Sexual Orientation Or Gender Identity Research Articles

Intersectionality-informed analysis of durable viral suppression disparities in people with HIV.

The aim of this study was to examine drivers of durable viral suppression (DVS) disparities among people with HIV (PWH) using quantitative intersectional approaches. A retrospective cohort analysis from electronic health records informed by intersectionality to better capture the concept of interlocking and interacting systems of oppression. We analyzed data of PWH seen at a LGBTQ federally qualified health center in Chicago (2012-2019) with at least three viral loads. We identified PWH who achieved DVS using latent trajectory analysis and examined disparities using three intersectional approaches: Adding interactions, latent class analysis (LCA), and qualitative comparative analysis (QCA). Findings were compared with main effects only regression. Among 5967 PWH, 90% showed viral trajectories consistent with DVS. Main effects regression showed that substance use [odds ratio (OR) 0.56, 0.46-0.68] and socioeconomic status like being unhoused (OR: 0.39, 0.29-0.53), but not sexual orientation or gender identity (SOGI) were associated with DVS. Adding interactions, we found that race and ethnicity modified the association between insurance and DVS ( P for interaction <0.05). With LCA, we uncovered four social position categories influenced by SOGI with varying rates of DVS. For example, the transgender women-majority class had worse DVS rates versus the class of mostly nonpoor white cisgender gay men (82 vs. 95%). QCA showed that combinations, rather than single factors alone, were important for achieving DVS. Combinations vary with marginalized populations (e.g. black gay/lesbian transgender women) having distinct sufficient combinations compared with historically privileged groups (e.g. white cisgender gay men). Social factors likely interact to produce DVS disparities. Intersectionality-informed analysis uncover nuance that can inform solutions.

Utterly Unbelievable: The Discourse of ‘Fake’ SOGI Asylum Claims as a Form of Epistemic Injustice

Abstract Media and political debates on refugees and migration are dominated by a discourse of ‘fake’ and ‘bogus’ asylum claims. This article explores how this discourse affects in acute ways those people claiming asylum on grounds of sexual orientation or gender identity (SOGI). In particular, the article shows how such a discourse of ‘fakeness’ goes far beyond the well-documented and often inadequate credibility assessments carried out by asylum authorities. By framing the analysis within the context of the scholarship on epistemic injustice, and by drawing on a large body of primary and secondary data, this article reveals how the discourse of ‘fake’ SOGI claims permeates the conduct not only of asylum adjudicators, but also of all other actors in the asylum system, including non-governmental organizations, support groups, legal representatives, and even asylum claimants and refugees themselves. Following from this theoretically informed exploration of primary data, the article concludes with the impossibility of determining the ‘truth’ in SOGI asylum cases, while also offering some guidance on means that can be employed to alleviate the epistemic injustice produced by the asylum system against SOGI asylum claimants and refugees.

Adverse Childhood Experiences and Adult Tobacco Use Among Sexual and Gender Minority Populations: Examining the Role of Mental, Social, and Community Health.

Purpose: We sought to evaluate the relationship between adverse childhood experiences (ACEs) and tobacco use, to assess the intersection of sexual orientation or gender identity (SOGI), and to explore risk and protective aspects of mental, social, and community health. Methods: This was a secondary analysis of the sexual and gender minorities (SGM) subsample (n = 1102) from a 2019 Community Health Needs Assessment. Nested binary logistic regression models were created to evaluate associations between ACEs and type of tobacco use: (1) cigarette use versus no cigarette or electronic nicotine delivery systems (ENDS) use, (2) ENDS use versus no cigarette or ENDS use, and (3) dual use versus use of either cigarettes or ENDS. Results: The sample population that reported four or more ACEs and ENDS use had statistically significant adjusted odds ratios (aORs) when adjusting the models for sociodemographic variables (aOR = 2.55; 95% confidence intervals [CIs]: 1.54-4.22), SOGI (aOR = 2.44; 95% CI: 1.46-4.10), current mental health (aOR = 2.23; 95% CI: 1.32-3.75), and social and community health (aOR = 2.19; 95% CI: 1.30-3.71). The sample population that reported poor mental health had statistically significant aORs when adjusting the models for sociodemographic variables, SOGI, and mental health (aOR = 2.26; 95% CI: 1.32-3.89) and social and community health (aOR = 2.06; 95% CI: 1.17-3.54). There was no statistically significant finding related to the other tobacco use variables (tobacco use and dual use). Conclusion: We found that high-risk ACEs were positively associated with cigarette use and ENDS use. SGM populations have differing experiences when considering community and social support.

LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity

We conducted in-depth, semi-structured interviews with LGBTQ+-identified individuals (n = 31) to explore the range of LGBTQ+ perspectives on genomic research using either sexual orientation or gender identity (SOGI) data. Most interviewees presumed that research would confirm genetic contributions to sexual orientation and gender identity. Primary hopes for such confirmation included validating LGBTQ+ identities, improved access to and quality of healthcare and other resources, and increased acceptance in familial, socio-cultural, and political environments. Areas of concern included threats of pathologizing and medicalizing LGBTQ+ identities and experiences, undermining reproductive rights, gatekeeping of health or social systems, and malicious testing or misuse of genetic results, particularly for LGBTQ+ youth. Overall, interviewees were divided on the acceptability of genomic research investigating genetic contributions to sexual orientation and gender identity. Participants emphasized researchers’ ethical obligations to LGBTQ+ individuals and endorsed engagement with LGBTQ+ communities throughout all aspects of genomic research using SOGI data.

Improving SOGI Asylum Adjudication: Putting Persecution Ahead of Identity

Abstract This article addresses the concern that decision-making in sexual orientation or gender identity (SOGI) asylum claims in Europe is often unfair, and that one way to remedy this is by improving the guidance provided to decision-makers when interpreting the Refugee Convention in respect of these claims. We begin by interrogating a number of different decision-making guidelines and models to assess whether they contribute to a fairer asylum system. We show that, for claims based on SOGI, success invariably depends on the decision-maker’s assessment as to whether a claimant is, or would be perceived in their home country to be, a member of a SOGI minority, and so belongs to a Particular Social Group. Such focus risks neglecting analysis of the actual risk of persecution. We set out our own recommendation for a fairer approach based on prioritising SOGI-specific Country of Origin Information (COI) and the risk of persecution, rather than focusing on whether applicants are ‘genuinely’ members of a SOGI minority. We argue that this will lead to fairer outcomes that are less likely to be overturned on appeal and more consistent with the Refugee Convention’s spirit and letter.

Analysing Norm-Based Advocacy Strategies to Address Asylum on the Basis of Sexual Orientation and Gender Identity in Europe

Abstract Whether and under what circumstances forced migrants can claim asylum on the basis of their sexual orientation or gender identity (SOGI) are questions that have received much attention in recent years as issues of human security are increasingly considered by scholars, civil society organization (CSO) practitioners, and the international community. Although there is an international institutional framework in place that establishes the bases for claiming asylum, SOGI is not explicitly mentioned, resulting in institutional gaps that potentially expose survivors of SOGI-related human rights violations to the risk of being denied international protection. At the regional level, individual member states within the European Union (EU) can interpret international legislation differently, resulting in inconsistencies in terms of who is granted protection. This situation has mobilized many CSOs to take action and work to create normative change. This article analyses how specific norm-based strategies for change that have been identified in advocacy work addressing other social and political issues are currently being applied to advocate for SOGI as a formal basis for claiming international protection in Europe. The analysis draws upon CSO documents, writings, and discourse in order to identify the norms they criticize and attempt to weaken, and to uncover the alternative norms they promote. Because norms are a key component of both formal and informal institutions, the article sheds light on how CSOs can use norm-based strategies as powerful mechanisms for advancing political and social change.

Measuring and Resolving LGBTQ Disparities in STEM

LGBTQ people have pioneered major scientific advances, but they face challenges in STEM that ultimately waste human talent and hinder scientific progress. Growing evidence suggests that LGBTQ people in STEM are statistically underrepresented, encounter non-supportive environments, and leave STEM at an alarming rate. Potential factors driving LGBTQ disparities in STEM include bias and discrimination, misalignments of occupational interests with STEM stereotypes, and STEM norms of impersonality that isolate LGBTQ people. LGBTQ retention shares common psychological processes with female and racial minority retention such as STEM identification and belonging. The key barrier to better understanding and addressing LGBTQ challenges in STEM is the lack of sexual orientation or gender identity (SO/GI) demographic data on the U.S. STEM workforce. Policy recommendations include (a) adding SO/GI measures to federal STEM-census surveys; (b) broadening agencies’ definition of underrepresented groups to include LGBTQ people; and (c) incorporating LGBTQ identity into accountability systems and diversity programs at STEM institutions.

