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LGBT Health Resources

Resources and Literature for Clinicians on LGBT Health Topics

Clinicians who are competent in LGBT care can better meet their patients' often complex healthcare needs. Below is a compilation of some of the top resources and literature on LGBT healthcare issues.

LGBT Health in the News:

General Clinician LGBT Health Resources

Resources

  • Creating an LGBT Friendly Practice. American Medical Association (AMA). Summary: Resources to help clinicians make their practice LGBT friendly, including a sample intake form, a podcast to help physician expand into the gay and lesbian market, recommended standards of practice with LGBT patients, and tips on providing a welcoming environment for LGBT patients.
  • Communicating with LGBT Patients. AMA. Summary: Resources to improve physician communication with LGBT patients, including a video on best practices when taking a sexual history and learning modules to introduce practitioners to the LGBT population.
  • Meeting the Healthcare Needs of LGBT People. AMA and the Fenway Institute. Summary: A comprehensive presentation on LGBT health care in America. This resource is filled with information on caring for LGBT patients, the national LGBT health care landscape, and the future of LGBT health care. Dr. Harvey J Makadon, Clinical Professor of Medicine at Harvard Medical School, presents.
  • CME on LGBT Health Topics. Gay and Lesbian Medical Association (GLMA).
  • The Health-Care Advocacy Guild. Summary: The Health-Care Advocacy Guild is a non-profit grassroots organization comprised of LGBT-Affirming Healthcare Providers. The site is clearinghouse for sexual and gender minority medical and mental healthcare.

  • The George Washington University LGBT Health Graduate Certificate Program. Summary: The LGBT Health Graduate Certificate program trains current and future healthcare leaders to develop strategies that address health issues and reduce health disparities for the LGBT Population. Administered by the Professional Psychology Program, the one-year, 12-credit program provides students with a general knowledge of the psychological, medical, and policy-based issues faced by LGBT individuals.
  • Drexel University Certificate in Lesbian, Gay, Bisexual, and Transgender Health. Summary: The Certificate is intended for graduate students and practicing healthcare professionals and has a strong emphasis placed on understanding the complex ethical considerations involved in the study of LGBT populations. The program consists of three online graduate-level courses, wherein participants will review the health concerns faced by LGBT people and critique the research, sampling and measurement methodologies used to investigate LGBT health and health disparities.
  • The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Published by the American College of Physician. Edited by Harvey Makadon, Ken Mayer, and Hilary Goldhammer of the Fenway Institute, and Jennifer Potter of Beth Israel Deaconess Medical Center. Summary: The Fenway Guide is the first American medical textbook dedicated to LGBT health.
  • LGBT Resources and Programs through the CDC.
  • LGBT Resources through HHS.
  • Reaching Out to "Other" Special Population: Providing Services to Lesbian, Gay, Bisexual and Transgender Patients. National Association of Community Health Centers. Summary: This Information Bulletin provides guidance on furnishing services to meet the needs of LGBT patients. The U.S. Department of Health and Human Services (DHHS) has identified lesbian and gay Americans as one of six U.S. population groups affected by health disparities. Because LGBT patients may not always feel comfortable self-identifying as LGBT, health centers should assume that they are already serving LGBT patients. To assist health centers in meeting the needs of this population, this Information Bulletin: Distinguishes between sexual and gender identity and sexual behavior; Identifies risk factors for LGBT health; Describes service delivery issues that arise in furnishing care to LGBT patients; and Offers strategies to improve services to LGBT patients.
  • National LGBT Health Education Center. The Fenway Institute.
  • Center Link: The Community of LGBT Centers. Summary: This database contains information about member LGBT Community Centers and member Affiliates in the United States and around the world. It also contains a listing of local, state and national LGBT advocacy groups.
  • OneVoiceIndiana. Summary: OneVoiceIndiana seeks to: 1. Educate the public and our state leaders regarding public health issues unique to the LGBT community; 2. Help Hoosiers understand the potential negative consequences of discriminatory law - such as the General Assembly's proposed HJR-6; and, 3. Create a common site for individuals and organizations to publicly show their support for all citizens of our state - affirming LGBTQ individuals, same-sex couples, and their families.

