Identifying the needs of LGBTQ immigrants and refugees in Southern Arizona

Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review

Refugees encounter numerous healthcare access barriers in host countries, leading to lower utilization rates and poorer health outcomes. In the US, social inequities and fragmented health systems may exacerbate these disparities. Understanding these factors is necessary to ensure equitable care of refugee populations. A systematic literature review of qualitative studies on US adult refugee healthcare access from January 2000 to June 2021 was performed in accordance with PRISMA. Studies were analyzed deductively and then inductively to incorporate previous findings in other resettlement countries and emergence of US-specific themes. 64 articles representing 16+ countries of origin emerged from the final analysis, yielding nine interrelated themes related to health literacy, cost of services, cultural beliefs, and social supports, among others. The main challenges to refugees' healthcare access emerge from the interactions of care fragmentation with adverse social determinants. Given diverse barriers, integrated care models are recommended in treating refugee populations.

Soins intégrés auprès des personnes LGBTQI+ migrantes : la place des soins psychosociaux

INTRODUCTION

LGBTQI+ migrants are at greater risk of facing health issues, including mental health issues, especially since the arrival of COVID-19. Furthermore, they face many barriers to accessing care in Quebec. It is in this context that Clinic Mauve was implemented, which aims to remove these barriers by offering medical and psychosocial care in an integrated care setting to LGBTQI+ migrants in Montreal.

PURPOSE OF RESEARCH

The purpose of this article is to identify the benefits and challenges of a model like the Clinic Mauve in addressing the psychosocial needs of LGBTQI+ migrant individuals.

RESULTS

The analysis shows that the Clinic Mauve model, because of its approaches is able to remove some of the barriers to accessing care for LGBTQI+ migrants and to allow for a certain degree of empowerment of these populations. However, some challenges have been identified, which are mainly due to the lack of resources and organizational constraints.

CONCLUSIONS

The article concludes that providing psychosocial care in an integrated care setting addresses some of the barriers to accessing care faced by LGBTQI+ migrants.

A Scoping Review of Health Outcomes Among Transgender Migrants

Purpose

Transgender people constitute diverse populations who experience a range of adverse health outcomes. Despite increasing awareness of adverse health outcomes among migrant populations, there has been a dearth of studies focused on the health of transgender migrants. The goal of this scoping review was to describe common themes and empirical trends in research on the health of transgender migrants and identify gaps for future research and programming.

Methods

Using a systematic review protocol, we searched PubMed, Embase, Scopus, PsycINFO, CINAHL, and Web of Science with a combination of terms to identify empirical articles that examined health outcomes among transgender migrants. The search included studies published as of May 2019.

Results

Twenty of 1666 identified records met inclusion criteria. All studies were cross-sectional, and 50% were quantitative designs, 45% were qualitative designs, and 5% were mixed-methods designs. The majority reported on sexually transmitted infections (55%), violence (40%), and mental health (35%). Qualitative studies were generally high quality, while many quantitative studies had high risk of bias. While some adverse health outcomes may abate, stigmatizing social conditions continue to impact transgender migrant's health postmigration.

Conclusions

Anti-transgender and anti-immigrant stigma may contribute to adverse health outcomes for transgender migrants. Additional research using rigorous inclusive methods to survey a broader range of health domains is needed. The lives of transgender migrants are continuously upended by oppressive policies; therefore, it is vital to continue to expand the breadth of transgender health research.

Transgender Polyvictimization in the U.S. Transgender Survey

Relative to cisgender people, transgender individuals not only are at an elevated risk of experiencing at least one form of physical or sexual violence, but also at an increased risk of polyvictimization: that is, exposure to multiple types of violence over the life course. Given that polyvictimization increases vulnerability to adverse mental and physical health sequelae, there is a pressing need to identify which sociodemographic subgroups of transgender people are at greater risk of polyvictimization. Understanding these risk profiles will have important implications for developing transgender-specific models for violence prevention, screening, and intervention. Responding to this need in the literature, the present article offers secondary data analyses of the 2015 U.S. Transgender Survey, the largest study to-date of transgender people in the United States (N = 27,715 transgender adults), with participants selected from all 50 states and Washington, D.C., as well as several U.S. territories and overseas military bases. Multiple variable regressions examine sociodemographic predictors of five distinct forms of violence, as well as how many of these five violence types were experienced. The examined sociodemographic predictors included gender, sexual orientation, race-ethnicity, citizenship status, ever been homeless, has a disability, transgender outness, gender visual conformity, household income, and age. The five assessed violence victimization types included intimate partner violence, nonpartner sexual assault, antitransgender family violence, antitransgender physical violence during Kindergarten through 12th grade, and past-year antitransgender physical violence. With some exceptions, results indicate that more marginalized segments of transgender communities have a greater likelihood of experiencing polyvictimization. Recommendations are discussed for future research and service provision.

LGBTQ Youth Homelessness: Why We Need to Protect Our LGBTQ Youth

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are 120% more likely to be homeless than cisgender and heterosexual youth, yet current federal policies are insufficient and exclude LGBTQ youth. Youth homeless shelters are inadequately equipped to serve LGBTQ homeless youth due to poor funding, a focus on heterosexual or cisgender clients in their programs, and a lack of LGBTQ-friendly policies. Given the pervasiveness of this issue, public health and social policy interventions must be considered. In this perspective, the LGBTQ homeless youth epidemic is introduced and described, past policies are analyzed, and policy recommendations are made.