169. Sexual and Gender Minority Homeless Youth and Their Sexual Relationships: A Systematic Review of Recent Literature

Youth with a minority sexual orientation or gender identity (SOGI) are over-represented among youth experiencing homelessness. It has become paramount to understand why SOGI youth and young adults are more prone to becoming homeless than their heterosexual and cisgender peers and homelessness’ association with health outcomes. Recent research on the sexual relationships of SOGI youth has made efforts to understand the social experiences of this population, yet, these studies are largely limited to providing prevalence and risk estimates (e.g., rates of victimization and odds of acquiring HIV/STIs) and does little to elucidate how social experiences are internalized and embodied by SOGI youth in their sexual relationships. The current literature review seeks to remedy this by reviewing and synthesizing relevant research related to the sexual development of SOGI youth experiencing homelessness.

New Research on Sexual Orientation and Gender Identity Discrimination: Effect of State Policy on Charges Filed at the EEOC

ABSTRACTIn 2013, the Equal Employment Opportunity Commission (EEOC) began allowing anyone who believed that they experienced sexual orientation or gender identity (SOGI) discrimination to file charges of sex discrimination under Title VII of the Civil Rights Act. Very little is known about the impact of the EEOC’s decision and whether it has enhanced protections for LGBT people. In this brief report, we present preliminary findings on trends and patterns in charge filing, paying particular attention to differences that emerge in charges filed in states with and without SOGI employment nondiscrimination laws. Differences in the characteristics of charging parties, allegations, and charge outcomes suggest that legal protections operating at the state level shape the experiences and disputing behaviors of LGBT individuals in pursuing Title VII remedies.

Lesbian, Gay, Bisexual, and Transgender Inpatient Satisfaction Survey: Results and Implications.

Background:Disparities in health care among lesbian, gay, bisexual, or transgender (LGBT) communities have been researched in primary care, but few have examined these phenomena among LGBT inpatients.Methods:Descriptive correlational study. A questionnaire was emailed to an LGBT population for a total of 508 participants. Questionnaires addressed level of satisfaction with hospital employees and whether this was related to their sexual orientation or gender identity (SOGI). Descriptive statistics describe participants and hospitals. χ2 was used to examine satisfaction and belief based on SOGI, recommendation to LGBT friends, and the relationship between location and likelihood of recommendation.Results:Those reporting dissatisfaction were likely to indicate it was related to their SOGI. They were less likely to recommend the hospital to LGBT friends or family. Analysis between location and recommendation identified rural hospitals as less likely to be recommended.Discussion:Lesbian, gay, bisexual, or transgender patients perceived lack of courtesy by hospital employees to be related to their SOGI.

Unmet support needs of sexual and gender minority breast cancer survivors.

This study explored sources of stress and support experienced by sexual and gender minority (SGM) breast cancer survivors and the impact of treatment on their lives. SGM breast cancer survivors were identified through purposive and referral sampling and invited to participate in a web-based survey containing both closed- and open-ended items. Sixty-eight SGM breast cancer survivors aged 18-75years completed the survey between May 2015 and January 2016. Bivariate analyses of quantitative data reveal that queer-identified (in either sexual orientation or gender identity (SOGI)) SGM survivors are more likely to report having bilateral mastectomy without reconstruction and to think that disclosing SOGI to providers affected their care. Queer-identified SGM survivors are also more likely to use LGBT-specific support groups and to report that their current level of social support is below average. Thematic analysis of qualitative comments revealed themes related to self-disclosure of SOGI to providers, need for recognition and support of partners, need for appropriate social supports for patients and partners, and impact of breast cancer treatment on intimate relationships. This study provides quantitative and qualitative evidence that many SGM breast cancer patients face a dearth of appropriate social supports, both from breast cancer survivor organizations and from within the medical system. These findings confirm the need for research on the physical and emotional effects of breast cancer treatment on SGM breast cancer survivors, as well as further exploration of the social support needs and experiences of SGM breast cancer patients and their partners.

