobacco control funding and thestatesutilize themoneystodealwiththeirbudgetcrisis,who will protect the health of citizens in each state?In this section the article titled, “More Money MoreMotivation? Master Settlement Agreement and TobaccoControl Funding in Communities of Color” the authorsdocument historical factors, institutional barriers, andthe state of MSA funding for priority populations. Theypresent three model approaches to achieving fundingparity in tobacco control for priority populations. “AnAnalysis of Tobacco Industry Marketing to Lesbian,Gay, Bisexual, and Transgender (LGBT) Populations:Strategies for Mainstream Tobacco Control and Preven-tion” describes the “short but turbulent” targeting bythe tobacco industry of the LGBT populations, resulting