The health needs of gay men: a discussion of the literature and implications for nursing

Healthy Aging in Community for Older Lesbians

PURPOSE

In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance.

METHODS

Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings.

RESULTS

Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging.

CONCLUSION

Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly.

Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men

HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.

Acceptance in the domestic environment: the experience of senior housing for lesbian, gay, bisexual, and transgender seniors

The social environment impacts the ability of older adults to interact successfully with their community and age-in-place. This study asked, for the first time, residents of existing Lesbian, Gay, Bisexual, and Transgender (LGBT) senior living communities to explain why they chose to live in those communities and what, if any, benefit the community afforded them. Focus groups were conducted at 3 retirement communities. Analysis found common categories across focus groups that explain the phenomenon of LGBT senior housing. Acceptance is paramount for LGBT seniors and social networks expanded, contrary to socioemotional selectivity theory. Providers are encouraged to develop safe spaces for LGBT seniors.

Substance use disorder in the context of LGBT health: a social work perspective

The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.

Widows and widowers in today's society

With the increasing life span in our society, the number of widowed individuals has increased dramatically. The loss of a spouse is one of the most stressful life events for both women and men, yet there is little nursing research on the physical and psychosocial needs of older adults who are experiencing this loss. Some studies suggest that widowed women and men develop significant physical and mental health problems and complicated grief. Thus, it is important for nurses to recognize the diversity of grieving experiences and the increased vulnerability of widowed individuals to psychiatric illnesses that may result in suffering and impairment of daily functioning. With a better understanding of these needs, nurses can provide interventions that help these individuals maintain their health and independence.

The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature

This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers. A total of 187 papers or chapters were retrieved, of which 66 were included in the study; major themes were identified and the findings synthesised using a meta-narrative approach. The main themes that emerged from the review were isolation, health behaviours, mental health and sexual health behaviours. The literature indicates that the health, social care and housing needs of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services. Understanding of the health, social care and housing needs of older LGBT people is limited and research in this area is scarce. The research which exists has been criticised for using small samples and for tending to exclude participants from less affluent backgrounds. The focus of research tends to be on gay men and lesbians; consequently, the needs of bisexual and transgender people remain largely unknown. Additionally, research which does exist tends to focus on a narrow range of health issues, often related to the health needs of younger LGBT people. Discrimination in various forms has a major impact on needs and experiences, leading to marginalisation of LGBT people both in the provision of health and social care services and neglect of these groups in public health research.

National policy and sexual health of men who have sex with men

Nurses continue to play a crucial role in helping to deliver the Department of Health's 10-year National Strategy for Sexual Health and HIV (DH, 2001) and the Government's White Paper, Choosing Health (DH, 2004). Both policies aim to reduce the transmission of sexually transmitted infections (STIs) and the prevalence of undiagnosed cases. However, over the past 10-years the rate of newly diagnosed STIs among men who have sex with men (MSM) has increased by 77% (Health Protection Agency, 2007). Genitourinary medicine (GUM) clinics have long been popular with MSM owing to their provision of non-judgemental services, and are increasingly becoming nurse-led. However, the relative underfunding of GUM clinics and the pressures placed on nursing staff to reach waiting time targets has called in to question the quality of service provided. Concurrently, potential contributors to poor sexual health among MSM, including the deep-rooted effects of homophobia and low self-esteem, continue to be overlooked in the fight against rising STIs. Despite the Government's pledge to transform sexual health services with 300 million pounds of extra funding, there has been little significant improvement in the sexual health of MSM. Poor stewardship of resources and poor management of service targets arising from current policy contribute to a negative impact on the sexual health of MSM and the quality and effectiveness of nursing care.