Sexual and gender minority breast cancer patients choosing bilateral mastectomy without reconstruction: “I now have a body that fits me”

ABSTRACTSexual and gender minority (SGM) breast cancer patients have begun embracing the choice to “go flat” or opt out of reconstruction after bilateral mastectomy, though little is known about this population. SGM breast cancer survivors were identified through purposive and referral sampling and invited to participate in a web-based survey containing both closed- and open-ended items. Of the sixty-eight SGM breast cancer survivors aged 18–75 years who completed the survey between May 2015 and January 2016, 25 percent reported “going flat” (flattoppers®). Bivariate analyses revealed that flattoppers® were significantly more likely to have been diagnosed in the past five years, to identify as genderqueer, to have disclosed their sexual orientation or gender identity (SOGI) to providers, and to report participating in lesbian, gay, bisexual, or transgender cancer support groups, compared to other participants. More flattoppers® believed that SOGI mattered in terms of getting the support they needed regarding their cancer; this difference was not statistically significant. Thematic analysis of qualitative comments from flattoppers® revealed themes related to reasons for making this treatment choice, interactions with health-care providers around treatment choice, and physical and emotional outcomes of treatment choice. Providers would benefit from training about SOGI as they relate to treatment choices.

Abstract IA20: Cancer in Sexual and Gender Minority populations

Abstract Introduction: The LGBTQ population, also known as sexual and gender minorities (SGM) has increased risks for some cancers, not because of sexual orientation or gender identity (SOGI), but due to risk behaviors more prevalent in this population. Risk factors include higher rates of obesity, smoking, and alcohol use. The conundrum of these risk behaviors is that they are likely to have developed as a result of perceptions of stigmatization, marginalization, and overt discrimination. Further, the oncology community may not be trained in the unique needs of this population and institutions may not be collecting sexual orientation and gender identity (SOGI) data appropriately or at all. Methods: The presentation will focus on two areas: 1) An overview of the seven cancer sites disproportionately affecting LGBTQ populations, reviewing the current available literature on, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late stage disease, clinical implications and psychosocial factors related to cancer survivorship and 2) Results from a 38 item, national survey of 500 oncologists knowledge, attitudes, and practice behaviors with LGBTQ cancer patients. Results: Anal, Breast, Cervical, Colorectal, Endometrial, Lung, and Prostate cancer disproportionately affect the LGBTQ community. 153 oncologists (37% response rate) completed the survey. Results showed low rates of knowledge about LGBTQ health; high rates of comfort and confidence in caring for LGBTQ (95%); low rates of collecting SOGI data (11.4% collect sexual orientation; ~19% collect gender identity) Conclusions: Greater acceptance of SGM in the healthcare setting is needed for disclosure to occur more routinely and health care providers to respond to SOGI disclosure in ways that address needs. A welcoming environment conducive to SOGI disclosure is a key element in improving the quality of care. The collection of SOGI and an accurate and thorough sexual history is necessary for LGBTQ patients to receive proper screening, diagnosis and treatment for their cancer healthcare needs. Equally important is ensuring healthcare providers and staff are properly educated on the increased prevalence of risk factors as well as the specific needs of the LGBTQ population in regards to cancer care. Citation Format: Gwendolyn P. Quinn, Matthew B. Schabath, Miles For Moffitt Work Group. Cancer in Sexual and Gender Minority populations. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA20.