Literature

  • Improving Health Care for Lesbian and Gay Communities. Harvey J. Mackadon. New England Journal of Medicine.
  • Optimizing Primary Care for Men Who Have Sex With Men. Harvey J. Makadon, Kenneth H. Mayer, Robert Garofalo. Journal of the American Medical Association. Summary: Given the range and fluidity of sexual behavior and identity among MSM, it is important for clinicians to recognize the medical implications of sexual behavior, as well as to identify patients whose sexuality may be evolving and who may want help identifying themselves as gay to friends, family, and society, ie, "coming out." At the same time, physicians and other clinicians must appreciate the need to provide care and support for MSM for whom social and cultural reality may preclude coming out or the desire to do so.
  • Health Care Screening for Men who have Sex with Men. Daniel Knight. American Family Physician. Summary: Men who have sex with men often do not reveal their sexual practices or sexual orientation to their physician. Lack of disclosure from the patient, discomfort or inadequate training of the physician, perceived or real hostility from medical staff, and insufficient screening guidelines limit preventive care. Because of greater societal stresses, lack of emotional support, and practice of unsafe sex, men who have sex with men are at increased risk for sexually transmitted diseases (including human immunodeficiency virus infection), anal cancer, psychologic and behavioral disorders, drug abuse, and eating disorders. Recent trends indicate an increasing rate of sexual risk-taking among these men, particularly if they are young. Periodic screening should include a yearly health risk and physical assessment, as well as a thorough sexual and psychologic history. The physician should ask questions about sexual orientation in a nonjudgmental manner; furthermore, confidentiality should be addressed and maintained. Office practices and staff should be similarly nonjudgmental, with confidentiality maintained. Targeted screening for sexually transmitted diseases, depression, substance abuse, and other disorders should be performed routinely. Screening guidelines, while inconsistent and subject to change, offer some useful suggestions for the care of men who have sex with men.
  • Primary Care for Lesbians and Bisexual Women. Sally A. Mravcak. American Family Physician. Summary:Review and recommendations from the American Academy of Family Physicians (AAFP).
  • Bisexual health: An introduction and model practices for HIV/STI prevention programming. National Gay and Lesbian Task Force Policy Institute, BiNet USA, and the Fenway Institute. Summary: Sexual health issues affecting bisexuals have been largely ignored and underrepresented in academic and professional literature. Many bisexuals have negative experiences with health care providers, whether it is because they are afraid to come out to their providers or because their providers give them improper or incomplete information on HIV/STI prevention. This report serves as an introduction to bisexuality and a model programming guide for HIV/STI prevention.
  • HHS LGBT Issues Coordinating Committee 2012 Report. Department of Health and Human Services.
  • Healthcare Equality Index. Human Rights Campaign. Summary: The HEI allows U.S. healthcare facilities to assess the degree to which they provide LGBT patient-centered care, to identify and remedy any gaps and to make public their commitment to LGBT patients and their families.

General LGBT Patient Health Resources
LGBT Demographics in the United States

Literature

  • Gallup Special Report: New Estimates of the LGBT Population in the United States. Gary J. Gates, Frank Newport February 2013. Summary: The percentage of adults in the United States who identify as lesbian, gay, bisexual or transgender (LGBT) ranges from 1.7% in North Dakota to 5.1% in Hawaii and 10% in the District of Columbia. While LGBT communities are clearly present in every state in the union, their visibility is generally higher in states with greater levels of social acceptance and LGBT supportive legal climates.
  • Demographic, Psychological, and Social Characteristics of Self-Identified Lesbian, Gay, and Bisexual Adults in a US Probability Sample. Herek, Norton, Allen, Sims. Sexual Research and Social Policy. Summary: Using data from a US national probability sample of self-identified lesbian, gay, and bisexual adults (N=662), this article reports population parameter estimates for a variety of demographic, psychological, and social variables. Special emphasis is given to information with relevance to public policy and law. Compared with the US adult population, respondents were younger, more highly educated, and less likely to be non-Hispanic White, but differences were observed between gender and sexual orientation groups on all of these variables. Overall, respondents tended to be politically liberal, not highly religious, and supportive of marriage equality for same-sex couples. Women were more likely than men to be in a committed relationship. Virtually all coupled gay men and lesbians had a same-sex partner, whereas the vast majority of coupled bisexuals were in a heterosexual relationship. Compared with bisexuals, gay men and lesbians reported stronger commitment to a sexual-minority identity, greater community identification and involvement, and more extensive disclosure of their sexual orientation to others. Most respondents reported experiencing little or no choice about their sexual orientation. The importance of distinguishing among lesbians, gay men, bisexual women, and bisexual men in behavioral and social research is discussed.

Treating Transgender Patients

Literature

  • Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Coleman, E., et.al. Abstract:
    The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.

