LGBT SEXUALITY OUTLINE (LESBIAN , GAY, BISEXUAL , TRANSEXUAL)

Prepared by: rabino, princess dianne c.

LGBT- is used as an umbrella term to reflect the many identities covered in what used to be called the gay community. This was a term that oversimplified the community, and was rejected by many it was intended to describe. LGBT stands for lesbian, gay, bisexual, transgender. The acronym LGBT is confusing to some, so it is important to break down its components and dissect the rationale for the inclusion each letter. The LGBT community is diverse and tied together as an acronym that suggests homogeneity, each letter represents a wide range of people of different races, ethnicities, ages, socioeconomic status and identities. What binds them together as social and gender minorities are common experiences of stigma and discrimination, the struggle of living at the intersection of many cultural backgrounds and trying to be a part of each, and, specifically with respect to health care, a long history of discrimination and lack of awareness of health needs by health professionals. LGBT people face a common set of challenges in accessing culturallycompetent health services and achieving the highest possible level of health.

SEXUAL ORIENTATION VS GENDER IDENTITY

DEFINITION OF TERMS
SEXUALITY- A major theme in contemporary reflections on identity, informed especdially by psychoanalysis, feminsim, and queer theory, the term is related to but distinct from sex (used to refer both to the physical distinction between men and women and sexual intercourse) and gender (the social and cultural distinctions between men and women). Sexuality is used rather, say Jackson and Scott, to refer to erotic desires, practices and identities or aspects of personal and social life which have erotic significance. This suggests a highly varied set of meanings. Debates on sexuality in the recent period are marked above all by an increased awareness of this tension; between an acceptance or affirmation of diversity on the one hand and a defense of the established norms on the other.

SEXUAL ORIENTATION-.It refers to the sex of those to whom one is sexually and romantically attracted. Categories of sexual orientation typically have included attraction to members of ones own sex (gay men or lesbians), attraction to members of the other sex (heterosexuals), and attraction to members of both sexes (bisexuals). While these categories continue to be widely used, research has suggested that sexual orientation does not always appear in such definable categories and instead occurs on a continuum (e.g., Kinsey, Pomeroy, Martin, & Gebhard, 1953; Klein, 1993; Klein, Sepekoff, & Wolff, 1985; Shiveley & DeCecco, 1977) In addition, some research indicates that sexual orientation is fluid for some people; this may be especially true for women (e.g., Diamond, 2007; Golden, 1987; Peplau & Garnets, 2000). GENDER IDENTITY- A persons own sense of identity as a man, woman, or a combination of both or neither. This personal sense of identity may or may not match biological sex, how an individual presents oneself to the world, or how an individual is socially perceived SEXUAL ORIENTATION: 1. Lesbian - A woman or girl whose attraction is to people of the same sex 2. Gay A man or boy whose attraction is to people of the same sex 3. Bisexual A person whose attraction is to people of either sex GENDER IDENTITY: 1. Transgender- A term used to describe someone whose gender identity falls outside of the stereotypical gender norm

LGBT STATISTICS WHY IS LGBT HEALTH IMPORTANT??

REASONS:
There is a long history of anti-LGBT bias in healthcare

In a pathologic understanding of homosexuality and transgender identity, many LGBT individuals were subjected to treatments such as electroshock therapy or castration in the past (Context 2011). Such treatments have now fallen from favor in the medical community and been formally disavowed by many medical and professional societies, but some clinicians continue to harbor anti-LGBT attitudes. As recently as the 1990s, nearly one-fifth of physicians in a California survey endorsed homophobic viewpoints, and 18% reported feeling uncomfortable treating gay or lesbian patients (Smith 2007). Attitudes have improved, but in a national survey in 2002, 6% of United States physicians still reported discomfort caring for LGBT patients (Kaiser 2002). Because of prior experiences of bias or the expectation of poor treatment, many LGBT patients report reluctance to reveal their sexual orientation or gender identity to their providers, despite the importance of such information for their health care (Eliason 2001).