Queer Forms: Producing Documentation in Sexual Orientation Refugee Cases

Queer Forms: Producing Documentation in Sexual Orientation Refugee Cases1At a meeting for volunteers who helped to facilitate a monthly lesbian, gay, bisexual, and transgender (LGBT) refugee support group in Toronto, main topic was how to deal with increasing numbers of group members and their needs. When I first joined group as a volunteer in June 2011, there were approximately 35-40 people showing up for each meeting; by July 2012, there were almost 100 members in attendance. When one volunteer said that this increase was proof that we're doing something right, group leader reminded us that many of refugee claimants attending these meetings were doing so in order to get letters confirming their membership in support group or their participation as volunteers in other activities run by this organization. These letters would then be submitted to Canadian Immigration and Refugee Board (IRB) as part of refugee claimant's file. The group leader told us that letters were viewed by IRB adjudicators as the gold standard of evidence confirming a refugee's claim to be a member of a particular social group based on sexual orientation or gender identity (SOGI).2 The problem was that volunteers who wrote these letters on behalf of organization were feeling overwhelmed by many last minute requests, or by requests from members who had only recently joined group. Also, some of volunteers indicated they felt uncomfortable writing letters for people whom they didn't think were gay, lesbian, or bisexual. We debated for some time how to revise letter-writing process in order to ensure better accountability, accuracy, and timeliness; in end, we decided to create one new form and revise two other forms that would help us better track membership and attendance and introduce more structure to letter-writing process. First, people attending support group for first time would fill out a revised membership form asking for more details about their refugee application status; second, we would circulate a revised attendance sheet at each meeting; and, third, we would now ask members to fill out a new form when they wanted to set up a meeting with a volunteer for a letter to be written. Furthermore, no letter would be written unless a group member had attended at least three meetings. It was also decided that if a volunteer didn't feel comfortable writing a statement about claimant's sexual orientation-if gaydar3 doesn't go off were group leader's exact words-then they shouldn't feel obligated to make any statement about it in letter.The result of this meeting was more documentation and more regulation of production in order to maintain quality of a key (the letter), reflecting heightened sensitivity to making claims authenticating a refugee claimant's sexual orientation in letter and concern about reputation of organization. These results raise a number of interesting questions about governmentality, credible SOGI refugee claimants, and role of local support service workers in production of refugee documentation as well as surveillance and control of this particular form of queer migration. In this article, I want to move away from tendency in socio-legal refugee research to analyze linguistic content of specific documents as evidence of state processes of exclusion and inclusion4 and instead focus on reasons for, meanings of, and effects of production and proliferation of documentation in Canadian refugee system. In exploring sites and personnel involved in producing SOGI refugee documents and tracking changes to processes involved in creating these documents, I will argue that concern for managing quality and reputation among low level document brokers (Hull 2012:258) reflects regulatory modes of Canadian refugee system and its increased levels of suspicion and surveillance of human traffic crossing its borders. …

Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents.

Sexual minority youth (SMY) are at higher risk for victimization and suicide than are heterosexual youth (HY). Relatively little research has examined which types of victimization are most closely linked to suicide, which is necessary to develop targeted prevention interventions. The present study was conducted to address this deficit. The data come from the 2011 Chicago Youth Risk Behavior Survey (n = 1,907). Structural equation modeling (SEM) in Mplus evaluated the direct, indirect, and total effects of sexual orientation on a latent indicator of suicidal ideation and behaviors via seven types of victimization. Four indicators of victimization were school-specific (e.g., harassment due to sexual orientation or gender identity (SO/GID), bullying, threatened or injured with a weapon, and skipping school due to safety concerns), and three indicators assessed other types of victimization (e.g., electronic bullying, intimate partner violence, and sexual abuse). Thirteen percent of youth were classified as SMY. Significantly more SMY than HY reported suicidal ideation (27.95% vs. 13.64%), a suicide plan (22.78% vs. 12.36%), and at least one suicide attempt (29.92% vs. 12.43%) in the past year (all P < .001). A greater percentage of SMY reported SO/GID-related harassment, skipping school, electronic bullying, and sexual abuse. Sexual orientation was not directly related to suicidal ideation and behaviors in SEM. Rather, SMY's elevated risk of suicidality functioned indirectly through two forms of school-based victimization: being threatened or injured with a weapon (B = .19, SE = .09, P ≤ .05) and experiencing SO/GID-specific harassment (B = .40, SE = .15, P ≤ .01). There also was a trend for SMY to skip school as a strategy to reduce suicide risk. Although SMY experience higher rates of victimization than do HY, school-based victimization that involves weapons or is due to one's SO/GID appear to be the most deleterious. That SMY may skip school to reduce their risk of suicidal ideation and behaviors is problematic, and schools should be encouraged to enact and enforce policies that explicitly protect SMY from victimization.