Crossing Boundaries and Fetishization: Experiences of Sexual Violence for Trans Women of Color

Transgender (trans) women are at higher risk of sexual violence than cisgender women, with trans women of color reported to be at highest risk. This study examined subjective experiences of sexual violence for 31 trans women of color living in Australia, average age 29 (range 18-54), through in-depth interviews. An additional photovoice activity and follow-up interviews were completed by 19 women. Data were analyzed through thematic analysis and feminist intersectionality theory, identifying the following themes. The first theme, "'A sexually tinged violation of boundaries': Defining sexual violence," examined women's definition of sexual violence, including staring and verbal abuse, nonconsensual touching and sexual assault, in both public and private contexts. The second theme, "'Crossing people's boundaries': Sexual harassment in the public domain," examined the frequent sexual harassment women experienced in their daily lives. This included the subtheme, "A hostile gaze: Public staring and 'weird looks'" and "Mockery and transphobic abuse: Verbal abuse is sexual violence." The third theme, "'Crossing bodily boundaries': Experiences of sexual assault," included the subthemes "'Unwanted sexual touch': Groping and forced sex by strangers," "Danger in relationships: Sexual assault and manipulation," "Sexual violence in the context of sex work," and "'We're turned into something we're not': Fetishization and the sexual other." The poor health outcomes experienced by many trans women are closely associated with their exposure to sexual violence and the social inequities and transphobia to which they are subjected. Trans women of color may experience additional prejudice and discrimination due to the intersection of gender, sexuality, race, and social class. Our research suggests that understanding these intersectionalities is integral in understanding the sexual violence experiences of trans women of color.

Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort

In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.

Gender affirmation and social exclusion amongst trans women of color in Australia

INTRODUCTION

Transgender (trans) women of color navigate the intersected identity frames of gender, race, social class and sexuality, whilst facing multiple layers of stigma, discrimination and violence during and following gender affirmation. However, little is known about the ways in which trans women of color negotiate gender affirmation, in the context of the risk of social exclusion and violence.

AIM

This article discusses the experience and construction of gender transitioning and gender affirmation for trans women of color living in Australia, associated with the risk of social exclusion or violence.

METHOD

In-depth interviews and photovoice were conducted with 31 trans women of color, analyzed through theoretical thematic analysis informed by intersectionality theory.

RESULTS

The following themes were identifed: 1) 'Gender affirmation: A bittersweet experience', with three subthemes: 'Self-empowerment is tempered by family rejection', 'Migration facilitates gender affirmation' and 'Gender affirmation and social support'; 2) 'Being a trans woman of color', subthemes: 'Bodily agency and passing', 'Femininity as pleasure and cultural self-expression', and 'Resisting archetypal White hetero-femininity'; 3) 'Hormones, surgical intervention and navigating the health system'.

CONCLUSION

Gender transitioning and gender affirmation involved the intersection of gender, cultural, social class and sexual identities, accomplished through personal agency and with the support of significant others. To ensure that policy and support services meet the needs of trans women of color, it is critical that the voices of such multiply-marginalized women are at the center of leadership, program and policy development.

Conceptualizing "Family" and the Role of "Chosen Family" within the LGBTQ+ Refugee Community: A Text Network Graph Analysis

This study analyzed meaning attributions regarding “family” and “chosen family” by Lesbian, Gay, Bisexual, Pansexual, Transgender, Gender Queer, Queer, Intersex, Agender, Asexual, and other Queer-identifying community (LGBTQ+) refugees. The meaning and significance of a chosen family in the newly established life of the refugees was also pin-pointed for its value of safekeeping the wellbeing and settlement process. We analyzed narrative statements given by 67 LGBTQ+ refugees from 82 YouTube videos. Using InfraNodus, a text graph analysis tool, we identified pathways for meaning circulation within the narrative data, and generated a contextualized meaning for family and chosen family. The conceptualization process produced a deduction within family relationships, exploring why people, other than in biological relationships, appear to be vital in their overall wellbeing and settlement, as well as the process through which this occurs. Biological family is sometimes associated with words that instigate fear, danger, and insecurity, while the concept of chosen family is associated with words like trusting, like-minded, understanding, welcoming, loving, committed, etc. The results of the study are intended to add knowledge to the gap by showing the types and characteristics of family relationships in LGBTQ+ refugee settings. It is also a call for the relevant research community to produce more evidence in such settings, as this is essential for obtaining a better understanding of these issues.

"We have to do a lot of healing": LGBTQ migrant Latinas resisting and healing from systemic violence

Using narratives from oral histories of LGBTQ migrant Latinas in Los Angeles, California, and Mexico City, Mexico, this article argues that, despite experiences of oppression, the narrators practice resistance in their daily lives. The article first addresses how the narrators confront conditions of detainability and deportability, making survival a constant struggle. It then presents different ways in which the narrators engage in resistance, from survival to community building and activism. Finally, it argues that healing is a key factor in the narrators' resistance-healing functions as both a tool for and outcome of resistance.

