Coping With Stress as an LGBTQ+ Health Care Professional

Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) health care providers face both general work-related stresses and working in heteronormative settings with ill-informed or hostile coworkers and patients, yet there has been little study of whether the coping strategies are specific to LGBTQ+ stress. We analyzed qualitative data from 277 health care professionals. Sources of stress included religiously and politically conservative coworkers, coworker/patient lack of knowledge, stresses of being closeted, and concerns about being out to patients. Consequences of being out as LGBTQ+ included lack of promotions, gossip, refusals of tenure, and anti-LGBTQ+ comments and behaviors in the workplace. Respondents showed mostly positive coping strategies to deal with stress, including becoming educators/advocates and self-care activities. Self-care options were common in rural areas with few LGBTQ+ social resources. Negative coping strategies were reported by 18% of respondents. The study highlights the extra burden of stress on LGBTQ+ health care providers.

Spanish Adaptation and Validation of the Short Internalized Homonegativity Scale (SIHS)

Internalized homophobia has been related to mental health problems and sexual risk behaviors among nonheterosexual people. This article validates the Spanish adaptation of the Short Internalized Homonegativity Scale (SIHS). For this purpose, 347 men and 183 women completed the instrument. Exploratory factorial analysis showed three factors: public identification as homosexual (PIH), sexual comfort with homosexual people (SEXC), and social comfort with homosexual people (SOCC). These factors explained 57.96% of total variance. In addition, confirmatory factorial analysis supported this structure and internal consistency (Cronbach's alpha) was.80 for the full scale. The three subscales ranged from.70 to.79. Convergent validity showed a positive correlation between the SIHS and depressive symptoms, and negative correlation with condom use, self-esteem, and having sex after alcohol consumption. In conclusion, the SIHS could be an accurate instrument to evaluate internalized homophobia among the Spanish population.

Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience

OBJECTIVES

Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults.

METHOD

Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (N = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES).

RESULTS

Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors.

DISCUSSION

Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals' unique risk and protective factors may be helpful in reducing health inequities.

Alternative Visions for Pastoral Work with LGBTQ Individuals, Families, and Communities: A Response

Multiple theological perspectives provide frameworks for pastoral work with lesbian, gay, bisesxual and trans individuals, families, and communities. One model is offered by those who argue for celibacy or heterosexual marriages for those who self-identify as part of LGBTQ communities. This article names other theologically grounded perspectives with the goal of inviting practitioners to broaden their understandings and wrestle with the implications of their theological and ethical stances. When reflecting on the intersection of spirituality and sexuality, the meaning of theological terms such as sin, contributions from queer theologians and pastoral counselors, and the limitations of binary categories common in our theological history, this article encourages pastoral counselors and spiritual care providers to re-examine theological assumptions they bring to their work. The article ends with questions and opportunities for ongoing pastoral theological work and reflection.

Examining ethnic differences in parental rejection of LGB youth sexual identity

Upward of 70% of lesbian, gay, and bisexual (LGB) youth experience some degree of parental rejection of their sexual identity, which is problematic in light of research documenting links between parental rejection and psychological difficulties in LGB youth. Additionally, emerging research suggests that ethnic minority LGB youth may be at greater risk to experience parental rejection than ethnic majority LGB youth. However, this research is inconclusive and has significant gaps. The current study is one of the first to include a multiethnic sample of LGB youth and their parents to investigate how ethnicity may be related to parental rejection. Specifically, the current study examined ethnic differences in parental rejection as well as in intrapersonal variables (i.e., homonegativity and traditional gender role beliefs), which are thought to be related both to ethnicity and parental rejection. Additionally, indirect effects of ethnicity on parental rejection through homonegativity and traditional gender role beliefs were examined. Participants included 90 parents (ages 32-63) and their 90 LGB children (ages 15-24). Fifty-nine percent of the sample were ethnic minority. Significant ethnic differences were found in parental rejection and homonegativity, but not in traditional gender role beliefs. Homonegativity was found to fully mediate the relation between ethnicity and parental rejection. These results provide important information on why ethnic minority parents, in general, may have a more difficult time accepting their LGB children than ethnic majority parents. (PsycINFO Database Record

Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries

PURPOSE

The aim of this study was to investigate homophobic attitudes in three European countries: Italy, Albania, and Ukraine. One thousand and forty-eight students were recruited in Italian (n = 766), Albanian (n = 180), and Ukrainian (n = 102) university centers.

METHODS

A socio-demographic questionnaire and Homophobia Scale (HS) were administered by our staff.

