LGBT Americans Research Articles

LGBTQ Capacity Building in Health Care Systems: A Social Work Imperative

Working within a diverse array of health care settings, social workers encounter a variety of client populations, many of whom we are well prepared to serve. We have specialties in working with children, adolescents, and older adults with mental illnesses, substance use issues, or particular health care concerns such as HIV. As a profession, we have begun to pay attention to racial and ethnic health disparities that may cut across each of these groups and have actively engaged in efforts of cultural competence. However, we have not, until recently, paid attention to the health disparities and particular health care needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Estimates of the size of the LGBTQ population in the United Sates vary, with Kinsey's (1948) 10 percent estimate holding almost mythical status. However, a recent estimate generated by Gary Gates at the Williams Institute, who cross-compared a number of different population surveys, put the number of LGB individuals at approximately 3.5 percent of the population and transgender individuals at 0.3 percent (Gates, 2011). Gates noted that this amounts to 9 million LGBT Americans, a figure roughly equivalent to the population of New Jersey (p. 1). Given this prevalence, it is likely that all social workers will encounter LGBTQ clients on their caseload whether or not they overtly identify their orientation or gender identity. Throughout history the dominance of a heteronormative paradigm has resulted in LGBTQ individuals experiencing stigmatization and discrimination. This discrimination may manifest as verbal or physical assaults (Kosciw, Greytak, Diaz, & Bartkiewicz, 2010) or as policies that render these individuals' relationships invisible (such as not being eligible for a life-partner's social security benefits). Having been socialized in a cultural environment that is at best heteronormative and at worst homophobic, health care providers frequently make assumptions of heterosexuality in the questions they ask their patients. In turn, patients anticipate that disclosure of sexual orientation will negatively affect the care they receive (James & Platzer, 1999). The impact of stigmatization of and discrimination against LGBTQ individuals is the potential for uneven care when accessed, or avoidance of care altogether, resulting in disparities emerging within health issues because many unaddressed social, contextual, psychological, developmental, interpersonal, and environmental factors can produce deleterious outcomes (Mayer et al., 2008)). The extent of these disparities is sufficient cause for concern that the U.S. Department of Health and Human Services has elevated sexual orientation from a noted disparity in their Health People 2010 (U.S. Department of Health and Human Services, 2000) objectives to a target group for concern and improvement in Healthy People 2020 (see http://www.healthypeople.gov/2020/ topicsobjectives2020/det:ault.aspx). Social workers have an important role to play in helping to address this charge. Social work's values, as articulated by the NASW Code of Ethics (NASW, 2008), call on us not only to honor the dignity and worth of all persons and to promote social justice, but also to more actively challenge social injustice, noting that social workers should pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people (p. 5). Social workers, therefore, have an ethical imperative to increase their capacity to provide culturally competent services to clients of all sexual orientations and gender identities, shedding assumptions of heterosexuality and creating more inclusive practices. They should also actively engage in the LGBTQ competency training for all health professionals. INEQUALITIES, SOCIAL JUSTICE, AND NEGATIVE HEALTH INDICATORS Recently, the Joint Commission for the Accreditation of Health Care Organizations set for a road map detailing requirements for the inclusion of LGBTQ loci within health care settings (Joint Commission, 2010). …

Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community

Members of the lesbian, gay, bisexual, and transgender (LGBT) community have unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. People from every race, nationality, gender, class, and political and religious affiliation are represented in the LGBT community, which is present in 99.3% of all counties in the United States.1–3 Clinicians care for patients, not populations; yet, if common health nuances within a population are unknown, how can best practices be applied?4 The National Standards for Diabetes Self-Management Education require an individualized assessment inclusive of cultural information, family support, and general psychosocial problems that may pose barriers to planning care effectively.5 This is the standard of clinical excellence and a guiding light for diabetes care professionals. The cornerstone of quality care starts with the assessment. If critical information is missed, in part because of institutional-level barriers (e.g., a climate that excludes LGBT individuals from equal-treatment models or forms that assume heterosexuality), provider-level barriers (unawareness of unique health traits or provision of substandard care solely based on presumed sexual orientation), and patient-level barriers (fear that disclosure could trigger provider homophobia and related harmful effects during their illness), then the diabetes care plan will lack completeness and potentially alienate these patients from seeking ongoing support.6–8 This article summarizes key concepts in providing culturally sensitive diabetes care for LGBT Americans by analyzing prevalence assumptions, unique health characteristics and diabetes risk factors, and patient concerns. It also offers tools to aid providers in caring for this underserved community. The author assumed that readers are allies for this special diabetes population and have first-hand experience or are familiar with the literature demonstrating that positive and supportive interactions with patients are crucial for successful …

