Inequities related to sexual orientation and gender identity


Health disparities between populations labelled as "sexual minorities" (either due to their sexual orentation or due to their gender identity) and the majority have been repeatedly documented in literature. The evidence suggests that the Lesbian, Gay, Bi sexual and Trans (LGBT) are disproportionately subjected to the negative social conditions that lead to health disparities. This is not really a matter of surprise since one can imagine the daunting challenge of having to grow up and remain healthy in a social and cultural milieu, where one has to constantly face unacceptance. This unacceptance could range from subtle and mild forms to overt and violent forms of rejection, isolation, verbal and physical abuse  both inside and outside the house throughut their lives. 

Sexual orientation refers to one's sexual identity based on the sex of those to whom one is sexually and romantically attracted to. Gender identity refers to “one’s sense of oneself as male, female, or transgender” (American Psychological Association, 2006). 

The disparities in physical and mental health observed between these groups and the rest have been described using many concepts, a major one being that of "minority stress". Four types of exposures have been found to contribute to this: negative events like discrimination, the stress of expecting negative events to occur, stress related to the concealment of sexual orientation, and internalization of societal negative attitudes. Another major aspect that is discussed in literature is the role of structural social and environmental discrimination in the form of unequal legislations and unfavourable policies and that of social capital. 

India is one among the countries where sexual orientation of citizens is still a matter of legal discrimination. The social conditions of existence, specific health needs, differential health vulnerabilities, health outcomes and other challenges of the LGBT population in this country is grossly under researched. There is also the need to explore the pathways through which structural discrimination or negative social environment impacts the health of these groups in the Indian context.

Our theme for the month is inequities related to sexual orientation and gender identity and we would be sharing with you learning resources and blogs relevant to the theme the whole of this month. We look forward to your inputs in the form of blogs, discussions and comments. Have a great month of learning!

Markwick L, Male, Female, Other: Transgender and the Impact in Primary Care, 2016: The Journal for Nurse Practitioners, Vol: 12, No: 5, p330-338.

In this paper, the authors discuss the transgender patient and outline basic care and issues that can arise in a primary care setting.

Philips JC, Morrisseau-Beck DA, Patsdaughter CA, ‘‘We Don’t Think You’re Special’’: Is Equitable HIV Prevention for Sexual Minorities Possible?, 2012: The Journal of the Association of Nurses in AIDS care, Vol: 23, No: 6, p478-486.

In this critical commentary, the authors describe epidemiological underpinnings that must guide all phases of structural approaches to HIV prevention, highlight global HIV prevention and sexual rights advocacy successes that have arisen for persons living with HIV and sexual minorities and call for dialog on and the development of a community-oriented public health (COPH) approach to HIV prevention, locally and globally.

Baldwin AM, Dodge B, Schick V, Sanders SA, Fortenberry JD, Sexual Minority Women’s Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation, 2017: Womens Health Issues, pii: S1049-3867(17)30019-1.

Using an ecosocial theory lens, the paper addresses the relationship between structural support or discrimination and satisfaction with one’s health care provider among sexual minority women.

Johnson MJ, Nemeth LS, Addressing Health Disparities of Lesbian and Bisexual Women: A Grounded Theory Study, 2014: Women Health Issues, Vol: 24, No: 6, p635-640.

This qualitative study based on grounded theory approach explores the barriers faced by Lesbian and Bisexual women to equitable health services.

Castaneda C, Developing gender: The medical treatment of transgender young people, 2014: Social Science and Medicine, Vol: 143.

Situated in an analysis of the history of engagement between between transgender activists and the medical community, this paper traces how the World Professional Association for Transgender Health's (WPATH) Standards of Care both achieves medical treatment for children and adolescents and reinforces a normative gender system by cleaving to a developmental approach.

Gridley SJ, Crouch JM, Evans Y Eng W, Antoon E, Lyapustina M Schimmel-Bristow A, Woodward J, Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth, 2016: Journal of Adolescent Health, Vol: 59, No: 3, p254-261.

The paper explores the barriers faced by transgender youth and their caregivers in accessing gender affirming health care

Agenor M , Krieger N, Austin SB, Haneuse S, Gottlieb BR, At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: Assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women, 2014: Vol: 116, p110-118.

Guided by ecosocial theory and intersectionality, the authors used data from the 2006-2010 National Survey of Family Growth, a national probability sample, to investigate how one dimension of sexual orientation, sex of sexual partners, and race/ethnicity jointly influence Pap test use among black, Latina and white U.S. women aged 21-44 years.

Bauer GR, Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity, Social Science & Medicine, 2014: Vol: 110, p10-17

In this paper, the challenges to incorporation of intersectionality theory into population health research are identified and expanded upon.

Newcomb ME, Mustanski B, Internalized homophobia and internalizing mental health problems: A meta-analytic review, 2010: Clinical Psychology Review, Vol: 30, No: 8, p1019-1029.

The study used Hierarchical Linear Modeling to perform meta-analysis of studies on internalized homophobia and mental health problems.  A small to moderate overall effect size for the relationship between the two variables. 

Fredriksen-Goldsen KI, Simoni JM, Kim H-J, Lehavot K, Walters KL, Yang J, Hoy-Ellis CP, The Health Equity Promotion Model: Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities, 2014: American Journal of Orthopsychiatry, Vol: 86, No: 6, p653-663.

To stimulate more inclusive research in the area of health outcomes of lesbian, gay, bisexual and transgender (LGBT) people, the authors present the Health Equity Promotion Model – a framework oriented toward LGBT people reaching their full physical and mental potential that considers both positive and adverse health-related circumstances.