Health disparities which affect members of this population

Health disparities stem from structural and legal factors, social discrimination, and a lack of culturally-competent health care. Sexually transmitted infections, including human immunodeficiency virus (HIV), are major concerns in some LGBT groups, particularly MSM and male-to-female transgender persons. Higher rates of breast and cervical cancer among lesbian and bisexual versus heterosexual women (Valanis 2000) LGBT have the highest smoking rates of any sub-population (Tobacco 2008). In addition to tobacco abuse, alcohol and other drug abuse may be more common among LGBT (Song 2008) . Several studies have also suggested higher rates of depression, anxiety, and suicidal ideation among gay, lesbian, and bisexual individuals (Ruble 2008). There is also a higher rate of substance abuse and mental disorders in LGBT that result in internalized homophobia, depression, and anxiety (Meyer 2003).

MARRIAGE, REPRODUCTION, AGING

MARRIAGE Marriage is a priority for many members of the LGBT community, but same-sex marriages are licensed in only six states; another two states recognize same-sex marriages performed in another jurisdiction, and another twelve states provide at least some statelevel spousal benefits to same-sex couples Thirty-nine states have laws banning same-sex marriage (NCSL 2012). Other than permitting same-sex couples to receive the same material and legal benefits available to others, the right to marry has also been associated with greater feelings of social inclusion among LGBT individuals, whether married or not (Badgett 2011). REPRODUCTION The pathways to child-rearing for lesbian and gay couples vary. In many cases, children being raised by same-sex couples are the products of previous, opposite-sex relationships (Family 2011) International adoption is rarely an option due to other countries bans on LGBT adoption (Adoption 2012). AGING LGBT individuals face unique challenges as they age. The current cohort of LGBT seniors grew up in periods of less social acceptance of LGBT lifestyles and thus may harbor greater fears of stigma and discrimination than their younger counterparts. FEARS may become particularly acute when LGBT elders are no longer able to live independently and must move into communal housing arrangements or avail themselves of social services, prompting some to newly conceal their sexual orientation after years of living openly (Johnson 2005). Less likely to have children, LGBT elders may have fewer options for family support in the face of illness and disability.

Older adulthood may also be more economically precarious for LGBT individuals, as they do not have access to spousal, survival, or death. LGBT persons demonstrate resilience as they age. Indeed, a majority of respondents in one recent survey of aging LGBT individuals felt that their LGBT status had prepared them for aging by fostering inner strength (MetLife 2010).

Transgender Elders
Gender is not congruent with biological sex Estimates 1 in 30,000 M to F, 1 in 100,000 F to M Being transgender does not go away with aging 74 year old M to F surgery after wife died

Bisexual Elders
Sexual attraction towards or sexual behavior with persons of both genders Little research 4% report attraction to both sexes .8% of men & .5% of women identify as bisexual

HEALTH ISSUES

Older Lesbians: Health Issues Heart disease Cancers Arthritis Higher rates of smoking

 Higher BMI Fewer preventive health exam

Older Gay Men: Health Issues Heart disease/ stroke Cancers STDs HIV/AIDS Higher rates of smoking

Transgender Older Adults: Health Issues

Hormones Surgical changes Organs & organ size Lab values Sexually transmitted diseases

Older Bisexuals: Health Issues Lack of research on bisexuals Same issues as gays and lesbians Risk Factors HIV/AIDS Mental Health/ Spiritual Issues of Older LGBT Adults Discrimination/ internalized homophobia Self image Depression

 Grief and loss Disenfranchised grief Substance abuse Exclusion from religious support Under-utilization of Health Care Much commitment to cultural sensitivity little to interests of LGBT community Negation as a cultural group Paucity of information Invisibility Coming out to providers is risky Lack of rights of partners/ isolation of patient and family Mental Health Issues: LGBTQ Adjustment to Aging Most well adjusted to aging Crisis competence Social support network: less family - more friends Major concerns: loneliness, health, income, and discrimination

MEET THE OLDER NEIGHBORS: A PORTRAIT OF RHODE ISLANDS OVER FIFTY LESBIAN, GAY, BISEXUAL, AND TRANSGENDER COMMUNITY BISEXUAL, AND TRANSGENDER COMMUNITY
SAGE/RI 2005

Survey design modeled after Meet the Neighbors Snowball sampling not generalizable; some refused in fear of being outed Self-identified as LGBT Surveys completed anonymously Sample size = 148 Age 50-59 55% 60-69 30% 70+ - 15% White - 97% Female 52%; male 45%; transgender 3% Sexual orientation: gay 45%; lesbian, 45%; bisexual 6%; other 3% Education 1. 22% college grads 2. 49% postgraduate education 3. Employment > age 60 4. 21% full time 5. 18% part time 6. 56% retired

TOPICS:
Living Arrangements/ Transportation/ Socialization 78.4% own homes 93.9% drove own car Most socialized mainly in private homes (85%) Of those > age 70, 18% didnt often socialize

Relationships 60% currently in a relationship 55% over age 70 were single Average time in current relationship 16.7 years (range 1 49) 17% had partner who died 40% were parents 42% had been in heterosexual marriage

Spirituality 31% were out to their clergy 22% felt supported by their clergy 10% had experienced or witnessed homophobia at their religious institution Sexual Orientation Issues: Homophobia 73% - no homophobia directed toward them personally in the past year Percent experienced or witnessed homophobia at some time in past year at Public establishment (35%) Work (By firefighter, police etc (11%) Religious institution (10%) In a medical setting (10%) Home (8%) In senior housing (5%) (2 people -daily)

Community/ Leisure Activities 97% registered to vote; 93% always voted in regular elections 66% volunteered in past year 56% participated in educational seminars at least yearly 62% used a computer daily (31% >70) 79% each watched TV and read daily 81% traveled a few times a year

Health 90% had good or excellent health Had no health insurance (2%) Exercised regularly (34%) Ate 4 or more servings fruits and vegetables (33%) Overweight by > 30 lbs. (21%) Trouble sleeping (46%) Smoked cigarettes (14%) Had been abused (51%) Currently being abused (7%) Of those > age 70 18% have difficulty with household tasks 4% have trouble with personal care 14% have difficulty with shopping and meal preparation

Who Will Care for Me? Partner 60% Friend 35% Child 9% Dont know 27%

Summary of Needs/ Issues Health Care LGBT sensitive health care providers and services LGBT friendly nursing homes

 Personal Health Issues Health behavior change exercise, weight loss, smoking, sleep improvement, HIV testing and risk reduction Options for provision of personal care LGBT Community Services Support services specifically for LGBT elders Strategies to Improve Quality of Life for the LGBTQ Elders Welcoming agencies and health care providers Sensitive assessments Education for providers Appropriate screenings Mental health care Resources for uninsured Support networks Local resources

References:
Jackson, Stevi and Scott, Sue (eds.) (1996) Feminism and Sexuality: A Reader *The 2011 guidelines replace the Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients adopted by the Council, February 26, 2000, which expired at the end of 2010. Gordon, V. N., Habley, W. R., Grites, T. J., & National Academic Advising Association (U.S.) (2008). Academic advising: A comprehensive handbook. San Francisco, CA: Jossey-Bass. King, E. B., Hebl, M. R., George, J. M., & Matusik, S. F. (2006). Negative consequences of perceived gender discrimination in male-dominated organizations: A field study. Unpublished manuscript, Rice University. Moorhead, C. (2005). Advising lesbian, gay, bisexual, and transgender students in higher education. Retrieved from the NACADA Clearinghouse of Academic Advising Resources Web site: www.nacada.ksu.edu/Clearinghouse/AdvisingIssues/LGBTA.htm. Smith, B. (2006). Working more effectively in advising: Understanding multicultural dimensions of gay, lesbian, bisexual, and transgender identities. Retrieved from the NACADA Clearinghouse of Academic Advising Resources Web site: http://www.nacada.ksu.edu/Clearinghouse/AdvisingIssues/GLBT-Definitions.htm Kevin L Ard MD, M. a. (n.d.). IMPROVING THE HEALTH CARE OF LESBIAN,. The National LGBT Health Education Center, The Fenway Institute1,2;, 1-16.