  • Controversies in Gender Diagnoses. Jack Drescher. LGBT Health. Summary: This article summarizes some of the published conclusions of the DSM-5 and ICD-11 revision processes regarding three particular controversies: (1) stigma versus access to care; (2) the retention of a child gender diagnosis; and (3) the treatment of prepubescent transgender children. Both the DSM and ICD work groups decided that despite the stigma associated with a diagnosis, retaining an adolescent and adult gender diagnosis is necessary to maintain access to care. As for the child gender diagnosis, given the heterogeneity of this clinical population and that gender dysphoria does not persist in most children, a child diagnosis of Gender Dysphoria (DSM) and Gender Incongruence (ICD) should be retained to facilitate ongoing evaluation and management in childhood while acknowledging the uncertainty of the outcome.
  • Management of Transgenderism. Norman P. Spack, MD. Journal of the American Medical Association. Summary: Despite increased awareness, transgenderism remains a poorly understood disorder among clinicians. Clinical treatment for transgenderism, officially known as gender identity disorder (GID), can include both hormone and surgical treatments. But patients also need counseling and medical monitoring. Recently, the Journal of the American Medical Association featured a GID treatment interaction in its Clinical Crossroads section. The article begins with a description of an actual patient diagnosed with GID and a discussion of the patient’s perspective as she receives medical care. It continues with an interview with the treating physician, Dr. Norman Spack, who talks about how he approached the care of this patient. There is a perceptible increase in the number of people in the United States coming forward as transgender, and at younger ages. This makes increasingly important for physicians to be aware of, and knowledgeable about the needs of, GID patients. This includes the mental health side. Dr. Spack explains that "the role of mental health clinicians in managing these patients through their self-discovery and treatment is critical."
  • Treating Transgender Children and Adolescents: An Interdisciplinary Discussion. Edited by Jack Drescher and William Byne. Summary: Extremely gender variant children and adolescents (minors), increasingly referred to as 'trans' or 'transgender children,' are small in number. In recent years, their situation has become highly sensationalized, whilst the matter of how to best treat them remains an area of controversy. A growing body of research supports emerging treatment approaches, but more research is still needed to answer a host of questions: Do trans minors have a psychiatric disorder or a normal variation of gender presentation? Should treatment be aimed at helping them accept the bodies into which they were born or should parents, clinicians and schools accommodate their wishes of transition? At what age should transition begin? What are the implications – physical, psychological, social and ethical – of various treatment approaches? The first part of this volume explores different clinical approaches to transgender minors in the USA and abroad. The second part contains responses to these approaches by commentators from various fields including biology, child psychiatry, civil rights activism, ethics, law, gender studies, queer theory and psychoanalysis. The work will be an invaluable source for parents and families looking at how to proceed with a trans child, as well as clinicians seeking to make appropriate referrals. This book was originally published as a special issue of the Journal of Homosexuality.
  • Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior. Summary: Both the diagnosis and treatment of Gender Identity Disorder (GID) are controversial. Although linked, they are separate issues and the DSM does not evaluate treatments. The Board of Trustees (BOT) of the American Psychiatric Association (APA), therefore, formed a Task Force charged to perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA. The literature on treatment of gender dysphoria in individuals with disorders of sex development was also assessed. The completed report was accepted by the BOT on September 11, 2011. The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups. With subjective improvement as the primary outcome measure, current evidence was judged sufficient to support recommendations for adults in the form of an evidence-based APA Practice Guideline with gaps in the empirical data supplemented by clinical consensus. The report recommends that the APA take steps beyond drafting treatment recommendations. These include issuing position statements to clarify the APA's position regarding the medical necessity of treatments for GID, the ethical bounds of treatments of gender variant minors, and the rights of persons of any age who are gender variant, transgender or transsexual.
  • Stigma, Mental Health, and Resilience in an Online Sample of the US Transgender Population. Walter O. Bockting, Michael H. Miner, Rebecca E. Swinburne Romine, Autumn Hamilton, and Eli Coleman. American Journal of Public Health. Summary: In 2003, the authors recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. The authors found few differences by gender identity. The findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.

LGBT Youth and Adolescents

Resources

  • AMA Webpage on LGBT Youth Suicide. Summary: Suicide is the leading cause of death for LGBT youth in America. Recent instances of suicide in the LGBT youth community have attracted major media attention and raised awareness of the issue, but there is much more that can be done to lower the number of suicides nationally. This AMA webpage helps clinicians learn about the issue, hear from people who have been affected, and find resources to help at-risk LGBT youth in your community.
  • Physicians for Reproductive Health's Adolescent Reproductive and Sexual Health Education Program (ARSHEP). Summary: This program prepares a select group of physicians to give free educational sessions to other providers about the best practices for adolescent reproductive and sexual health. They have created a comprehensive, evidence-based curriculum (available on CD-ROM) for residency programs, providers, and other professionals who serve adolescents on critical reproductive and sexual health topics. With this information, health care providers nationwide can focus their attention on what's most important—helping their young patients make informed decisions about their reproductive and sexual health.

Literature

  • Growing up LGBT in America. Human Rights Campaign. Summary: HRC's report is a groundbreaking survey of more than 10,000 LGBT-identified youth ages 13-17. It provides a stark picture of the difficulties they face – the impact on their wellbeing is profound however these youth are quite resilient. They find safe havens among their peers, online and in their schools. They remain optimistic and believe things will get better. Nevertheless, the findings are a call to action for all adults who want to ensure that young people can thrive.
  • A Review of Gay, Lesbian, Bisexual, and Transgender Youth Issues for the Pediatrician. Pediatric Annals. Summary: CME article with objectives of 1) Reviewing common lesbian, gay, bisexual, and transgender (LGBT) terminology and discuss sexual constructs as they are currently understood; 2) Determining the prevalence of LGBT youth and identify health disparities in the LGBT population; and 3) Providing strategies to develop an accepting atmosphere for LGBT youth in the pediatric practice, including the maintenance of ongoing health and appropriate screening for at-risk behaviors.
  • Findings from a National Survey of Service Providers: Working with Lesbian, Gay, Bisexual and Transgender Youth Who are Homeless or at Risk of Becoming Homeless. The Pallette Fund, The Williams Institute, and The True Colors Fund. Summary: This report by the The Palette Fund, True Colors Fund, and the Williams Institute presents data from The LGBT Homeless Youth Provider Survey, a web-based survey conducted from October 2011 through March 2012. The survey was designed to assess the experiences of homeless youth organizations in providing services to LGBT youth. It also assessed the prevalence of LGBT youth within the homeless populations being served by these organizations.
  • Developmental Trends in Peer Victimization and Emotional Distress in LGB and Heterosexual Youth. Joseph P. Robinson, Dorothy L. Espelage, and Ian Rivers. Pediatrics. Summary: Victimization of LGB youth decreases in absolute, but not necessarily relative, terms. The findings suggest that addressing LGB victimization during adolescence is critical to reducing LGB–heterosexual emotional distress disparities but additional support may be necessary to fully eliminate these disparities.
  • Sexual Orientation in Child and Adolescent Health Care. Ellen Perrin. Summary: A resource for child health care professionals including pediatricians, family physicians, nurses, pediatric psychologists, child and adolescent psychiatrists, and social workers. The issues of sexuality and sexual orientation now generate great interest among those who treat children. This volume describes the effects of stigmatization on non-heterosexual physicians, patients, and students, and discusses a variety of clinically relevant topics including the development of sexual orientations, children of gay or lesbian parents, young children with gender atypical behavior, and the healthcare needs of gay and lesbian adolescents. The last two chapters describe methods for improvement in medical education and medical care, and provide extensive resources available to professionals and consumers.

Treating Older LGBT Patients

Resources

  • Working with Older Lesbian, Gay and Bisexual People: A guide for Care and Support Services. Stonewall. Summary: The guide offers an overview of what older gay people need, advises on what care and support workers can do to make their aging process easier, and suggests further resources for care providers wanting to learn more about this at-risk population.
  • SAGE – Services and Advocacy for LGBT Elders. Services & Advocacy for LGBT Elders (SAGE) is the country's largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual and transgender (LGBT) older adults. Founded in 1978 and headquartered in New York City, SAGE is a national organization that offers supportive services and consumer resources for LGBT older adults and their caregivers, advocates for public policy changes that address the needs of LGBT older people, and provides training for aging providers and LGBT organizations, largely through its National Resource Center on LGBT Aging. With offices in New York City, Washington, DC and Chicago, SAGE coordinates a growing network of 23 local SAGE affiliates in 16 states and the District of Columbia.

Literature

  • Stress and Mental Health Among Midlife and Older Gay-Identified Men. Richard G Wight, Allen J. LeBlanc, Brian de Vries, and Roger Detels. Summary: Sexual minority stress, along with aging-related stress, jeopardizes the mental health of midlife and older gay men. In the study, sexual minority stress included the men's perceptions that they needed to conceal their sexual orientation or that others were uncomfortable with or avoided them because of their sexual orientation. The study also found that legal marriage for same-sex couples may confer a unique protective effect against poor mental health. Having a same-sex domestic partner or same-sex spouse boosted the emotional health of the studied men, but having a same-sex legal spouse appeared to be the most beneficial relationship arrangement.
  • End-of-life care considerations for gay, lesbian, bisexual, and transgender individuals. Rawlings. Palliative & Supportive Services. Summary: Negative social attitudes, discrimination, and homophobia affect LGBT individuals during their lifetimes. These experiences can affect how these individuals access health services and interact with health professionals, resulting in adverse outcomes compared with their heterosexual counterparts. End-of-life experiences can also be shaped by these factors. There are implications for health professionals in terms of equity of access to targeted health care, preventive screening, and visibility in policy, as well as in principles of inclusiveness, dignity and respect, and competence in care. This article takes a brief look at some of the issues specific to the end-of-life care of LGBT individuals, using a case study as an illustrative example. Holistic care at the end of life is a familiar concept to palliative care nurses, but it is important to place greater emphasis on considering competence in aspects of care relating to sexuality.