Coming Out of the Shadows and the Closet: Visibility Schemas Among Undocuqueer Immigrants

Centering the experiences of 31 undocuqueer immigrants, this study seeks to understand the ways that undocuqueer immigrants negotiate the boundaries of social performance by revealing or concealing their gender, sexuality, and immigration status. Findings of this study reveal how, in order to avoid the constant threat of rejection (both legal and social), undocuqueer immigrants engage visibility schemas and make strategic decisions about coming out of the shadows and the closet across different contexts. Undocuqueer immigrants' narratives reveal the ways the closet resembles the shadows in that both provide protection from the outside world, yet neither are considered suitable places for sustaining life. This study raises implications for both research and policy by considering how the intersection of gender, sexuality, and immigration status nullifies neoliberal narratives of coming out as an empowering process and illustrating the uneven landscapes of social acceptance and political control that undocuqueer immigrants must negotiate.

Working with the Complexity and Refusing to Simplify: Undocuqueer Meaning Making at the Intersection of LGBTQ and Immigrant Rights Discourses

This study brings gender, sexuality, and immigration status, and their conceptual margins, to the center of analysis via the narratives of 31 self-identified undocuqueer immigrants. Undocuqueer immigrants ascribe meaning to their experiences by producing alternate subjectivities and subject positions that resist multiple axes of oppression. These subjectivities problematize the exclusionary repercussions of single-axis identity categorization that mostly benefit those who already have some structural privileges. Undocuqueer as a form of resistance to essentialized identity discourses was evidenced in participants' opposition to heteronormative, homonormative, and DREAMer discourses. This study has implications for further understanding the way that queer politics and identity interact with various axes of inequality.

Promoting the wellbeing of lesbian, gay, bisexual and transgender forced migrants in Canada: providers' perspectives

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems. This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms. Participants' accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients' nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients' mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.

"It's for us -newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be": a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada

BACKGROUND

Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT) people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however, has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study was to explore experiences of social support group participation among LGBT African and Caribbean newcomers and refugees in an urban Canadian city.

METHODS

We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers and refugees (n = 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques.

RESULTS

Participant narratives highlighted immigration stressors, social isolation, mental health issues, and challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community (reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care) levels.

CONCLUSIONS

Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and refugees can address social isolation, community resilience, and enhance resource access. Health care providers can provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT newcomers and refugees' health and wellbeing.

"It's for us -newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be": a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada

BACKGROUND

Stigma and discrimination harm the wellbeing of lesbian, gay, bisexual and transgender (LGBT) people and contribute to migration from contexts of sexual persecution and criminalization. Yet LGBT newcomers and refugees often face marginalization and struggles meeting the social determinants of health (SDOH) following immigration to countries such as Canada. Social isolation is a key social determinant of health that may play a significant role in shaping health disparities among LGBT newcomers and refugees. Social support may moderate the effect of stressors on mental health, reduce social isolation, and build social networks. Scant research, however, has examined social support groups targeting LGBT newcomers and refugees. The purpose of this qualitative study was to explore experiences of social support group participation among LGBT African and Caribbean newcomers and refugees in an urban Canadian city.

METHODS

We conducted 3 focus groups with a venue-based sample of LGBT African and Caribbean newcomers and refugees (n = 29) who attended social support groups at an ethno-specific AIDS Service Organization. Focus groups followed a semi-structured interview guide and were analyzed using narrative thematic techniques.

RESULTS

Participant narratives highlighted immigration stressors, social isolation, mental health issues, and challenges meeting the SDOH. Findings reveal multi-level benefits of social support group participation at intrapersonal (self-acceptance, improved mental health), interpersonal (reduced isolation, friendships), community (reciprocity, reduced stigma and discrimination), and structural (housing, employment, immigration, health care) levels.

CONCLUSIONS

Findings suggest that social support groups tailored for LGBT African and Caribbean newcomers and refugees can address social isolation, community resilience, and enhance resource access. Health care providers can provide support groups, culturally and LGBT competent health services, and resource access to promote LGBT newcomers and refugees' health and wellbeing.

Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research

Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.

Community-Level Interventions for Reconciling Conflicting Religious and Sexual Domains in Identity Incongruity

Two of the most unstable domains involved in identity formation, the religious and sexual domains, come into conflict when vulnerable populations of the lesbian, gay, bisexual and transgender community experience oppression from the indoctrination of religious beliefs that persecute their sexual orientation. This conflict, aptly termed identity incongruity in this article's discourse, results in a schism that adversely affects these vulnerable populations. This paper investigates the roles of religion, spirituality and available institutional solutions to propose customized, culturally adapted, contextually based and collaborative community-level interventions that would facilitate the reconciliation of the conflicting identity domains.

Towards full citizenship: correlates of engagement with the gender identity law among transwomen in Argentina

Introduction

In May 2012, Argentina passed its “Gender Identity” Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina.

Methods

Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law.

Results

Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27–3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58–5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06–3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06–0.33).

Conclusions

More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreign-born status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina.