When love meets hate: The relationship between state policies on gay and lesbian rights and hate crime incidence

Experiences of interpersonal violence among a diverse sample of male sex workers

A notable portion of men who have sex with men engage in exchange sex-i.e. the trading of sex for money, drugs, shelter or other material goods. Despite the risks for physical and sexual violence, threatening behaviour and robbery that male sex workers confront, very little is known about their experiences of such actions by clients. To gain more insight into male sex workers' experiences of interpersonal violence, we analysed qualitative interview data from 180 men who have sex with men from 8 US cities who engaged in sex work with clients they had met primarily through dating/hookup websites and apps. Participants discussed their experiences of a range of untoward behaviours by clients including physical violence, sexual violence, threats and robbery. Healthcare and social services providers can play a significant role in violence prevention among male sex workers. The decriminalisation of sex work could also potentially reduce the risks many sex workers face by facilitating their reporting of harms suffered.

A research agenda for understanding how social inequality is linked to brain structure and function

Consistent evidence documents powerful effects of social inequality on health, well-being and academic achievement. Yet research on whether social inequality may also be linked to brain structure and function has, until recently, been rare. Here we describe three methodological approaches that can be used to study this question-single site, single study; multi-site, single study; and spatial meta-analysis. We review empirical work that, using these approaches, has observed associations between neural outcomes and structural measures of social inequality-including structural stigma, community-level prejudice, gender inequality, neighbourhood disadvantage and the generosity of the social safety net for low-income families. We evaluate the relative strengths and limitations of these approaches, discuss ethical considerations and outline directions for future research. In doing so, we advocate for a paradigm shift in cognitive neuroscience that explicitly incorporates upstream structural and contextual factors, which we argue holds promise for uncovering the neural correlates of social inequality.

Anticipated Sexual Minority Stress and Mental Health after the 2016 Presidential Election: Examining a Psychological Mediation Framework

Sexual minorities are at an increased risk for psychopathology, compared to heterosexual counterparts, in part due to stressors unique to their sexual minority identity. The greater socio-political climate may exacerbate sexual minority stress, and the context of the 2016 United States presidential election infringed upon the rights and well-being of LGBQ individuals. In our sample of sexual minorities (n = 253), we examined the association between anticipated stigma in response to the 2016 presidential election and symptoms of anxiety and depression, and the potential mediating role of self-compassion, hopelessness and social support. Greater anticipated stigma was associated with less self-compassion, less perceived social support, and greater hopelessness, and, in turn, greater symptoms of anxiety and depression. Anticipated stigma may erode feelings of environmental support and may be internalized as negative views of the self and future. From a public health perspective, policy-makers should be aware that the discussion and/or enactment of policies which discriminate against LGBQ persons may negatively impact mental health. Clinically, bolstering self-compassion and interpersonal functioning, and targeting hopelessness, through strategies such as Acceptance and Commitment Therapy and Compassion-Focused Therapy, may buffer the impact of minority stress among sexual minorities.

State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People

Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018−2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.

Hate Crime and Place: The Spatial and Temporal Concentration of Bias-Motivated Crime in Washington, D.C

Prior research suggests that many crime types are spatially concentrated and stable over time. Hate crime, however, is a unique crime type that is etiologically distinct from others. As such, examination of hate crime from a spatial and temporal perspective offers an opportunity to understand hate crime and the spatial concentration of crime more generally. The current study examines the spatial stability of hate crimes reported to the police in Washington, D.C., from 2012 through 2018 using street segments, intersections, and block groups as units of analysis. Findings reveal that hate crime is spatially concentrated, with less than 4% of street segments and intersections experiencing hate crime over the study period. Results reveal a high degree of spatial stability, both year-to-year and over the long term even when restricting the analysis to units that experienced at least one hate crime.

Is There Such a Thing as a Hate Crime Paradigm? An Integrative Review of Bias-Motivated Violent Victimization and Offending, Its Effects and Underlying Mechanisms

Despite the growing number of bias-motivated violence studies, the evidence available remains limited, and there are several gaps in our understanding of the complex relationship between negative attitudes and biased violence. In addition, the literature on this topic has many facets and nuances and is often contradictory, so it is difficult to obtain a clear overall picture. Research has made good progress in this area, but it still suffers from a lack of systematization and from a highly segmented approach to victimization and offending. To contribute to a more comprehensive understanding of the subject, this integrative narrative review provides a critical reappraisal of the theoretical, methodological, and empirical research from a systemic perspective. To this end, 134 academic publications on personality and social psychology, clinical psychology, sociology, criminology, and related disciplines were examined. The evidence suggests that although bias-motivated violence shares characteristics with other types of offensive behavior, it is actually a unique phenomenon due to its background rooted in prejudice, identity, and attitudes in which the intersection of individual, psychosocial, and ecological factors is especially relevant. The impact on the victim and their community is diverse, but it has a series of distinctive severe psychological consequences that significantly reduce the probability that incidents will be reported. Here, we present a series of findings and reflections on bias-motivated violence and provide recommendations for research, practice, and policy.

Evolution of Legislation and Crimes Based on Sexual Identity or Orientation in Spain: A Retrospective Observational Study (2011-2021)

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011–2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people.

Trends in State Policy Support for Sexual Minorities and HIV-Related Outcomes Among Men Who Have Sex With Men in the United States, 2008-2014

BACKGROUND

To examine trends in state-level policy support for sexual minorities and HIV outcomes among men who have sex with men (MSM).