Disparities and Gaps in LGBT Care/Research

Resources

Literature

  • The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Institute of Medicine. Summary: To help assess the state of the science, the National Institutes of Health (NIH) asked the IOM to evaluate current knowledge of the health status of lesbian, gay, bisexual, and transgender populations; to identify research gaps and opportunities; and to outline a research agenda to help NIH focus its research in this area. The IOM finds that to advance understanding of the health needs of all LGBT individuals, researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. Building a more solid evidence base for LGBT health concerns will not only benefit LGBT individuals, but also add to the repository of health information we have that pertains to all people.
  • LGBT Health Research Falls Far Short: Little Known About Health Needs in U.S. for Lesbian, Gay, Bisexual, and Transgender People. Daniel J. DeNoon. WebMd.com.
  • New Doctors Trained to Overcome LGBT Health Care Gap. Carolyne Krupa. American Medical News.
  • Lesbians in empirical psychological research: a new perspective for the twenty-first century? Lee IC, Crawford M.  Journal of Lesbian Studies. Summary: Lesbians have been consistently ignored in empirical psychological research. The current research extends Lee and Crawford's (2007) comprehensive review, which used both quantitative and qualitative approaches to analyze the amount and kind of research on lesbians. Quantitative measures from 1975-2009 showed that the increase found in Lee and Crawford in 2001 has leveled off and the neglect of lesbians remains pronounced. Using cluster analysis of data derived from content analysis of abstracts published from 2003-2009, the authors identified six topic groups: Others' Attitudes, Sexual Orientation, Intimate Relationships, Coping and Coming Out, Lesbians' Problems, and Life in Heterosexual Society. In particular, transformative research was scarce and scattered across the identified clusters. Results are discussed in terms of what they reveal about the social construction of lesbianism in psychological research.
  • Development of Expertise in Mental Health Service Provision for Lesbian, Gay, Bisexual and Transgender Communities. Rutherford K, McIntyre J, Daley A, Ross LE. Medical Education. Summary: Data from this study suggest there are few opportunities for medical providers to access training and gain expertise in the provision of care to LGBT people. Additional research is needed to consider whether the lack of LGBT health content in medical and psychiatric training programme curricula indirectly contributes to the health disparities experienced by these populations
  • Ending Gay and Transgender Health Disparities. Center for American Progress.

Mental Health

Literature

STDs, HIV and AIDS in the LGBT Population

Resources

Literature

  • STI trends among MSM at the Largest Health Center Caring for Gay Men in New England, 1997-2003. The Fenway Institute. Summary: STI rates appear to have risen dramatically among male clients. HIV+ MSM in their 30's bear a disproportionate burden of syphilis infection. Because STIs can augment the transmissibility of HIV, these findings emphasize the continued need for early detection and treatment of STIs. These findings also underscore the need for targeted screening and culturally-sensitive behavioral interventions. In addition, the suggestion of sexual sorting patterns by age and HIV serostatus calls for further research into core groups and sexual networks. Finally, the increased proportion of STIs found outside the FCH area could be associated with the growing use of Internet sites to find sexual partners; further research is needed.
  • Two strategies to increase adherence to HIV antiretroviral medication: Life-Steps and medication monitoring. Steven A. Safren, Michael W. Otto, Jonathan L. Worth, Elizabeth Salomon, William Johnson, Kenneth Mayer, and Steven Boswell. Behaviour Research and Therapy. Summary: Advances in the medical treatment of HIV have made it clear that adherence to highly active antiretroviral treatment is a crucial feature for treatment success. The present paper had two goals: (1) to examine psychosocial predictors of adherence in persons receiving HIV antiretroviral therapy; (2) to compared two minimal-treatment interventions to increase HIV medication adherence in a subset of persons who selfreported less than perfect adherence. One of the interventions, Life-Steps, is a single-session intervention utilizing cognitive-behavioral, motivational interviewing, and problem-solving techniques. The other intervention, self-monitoring, utilizes a pill-diary and an adherence questionnaire alone. Significant correlates of adherence included depression, social support, adherence self-efficacy, and punishment beliefs about HIV. Depression was a significant unique predictor of adherence over and above the other variables. Both interventions yielded improvement in adherence from baseline, and the Life-Steps intervention showed faster improvements in adherence for persons with extant adherence problems.
  • Access to HIV Prevention Services and Attitudes about Emerging Strategies. MSMGF. Summary: A Global Survey of Men Who have Sex with Men (MSM) and their Healthcare Providers.
  • HIV among Youth in the U.S. A report from the Center for Disease Control.
  • HIV in Men who have Sex with Men. The Lancet. Summary: Despite great progress in tackling the HIV epidemic worldwide in the past two decades, there is one population in which the epidemic continues to grow in countries of all incomes: men who have sex with men (MSM). This Lancet series explores the unique aspects of the HIV epidemic in MSM, showing that it is factors such as the biology of anal sex, the characteristics of MSM networks, and known behavioural factors that are driving the epidemic in this population. The Series addresses the unique challenges faced by black MSM around the world, and discusses initiatives that reduce infectiousness of HIV—such as treatment-as-prevention and pre-exposure prophylaxis—that could have a huge impact in curbing the HIV epidemic in MSM and other populations.
  • Why youths aren't getting tested for HIV. Sari Zeidler. CNN. Summary: A quarter of those infected with HIV are between the ages of 13 and 24 and more than half of youths with HIV don’t know they have it. The reasons youths don’t get tested can vary widely, but a message of abstinence may not work for all teens and young adults.
  • "We never expected this to happen": narratives of ageing with HIV among gay men living in London, UK. Owen and Catalan. Culture, Health, and Sexuality. Summary:The proportion of HIV-positive people over the age of 50 is rapidly increasing in the UK. This reflects the use of antiretroviral therapies and the transformation of HIV from life-threatening disease to chronic treatable illness. In this study a biographical narrative approach was used to explore the lived experience of ageing in 10 HIV-positive gay men aged between 50 and 78. While some participants regarded ageing as an opportunity to continue progressing towards valued life goals, others were more ambivalent about their future prospects. The findings suggest that these differences were particularly influenced by an individual's biographic relationship to the history of the HIV epidemic rather than chronological age. Those with long histories of involvement with HIV were more likely to be disadvantaged by careers interrupted by illness, to be dependent on state benefits and to have social networks damaged by multiple AIDS-related bereavements. The research identifies a cohort of older gay men likely to require additional support in adapting to the challenge of growing older with HIV. The article also explores the construction of moral identities in relation to discourses of 'successful ageing' and the possibility of building supportive communities that are sensitive to the needs of older gay men.