The Lesbian and Gay Movements: Assimilation or Liberation? (review)

Reviewed by: The Lesbian and Gay Movements: Assimilation or Liberation? Colin R. Johnson The Lesbian and Gay Movements: Assimilation or Liberation? By Craig A. Rimmerman. Boulder: Westview Press. 2008. Nothing makes a young man feel old faster than reading a book that dwells primarily on the "history" of the 1980s and 90s. At least for me, this is particularly true when the history in question is the history of conflict between LGBT Americans and members of the right-wing under the past four presidential administrations. After all, for many people, including myself, these conflicts—conflicts that political scientist Craig A. Rimmerman seeks to put in some historical perspective in his new book—still have an overwhelming sense of ongoingness about them. Nevertheless, Rimmerman is arguably justified in stepping back a bit to ask "How much progress have the lesbian and gay movements made over the years in achieving larger movements' goals?" and "What political organizing strategies are the most effective, and which are the least effective?" (xi). As the book's interrogative title suggests, Rimmerman's answer to these important questions begins with an acknowledgement that the LGBT movements, as the author pluralistically refers to them, have themselves vacillated between two ideological dispositions: a desire to win equal inclusion within American society as it is, and a more confrontational drive to upend [End Page 250] fundamentally the gender and sexual normativity that underwrites homophobic antipathy in the United States. Somewhat reductively, Rimmerman lumps these impulses under the descriptors "assimilationist" and "liberationist" respectively, and then proceeds to weigh and consider their relative merits and demerits as political strategies within the context of four historical case studies: the homophile and gay liberation movements of the 1950s and 1960s, debates surrounding the formulation and implementation of HIV/AIDS policy during the 1980s and 1990s, the controversy over gays in the military that erupted when President Clinton announced that he would end the ban during his first campaign for the White House, and the rancorous squabble over gay marriage that is currently raging today. Ultimately, Rimmerman politely advocates what he calls "a dual organizing strategy, one that builds on the best of the assimilationist perspective, but one that also considers the possibilities for more radical, liberationist, structural, social and policy change" (147). As concluding recommendations go this one is certainly tidy, optimistic, and just about as even-handed as they come. But it also seems rather hollow given the fact that he has just spent almost a hundred and fifty pages demonstrating that these competing impulses began to emerge almost sixty years ago and have been with us, to one extent or another, ever since. Fortunately, there is much to recommend this book other than its argument, such as it is. Among other things, Rimmerman offers readers a detailed yet admirably concise survey of most of the major political and legislative skirmishes that have surrounded lesbians and gay men in the United States over the past half century. This alone makes the book a valuable resource for anyone wanting to inject some official political history into gender or LGBT studies courses—courses which often tend to huddle exclusively around "culture" as the proper domain of analysis. Additionally, Rimmerman's book also contains a nicely chosen collection of supplementary materials for which any teacher will undoubtedly be grateful. Along with chapter specific discussion questions, the book includes a glossary of terms, a relatively detailed timeline chronicling major events during the first twenty-five years of the HIV/AIDS pandemic, the exact language of the "Don't Ask, Don't Tell" law, and the names, telephone numbers, and website addresses for major U.S. LGBT organizations and advocacy groups associated with the Christian right. In other words, The Lesbian and Gay Movements: Assimilation or Liberation? is a volume that was quite obviously written to be taught—in undergraduate LGBT history courses, in courses dealing with the history of civil rights movements in the United States, and in courses that examine sexuality and American public policy. Readers who turn to Rimmerman's book with this purpose in mind will undoubtedly be pleased with much of what they find there. Colin R. Johnson Indiana University, Bloomington Copyright...