RESULTS

Cross-cultural and significant differences among Italian, Albanian, and Ukrainian students were found on the Homophobia Scale (HS; Italy: mean = 22.26 ± 16.73; Albania: mean = 38.15 ± 17.28; Ukraine: mean = 59.18 ± 16.23). The analysis of socio-demographic characteristics revealed that the male gender emerged as main predictor of homophobic attitude in all the three countries, although also a conservative political orientation and the religious belief predict higher homophobia levels in Italy and Albania, particularly.

CONCLUSIONS

This study revealed that in these European countries assessed, attitudes toward homosexuality are different. Ukrainians display higher levels of homophobia than Albanians and Italians, confirming the central role of cultural differences in homophobic attitudes. Nevertheless, some socio-demographic aspects such as identification as male have a similar influence on homophobic attitudes in all assessed populations.

Heterosexism, Depression, and Campus Engagement Among LGBTQ College Students: Intersectional Differences and Opportunities for Healing

LGBTQ people experience health disparities related to multilevel processes of sexual and gender marginalization, and intersections with racism can compound these challenges for LGBTQ people of color. Although community engagement may be protective for mental health broadly and for LGBTQ communities in buffering against heterosexism, little research has been conducted on the racialized dynamics of these processes among LGBTQ communities. This study analyzes cross-sectional survey data collected among a diverse sample of LGBTQ college students (n = 460), which was split by racial status. Linear regression models were used to test main effects of interpersonal heterosexism and engagement with campus organizations on depression, as well as moderating effects of campus engagement. For White LGBTQ students, engaging in student leadership appears to weaken the heterosexism-depression link-specifically, the experience of interpersonal microaggressions. For LGBTQ students of color, engaging in LGBTQ-specific spaces can strengthen the association between sexual orientation victimization and depression.

Anti-homosexual legislation and HIV-related stigma in African nations: what has been the role of PEPFAR?

BACKGROUND

Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it.

OBJECTIVES

We analyzed the ways in which policies and practices of the US President's Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated.

METHODS

We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality.

RESULTS

We found 16 of Africa's 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Most (14) of the 16 African 'Partnership Framework' (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction; however, none call for reducing penalties on individuals who engage in homosexual behavior.

CONCLUSIONS

We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation.

Karl Heinrich Ulrichs: First Theorist of Erotic Age Orientation

The nomination of Karl Heinrich Ulrichs (1825-1895) as the first theorist of homosexuality may be placed in the oblique light of his eligibility for the nomination as the first theorist of erotic age orientation. In Ulrichs's pamphlets, "man-manly" homosexuality emerged as a particular age orientation, with a subsequent typological breakdown that, importantly, blended gender orientation and age orientation. Into the early 20th century, erotic age orientation remained bound up with the classification and emancipation of what here was demarcated as Urningsliebe. Ulrichs's pioneering and shifting comments on age eventually fed into his legal model of consenting adults in private. They also provide a starting point for the historical understanding of the trope of "grooming pedophile" as it, arguably, crossfaded with that of the "seducing homosexual" after the latter's depsychiatricization across the Western world.

[Omosexual parents: does a need exist for a reflection by mental health experts?]

The upbringing of children by couples of omosexual parents, both male and female, is a rapidly growing phenomenon in many countries, despite some differences due to variable national laws. In front of the numerical increase of new family typologies, their acceptance by the public opinion is very often a critical and this attitude is prevailingly shared also by the experts of mental health, such as psychologists and psychiatrists. Nevertheless, absolutely without any a priori prejudice, the absence of not yet available statistical data in large populations emphasizes the need to explore in depth the possible existence of specific psychological late consequences in young and adult age, in studies devoid of any cultural bias. Considering the children not as objects of the right of a couple to have sons, but as subjects of their own right to receive a well regulated and balanced affective and relational education should be a critical ethical issue.

Homosexual Parents in Custody Disputes: A Thousand Child-Years Exposure

Through 1998, 78 custody appeal decisions involving 79 homosexual parents were evaluated. The 142 children involved in these cases were exposed to a thousand child-years of homosexual parenting. In appeals records (a) parents recorded as lying or engaging in criminality or homosexuality were more apt to be recorded as harming children; (b) homosexuals more frequently were recorded as lying or engaging in criminality; (c) in 54 (70%) disputes the homosexual parent or his associates and in 4 (5%) the heterosexual parent was recorded as having exposed the children to harm(s), e.g., neglect, seduction; and (d) homosexuals were responsible for 111 (97%) of the 115 recorded harms to children. For 78 nonhomosexual vs nonhomosexual control cases, in 11 (14%) the 141 children were exposed to 12 harms.

Caring for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Inclusive and Affirmative Environments

Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth may experience interpersonal and structural stigma within the health care environment. This article begins by reviewing special considerations for the care of LGBTQ youth, then turns to systems-level principles underlying inclusive and affirming care. It then examines specific strategies that individual providers can use to provide more patient-centered care, and concludes with a discussion of how clinics and health systems can tailor clinical services to the needs of LGBTQ youth.

The association between AIDS-related stigma and aggression toward gay men and lesbians

This study examined whether self-identified race and prior contact with a gay man or lesbian moderate the association between AIDS-related stigma and aggression toward gay men and lesbians when controlling for sexual prejudice. A regional, community-recruited sample of 194 heterosexual men (50% Black, 50% White) completed measures of AIDS-related stigma, sexual prejudice, and prior contact with gay men and lesbians. Regression analyses showed that AIDS-related stigma was positively associated with aggression toward gay men and lesbians among White men who reported no prior contact, but not among White men who endorsed prior contact and Black men regardless of prior contact. Findings suggest that intergroup contact may be a key component to reducing the effects of AIDS-related stigma towards stigmatized groups. Implications for aggression theory and intervention are discussed. Aggr. Behav. 42:542-554, 2016. © 2016 Wiley Periodicals, Inc.

Lessons Learned from an LGBTQ Senior Center: A Bronx Tale

This article describes an interdisciplinary pilot study exploring the impact of LGBTQ senior centers on the lives of center members. Many LGBTQ adults face the future having experienced stigma and bias, restricted rights, and rejection from family of origin, and are now growing older without the support of a partner and adult children. As a result, older LGBTQ adults experience higher rates of depression, loneliness and isolation, and shortened life expectancy as compared to non-LGBTQ peers. Findings from focus group and key informant interviews highlight features of LGBTQ senior center experiences that can significantly improve members' quality of life. These include providing family, acceptance and a home, which can have an impact on outlook and outcomes. Moreover, findings suggest the need for re-thinking hetero-normative definitions of "community" in the context of LGBTQ aging. Beyond sharing findings from the study, suggesting a conceptual framework for deepening understanding about LGBTQ aging, and identifying lines of future inquiry, the article articulates implications for social work research, practice and education. Ultimately, the article argues that social work is well positioned to improve quality of life for this under-served population when it adopts a cultural humility stance in research, practice and education.

The Influence of Pastors' Ideologies of Homosexuality on HIV Prevention in the Black Church

Young, Black men who have sex with men (YBMSM) are disproportionately affected by HIV, and Black Churches may be a source of stigma which can exacerbate HIV risk and contribute to negative health and psychosocial outcomes. Findings from this study are based on 21 semi-structured interviews with pastors and ethnographic observation in six Black Churches. Interview transcripts and field notes were analyzed in MAXQDA using thematic content analysis. Although pastors espoused messages of love and acceptance, they overwhelmingly believed homosexuality was a sin and had difficulty accepting YBMSM into their churches. The tension around homosexuality limited pastors' involvement in HIV prevention efforts, although there still may be opportunities for some churches.

Invisible Scars: Comparing the Mental Health of LGB and Heterosexual Intimate Partner Violence Survivors

Intimate partner violence (IPV) affects countless women and men in lesbian, gay, and bisexual (LGB) as well as heterosexual relationships, but few studies have examined how such abuse is associated with the mental health of LGB victims. The present study addresses this issue using data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey to examine differences in depression and anxiety among IPV victims in LGB and heterosexual partnerships. The findings indicate LGB IPV victims are much more likely to have a history of depression (OR 1.70, p < .05) and anxiety (OR 1.70, p < .05) than heterosexual victims. These differences are slightly mediated by the victim's perceived emotional support but not the type of abuse experienced. Our findings accentuate the need for greater inclusion of LGB persons in the IPV and mental health discourse, as well as the importance of social support for IPV victims. Policy implications for members of the LGB community are discussed.

Differential Risk Theory as a Subset of Social Exchange Theory: Implications for Making Gay Marriage Culturally Normative and for Understanding Stigma against Homosexuals

Differential risk theory, a subset of social exchange and equity theories, is proposed as an explanation for stigma towards homosexuals and as a basis for normative preferences for heterosexual marriage. Numerous gender differences involved in long-term relationships require members of such close relationships to assume greater interpersonal and social risks and thus costs, compared to same-gender relationships. Without compensating rewards or reduced costs, heterosexual relationships would be unfairly disadvantaged. Resistance to making gay marriage normative and/or equivalent legally to heterosexual marriage may be traced, rather than to homophobia, to societal attempts to maintain equity between classes of relationships characterized by inherent differential risks.