Substance Abuse

Resources

Literature

  • Sexual orientation and women's smoking. Hughes TL, Jacobson KM. Current Women's Health Report. Summary: An extensive review of the literature on sexual orientation and health, lesbian health, and women and smoking revealed no studies that focus on smoking among lesbians or bisexual women. However, several health surveys conducted in the past 15 to 20 years report rates of current smoking. Findings from these studies as a whole suggest that lesbians are more likely than heterosexual women to smoke. Research on women and smoking is reviewed to identify potential risk factors for lesbians' smoking. Implications for future research and for prevention and intervention are discussed.
  • Smoking Cessation Treatment Preferences, Intentions, and Behaviors among a Large Sample of Colorado Gay, Lesbian, Bisexual, and Transgendered Smokers. Levinson AH, Hood N, Mahajan R, Russ R. Nicotene and Tobacco Research. Most respondents (80.4%) smoked daily. Nearly one-third smoked 20 or more cigarettes/day. Fewer than half (47.2%) had attempted quitting in the previous year, and only 8.5% were preparing to quit in the next month. More than one-fourth (28.2%) of quit attempters had used nicotine replacement therapy (NRT), and a similar proportion said they intended to use NRT in their next quit attempt. Lesbians were significantly less likely than gay men to have used or intend to use NRT. One-fourth of respondents said they were uncomfortable talking to their doctor about quitting smoking. Four factors (daily smoking, ever having used NRT, a smoke-free home rule, and comfort asking one's doctor for cessation advice) were associated with preparation to quit smoking. Conclusions: LGBT self-identification was not associated with lower than average acceptance of evidence-based smoking cessation strategies, especially NRT, but a large minority of LGBT smokers were unlikely to seek cessation assistance through clinical encounters. Public health campaigns should focus on supporting motivation to quit and providing nonclinical access to evidence-based treatments.

Coming Out/Clinician Disclosure

Resources

Literature

  • African American Gay Youth and Their Families: Redefining Masculinity, Coping with Racism and Homophobia. Michael C. LaSala and Damien T. Frierson. Journal of GLBT Family Studies. Summary: The findings of this small, exploratory qualitative study of young African American gay men and their parents, combined with the extant theoretical literature describe the unique challenges facing Black gay male youth and their families. Parents and youth alike worry that gay men cannot meet the rigid expectations of exaggerated masculinity maintained by their families and communities, and they also struggle to cope with the intersecting oppressions that challenge Black gay youth. These unique difficulties warrant the development of targeted interventions that can assist such families with the burdens of homophobia and racism. It is vital that clinicians engage fathers as they assist young Black gay men and their families to resolve the clash between homosexuality and the male gender role expectations in their communities.  In addition, clinicians are advised to help these families recognize, harness, and build upon their existing coping skills, and it is also recommended that they facilitate family discussions that lead to expanded and more flexible views of masculinity.
  • Patterns and Predictors of Disclosure of Sexual Orientation to Healthcare Providers Among Lesbians, Gay Men and Bisexuals. Laura E. Durso and Ilan H. Meyer. Sexual Research and Social Policy. Summary: Authors assessed the relationships among disclosure of sexual orientation, demographic characteristics, health, and minority stress. Rates of nondisclosure to healthcare providers were significantly higher among bisexual men (39.3%) and bisexual women (32.6%) compared with gay men (10%) and lesbians (12.9%). Bivariate and multivariate logistic regression models predicting disclosure of sexual orientation indicated that patient age, level of education, immigration status, medical history, level of internalized homophobia, and degree of connectedness to the LGBT community were significant factors, along with sexual identity. Nondisclosure of sexual orientation was related to poorer psychological well-being at 1 year follow-up. Our findings suggest that interventions targeting sexual minorities ought to carefully tailor messages to subpopulations. In particular, interventionists and clinicians ought to be mindful of differences between bisexually and gay/lesbian-identified individuals.
  • Coming Out Stories of Gay and Lesbian Young Adults. Rossi NE. Journal of Homosexuality. Summary: Gay and lesbian young adults were interviewed about coming out to their parents. Analyses of memory content were conducted. Hypotheses related to disclosure were largely supported. Participants typically first disclosed their sexual orientation to a friend. More participants came out to their mother than their father. When disclosure was made to both parents, mothers were told prior to fathers. Mothers were often told using direct methods, whereas fathers were typically informed using indirect methods. Mothers tended to inquire about their sons' sexuality; mothers inquired less with daughters. Findings are discussed in relation to autobiographical memory, sexuality, and clinical literatures.