METHODS

This longitudinal analysis linked state-level policy support for sexual minorities [N = 94 metropolitan statistical areas (MSAs) in 38 states] to 7 years of data (2008-2014) from the Centers for Disease Control and Prevention on HIV outcomes among MSM. Using latent growth mixture modeling, we combined 11 state-level policies (eg, nondiscrimination laws including sexual orientation as a protected class) from 1999 to 2014, deriving the following 3 latent groups: consistently low policy support, consistently high policy support, and increasing trajectory of policy support. Outcomes were HIV diagnoses per 10,000 MSM, late diagnoses (number of deaths within 12 months of HIV diagnosis and AIDS diagnoses within 3 months of HIV diagnosis) per 10,000 MSM, AIDS diagnoses per 10,000 MSM with HIV, and AIDS-related mortality per 10,000 MSM with AIDS.

RESULTS

Compared with MSAs in states with low policy support and increasing policy support for sexual minorities, MSAs in states with the highest level of policy support had lower risks of HIV diagnoses [risk difference (RD) = -37.9, 95% confidence interval (CI): -54.7 to -21.0], late diagnoses (RD = -12.5, 95% CI: -20.4 to -4.7), and AIDS-related mortality (RD = -33.7, 95% CI: -61.2 to -6.2), controlling for time and 7 MSA-level covariates. In low policy support states, 27% of HIV diagnoses, 21% of late diagnoses, and 10% of AIDS deaths among MSM were attributable to the policy climate.

CONCLUSION

The state-level policy climate related to sexual minorities was associated with HIV health outcomes among MSM and could be a potential public health tool for HIV prevention and care.

Structural stigma and all-cause mortality among sexual minorities: Differences by sexual behavior?

Using updated data from the General Social Survey/National Death Index (GSS/NDI) study, we examined whether the relationship between structural stigma-measured by aggregating 4 items assessing prejudice towards homosexuality to the community level-and all-cause mortality is present among gay men/lesbian women. Our hypothesis is based on emerging evidence that indicators of structural stigma specific to homosexuality, such as those used in the GSS/NDI, uniquely predict health outcomes among this group. Because the GSS/NDI lacked an identity-based measure of sexual orientation, we tested our hypothesis by employing a strategy that has a relatively high degree of sensitivity and specificity for ascertaining individuals most likely to identify as gay or lesbian: restricting analyses to individuals who reported same-sex sexual partners in the past year. We compared this approach against an alternative strategy, which has weaker specificity for identifying gay men/lesbian women: restricting analyses to individuals who reported any lifetime same-sex sexual behaviors. After controlling for 6 individual-level factors and fixed effects of survey year, structural stigma was associated with mortality among individuals who reported past-year same-sex sexual partners (HR = 1.95, 95% CI: 1.14, 3.31). Further, there was a dose-response relationship with mortality in this group, such that those residing in communities in the highest quartile of structural stigma had the greatest mortality risk, controlling for these same factors (HR = 2.12, 95% CI: 1.03, 4.38). In sensitivity analyses, the effect size for structural stigma ranged from 1.54 to 2.30, indicating a consistent, but small-to-moderate, effect. In contrast, no association between structural stigma and mortality was observed among respondents who reported lifetime same-sex sexual partners, nor among those reporting only opposite-sex sexual partners. This analysis therefore delimits potential boundary conditions of the association between structural stigma related to same-sex sexuality and all-cause mortality, highlighting the conditions under which this association is (and is not) observed.

Legal Remedies to Address Stigma-Based Health Inequalities in the United States: Challenges and Opportunities

Policy Points Stigma is an established driver of population-level health outcomes. Antidiscrimination laws can generate or alleviate stigma and, thus, are a critical component in the study of improving population health. Currently, antidiscrimination laws are often underenforced and are sometimes conceptualized by courts and lawmakers in ways that are too narrow to fully reach all forms of stigma and all individuals who are stigmatized. To remedy these limitations, we propose the creation of a new population-level surveillance system of antidiscrimination law and its enforcement, a central body to enforce antidiscrimination laws, as well as a collaborative research initiative to enhance the study of the linkages between health and antidiscrimination law in the future.

CONTEXT

Stigma is conceptualized as a fundamental cause of population health inequalities. Antidiscrimination law is one important lever that can influence stigma-based health inequities, and yet several challenges currently limit the law's potential to address them.

METHODS

To determine whether antidiscrimination law adequately addresses stigma, we compared antidiscrimination law for its applicability to the domains and statuses where stigma is experienced according to the social science literature. To further examine whether law is a sufficient remedy for stigma, we reviewed law literature and government sources for the adequacy of antidiscrimination law enforcement. We also reviewed the law literature for critiques of antidiscrimination law, which revealed conceptual limits of antidiscrimination law that we applied to the context of stigma.

FINDINGS

In this article, we explored the importance of antidiscrimination law in addressing the population-level health consequences of stigma and found two key challenges-conceptualization and enforcement-that currently limit its potential. We identified several practical solutions to make antidiscrimination law a more available tool to tackle the health inequities caused by stigma, including (1) the development of a new surveillance system for antidiscrimination laws and their enforcement, (2) an interdisciplinary working group to study the impact of antidiscrimination laws on health, and (3) a central agency tasked with monitoring enforcement of antidiscrimination laws.

CONCLUSIONS

Antidiscrimination law requires better tailoring based on the evidence of who is affected by stigma, as well as where and how stigma occurs, or it will be a poor tool for remedying stigma, regardless of its level of enforcement. Further interdisciplinary research is needed to identify the ways in which law can be crafted into a better tool for redressing the health harms of stigma and to delimit clearer boundaries for when law is and is not the appropriate remedy for these stigma-induced inequities.