Homosexual Sex as Harmful as Drug Abuse, Prostitution, or Smoking

In 2003, the U.S. Supreme Court said same-sex sexual activity could not be prohibited by law. Analyzing data from the 1996 National Household Survey of Drug Abuse ( N = 12,381) and comparing those who engaged in four recreational activities—homosexual sex, illegal drug use, participation in prostitution, and smoking—against those who abstained, participants (1) were more frequently disruptive (e.g., more frequently criminal, drove under the influence of drugs or alcohol, used illegal drugs, took sexual risks), (2) were less frequently productive (e.g., less frequently had children in marriage, more frequently missed work), and (3) generated excessive costs (e.g., more promiscuous, higher consumers of medical services). Major sexuality surveys have reported similar findings for homosexuals. Societal discrimination inadequately accounts for these differences since parallel comparisons of black and white subsamples produced a pattern unlike the differences found between homosexuals and nonhomosexuals.

Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress

Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.

What Was Really Learned from Tasker and Golombok's (1995) Study of Lesbian and Single Parent Mothers?

Limitations of research on gays and family life are discussed, including the low statistical power of small samples, a condition which increases the likelihood of failing to reject null hypotheses. In particular, it is observed that Fitzgerald in 1999 shifted from very tentative arguments in her review of literature to rather conclusive statements in her abstract about outcomes for children of gay parents. Furthermore, an often quoted 1995 article by Tasker and Golombok, upon closer examination, appears to indicate that being raised in a lesbian family increases the odds of a child later adopting a homosexual lifestyle even in the absence of homosexual attractions. For such reasons, scholars and policymakers all should be very cautious in accepting, at face value, at least some of the research being reported on gays and family life.

Molestations by Homosexual Foster Parents: Newspaper Accounts vs Official Records

To assess whether a systematic tally of newspaper accounts reflect official foster-parent molestation a review of 6,444 news stories on Lexis-Nexis Academic Universe from 1989 through 2002 about child molestation yielded 33 stories involving foster parents. Of the 25 foster-parent perpetrators, at least 15 (60%) engaged in homosexuality In Illinois 1997–2002, 92 (34%) of 270 foster- or adoptive-parent perpetrators who engaged in “substantiated” sexual abuse homosexually abused their charges. These findings suggest that the proportion of homosexual perpetrators in a systematic tally of newspaper stories is similar to the proportion of homosexual perpetrators in datasets from large entities and put in question the current policy of utilizing homosexuals as foster and adoptive parents.

Emotional and Sexual Jealousy as a Function of Sex and Sexual Orientation in a Brazilian Sample

The goal of the present study was to compare the relative distress of homosexual and heterosexual Brazilian men and women on scenarios in which they imagined their partners sexually or emotionally involved with another person, using a forced-choice paradigm and continuous measures. Participants were 68 heterosexual men, 72 heterosexual women, 42 homosexual men, and 35 homosexual women. On the forced-choice questions heterosexual men (39 on one question and 37 on the other) were more upset than their female counterparts (21 on one question and 15 on the other) by scenarios of sexual infidelity than those of emotional infidelity. On questions using continuous measures no significant difference was found between pleasurable sex and attachment scenarios for heterosexual women or heterosexual men. On the highly upsetting scenarios heterosexual men discriminated between flirting and both pleasurable sex and attachment scenarios, being less disturbed by the former. In contrast, heterosexual women were equally distressed by the three scenarios. Scores for the homosexual men and homosexual women fell in between those of the heterosexual men and heterosexual women and did not show a clear cut preference for the sexual infidelity or the emotional alternative on the forced-choice paradigm. However, on the continuous measures of jealousy homosexuals resembled heterosexuals of the opposite sex. There was no evidence that jealousy would be less intense among homosexuals although reproductive outcomes were not at risk.

Working with Nonheterosexual Youth to Understand Sexual Identity Development, At-Risk Behaviors, and Implications for Health Care Professionals

This article outlines special issues related to being a nonheterosexual youth. Information is presented on the sexual development of homosexual youth and their unique challenges. Included are data about the average age of initial awareness and self-identification of gay, lesbian, bisexual, transgendered, and questioning youth. The average age of awareness of homosexual orientation is between 10 or 11 years, while the average for identifying or self-labeling is ages 13–15. This age range is consistent across studies. The special issues related to a unique sexual development, prejudices associated with being a nonheterosexually oriented youth, typical behavioral outcomes of dealing with discrimination, and major health concerns for this at-risk population are identified. Finally, implications for health care professionals working with these adolescents are outlined.