Same-sex Partnership/Marriage

Resources

  • Gender, Health Behavior, and Intimate Relationships: Lesbian, Gay and Straight Contexts. Corinne Reczek and Debra Umberson. Social Science and Medicine. Summary: Same-sex couples are more likely to influence each other's health habits for better or for worse. Researchers Corinne Reczek and Debra Umberson followed 20 heterosexual marriages, 15 long-term gay and 15 long-term lesbian partnerships to determine which members had the most influence on their significant other's health.  They specifically examined "health work," any activity or dialogue concerned with enhancing another's health.  The results revealed that women in heterosexual marriages bore the brunt of influencing health habits for their spouses, with the couples usually labeling the wife as the "health police." Conversely, lesbian (85 percent) and gay (80 percent) couples were significantly more likely to mutually reinforce health behaviors than were heterosexual couples (10 percent). The authors concluded that the same-sex partnership "structure results in a unique relational context for cooperative, more egalitarian health work processes to emerge."
  • Same-Sex Cohabitors and Health: The Role of Race-Ethnicity, Gender, and Socioeconomic Status. Hui Liu, Corinne Reczek, and Dustin Brown. Journal of Health and Social Behavior. Summary: Study pools data from the 1997 to 2009 National Health Interview Surveys to compare the self-rated health of same-sex cohabiting men and same-sex cohabiting women with that of their different-sex married, different-sex cohabiting, and unpartnered divorced, widowed, and never-married counterparts. Results from logistic regression models show that same-sex cohabitors report poorer health than their different-sex married counterparts at the same levels of socioeconomic status. Additionally, same-sex cohabitors report better health than their different-sex cohabiting and single counterparts, but these differences are fully explained by socioeconomic status. Without their socioeconomic advantages, same-sex cohabitors would report similar health to nonmarried groups.
  • Same-Sex Legal Marriage and Psychological Well-Being: Findings From the California Health Interview Survey. Richard G. Wight, Allen J. LeBlanc, and M. V. Lee Badgett. American Journal of Public Health. Summary: Being in a legally recognized same-sex relationship, marriage in particular, appeared to diminish mental health differentials between heterosexuals and lesbian, gay, and bisexual persons. Researchers must continue to examine potential health benefits of same-sex marriage.
  • The Effects of Marriage, Civil Union, and Domestic Partnership Laws on the Health and Well-being of Children. Pawelski, et al. Pediatrics. This analysis from the American Association of Pediatrics (AAP) explores the unique and complex challenges that same-gender couples and their children face as a result of public policy that excludes them from civil marriage. The AAP Board of Directors approved the broad dissemination of this analysis to assist pediatricians with addressing the complex issues related to same-gender couples and their children.
  • Same-Sex Cohabitors and Health: The Role of Race-Ethnicity, Gender, and Socioeconomic Status. Hui Liu, Corinne Reczek, and Dustin Brown. Journal of Health and Social Behavior. Summary: A legacy of research finds that marriage is associated with good health. Yet same>sex cohabitors cannot marry in most states in the United States and therefore may not receive the health benefits associated with marriage. The authors pooled data from the 1997 to 2009 National Health Interview Surveys to compare the self-rated health of same-sex cohabiting men and sex cohabiting women with that of their different-sex married, different-sex cohabiting, and unpartnered divorced, widowed, and never-married counterparts. Results from logistic regression models show that same-sex cohabitors report poorer health than their different-sex married counterparts at the same levels of socioeconomic status. Additionally, same-sex cohabitors report better health than their different-sex cohabiting and single counterparts, but these differences are fully explained by socioeconomic status . Without their socioeconomic advantages, same-sex cohabitors would report similar health to nonmarried groups.

     

LGBT Health Policy Resources

Resources

LGBT Parenting

Literature

  • Lesbian and Gay Parents and Their Children: Research on the Family Life Cycle. Abbie E. Goldberg.
  • Summary: The book provides a comprehensive overview of the research on same-sex parenthood, exploring ways in which lesbian and gay parents resist, accommodate, and transform fundamental notions of gender, parenting, and family. The book takes a family life cycle approach, beginning with research on how same-sex couples meet and build healthy relationships, then describing how and why same-sex couples decide to have children and how they grapple with the changing roles each partner must adopt. Their experiences raising children through young adulthood are explored, including the challenges of interacting with their children's schools and teachers. In the end, the book considers the perspectives of the children themselves—as young adults and adults speak out about their experiences having lesbian or gay parents.
  • Lesbian Parenthood: A Review of the Literature. Parks CA. American Journal of Orthopsychiatry. Summary: Findings of lesbian family research published between 1980 and 1996 are reviewed. The research describes characteristics of lesbian families, and challenges faced by these families, in the context of heterosexist and homophobic societal attitudes. The major research findings are discussed, clinical implications are noted, and areas in need of further investigation are proposed.
  • Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Wainright, et al. Child Development. Summary: This study examined associations among family type (same-sex vs. opposite-sex parents); family and relationship variables; and the psychosocial adjustment, school outcomes, and romantic attractions and behaviors of adolescents. Participants included 44 12- to 18-year-old adolescents parented by same-sex couples and 44 same-aged adolescents parented by opposite-sex couples, matched on demographic characteristics and drawn from a national sample. Normative analyses indicated that, on measures of psychosocial adjustment and school outcomes, adolescents were functioning well, and their adjustment was not generally associated with family type. Assessments of romantic relationships and sexual behavior were not associated with family type. Regardless of family type, adolescents whose parents described closer relationships with them reported better school adjustment.
  • Family formation and raising children among same-sex couples. Gary J. Gates. National Council on Family Relations. Summary: Proportionally fewer same-sex couples are raising children today than in 2006, and their families reflect greater racial/ethnic and socioeconomic diversity than often represented in the media and academic research. Notably, childrearing is substantially higher among racial/ethnic minorities. Also, among individuals in same-sex couples who did not finish high school, 43% are raising children, and 20% of children raised by same-sex couples live in poverty. The decrease in the proportion of couples raising children may be due to decreases in parenting by lesbian, gay and bisexual (LGB) individuals who had children at a relatively young age while in a relationship with a different-sex partner. Declining social stigma toward LGB people may mean that more are coming out earlier in life and are becoming less likely to have children with different-sex partners. Despite the proportional declines in parenting, analyses also show that adoptive parenting is clearly increasing. Among couples with children, the proportion of same-sex couples who have adopted children has nearly doubled from 10% to 19% between 2000 and 2009. Despite the decline, the number of same-sex couples raising children is still much higher today than ten years ago since many more couples are reporting themselves in Census Bureau data. In 2000, the Census reported about 63,000 couples raising children. Today, the figure is now more than 110,000.
  • Gender-Typed Play Behavior in Early Childhood: Adopted Children with Lesbian, Gay and Heterosexual Parents. Abbie E. Goldberg, Deborah A. Kashy, and JuliAnna Z. Smith. Sex Roles. Summary: A study of young children of first-time adoptive parents found that the children of same-gender parents were less gender stereotyped in their play behavior than the children of heterosexual parents, which may translate to strengths that aid them later in life. How parents play, and what kinds of toys they let their kids play with, can affect child development. Past research has shown that strict adherence to traditionally gender-stereotyped toys may constrain some necessary skill building, and the some flexibility in play-type has psychological benefits for children. In the study, the children of same-gender parents were found to engage in more flexible play behavior, thus facilitating their ability to engage in a wide range of behaviors and activities.
  • De Novo Lesbian Families: Legitimizing the Other Mother Brenda Hayman, Lesley Wilkes, Debra Jackson & Elizabeth Halcomb. Journal of GLBT Family Studies. Summary: This study aimed to explore the experiences of other mothers in de novo or planned lesbian-led families in Australia to elaborate on one theme: legitimizing our families. Little is known or understood about how lesbians construct mothering within their families. Even less is understood about the experiences of the often marginalized and invisible other mother; that is, the non-birth mother in lesbian families. Fifteen self-identified lesbian couples participated in semistructured, in-depth interviews (as couples) using a story-sharing approach, undertook journaling, and completed a demographic data collection sheet. Legitimizing our families was described by participants in terms of several subthemes, including the following: the role of the other mother in planning, conception, pregnancy, and birth; symbols of family connection; and negotiating health care. Other mothers participating in the study were acutely aware that people in society generally did not perceive them as genuine parents. This finding was consistent with the concepts of Others and Othering. To this end, other mothers sought to legitimize their role within their families by establishing symbols and using ceremonies, names, and other methods of formal recognition to justify their role as an authentic mother and signify legitimate de novo family connections.

Resources