Exploring the implications for health professionals of men coming out as gay in healthcare settings

Coming out as gay is a social process which redefines the relationship between the persons who have decided to disclose their homosexuality and their listeners. This paper, drawing upon Bakhtin's (1984) theories of dialogue, the coming-out literature of gay men and lesbians and contemporary literature on doctor-patient communication, explores the coming-out experiences of gay men with their general practitioners and sexual health clinic staff. The findings are based upon a study of 38 gay men and 12 health service managers in London. The informants were recruited purposively to reflect some of the diversity of the London setting; recruitment was carried out through the channels of gay voluntary organisations and through snowballing. Semi-structured interviews were conducted and a grounded-theory approach was adopted. It was found that coming out in general practice was often/mostly followed by silence/noncommunication on the part of the practitioner; coming out could, however, result in an improvement in communication if the patients were well supported and assertive. If coming out in sexual health clinics did not result in improved communication, the informants in this study were likely to change clinics until they did find improved communication. This paper raises questions about the communication and training needs of general practitioners. It also raises questions about inequalities of access to 'respectful' sexual health clinics; while men who are articulate about the narratives of their lives as gay men are able to exercise informed choices, there were grounds for concern about the choice behaviours of men who are less articulate about their life narratives.

Homophobia in nursing: a concept analysis

It could be argued that the term homophobia may have an array of meanings, which makes it difficult to truly define. Therefore, the purpose of this article is to explore homophobia in nursing using concept analysis as described by Walker and Avant (1995). Definitions of homophobia in general terms will be identified together with a working definition of homophobia in nursing in order for the critical attributes to be explored and identified. The formation of model, borderline, and contrary cases will exemplify the key characteristics of what homophobia in nursing is and is not. The examination of the antecedents, consequences, and empirical referents allows for further refinement of the key attributes, which define homophobia in nursing.

Nursing staff and nursing students' emotions towards homosexual patients and their wish to refrain from nursing, if the option existed

Studies have reported that homosexual patients fear they will not receive adequate care if they openly show their sexual orientation, for example, when introducing their partner. The aims of this study were to investigate the emotions of nursing staff and nursing students, and possible relations to cultural background and gender, towards homosexual patients; whether nursing staff and nursing students would choose to refrain from nursing homosexual patients, if the option existed; and, if so, how they express their wish to refrain from nursing this group of patients. All participants received verbal and written information before the study started. Returning a completed questionnaire indicated a participant's tacit consent. Approval was obtained from the heads of departments and persons in charge of nursing and nursing assistant programmes. The study had a descriptive, comparative design, and an Affect Adjective Checklist (AAC) and specially designed Nursing Behaviour Questionnaire (NBQ) were used. The participants included nurses and assistant nurses from an infectious disease clinic, and students enrolled in a university nursing programme and upper secondary assistant nurses' training, all in central Sweden. The findings showed that both professional nursing staff (response rate 67%, n = 57), and students (response rate 62%, n = 165), expressed emotions of homophobic anger, homophobic guilt and delight. Groups with a cultural background other than Swedish expressed more homophobia. No gender differences were indicated for homophobic emotions. In the professional group, 36% would refrain from nursing for homosexual patients if given the option. The corresponding figure for the students was 9%. The limitations were that the sample was small and not randomly selected, and as participation was anonymous no follow-up could be done. It was concluded that the emotional factors of homosexual anger and homosexual guilt might be of value in helping to explain and predict attitudes towards homosexuals.

The well-being of gays, lesbians and bisexuals in Botswana

AIMS

To investigate the level of well-being of gays, lesbians and bisexuals (GLBs) in Botswana, how this level of well-being could be promoted and whether their health care needs were met by health care professionals.

RATIONALE

It is illegal to engage in same-sex activities in Botswana, punishable by imprisonment. Although Botswana's citizens have one of Africa's best health care systems, little is known about the health status, health care needs and general well-being of Botswana's GLBs. This survey attempted to uncover some of these potential health care needs, impacting on the GLBs' well-being.

DESIGN/METHODS

The research framework adopted was the health and human rights approach, placing dignity before rights. A survey design, with structured questionnaires, was used. Snow-ball sampling techniques were used.

RESULTS

Results indicated that varying degrees of distress were experienced by 64% of the GLBs in this study. The GLBs identified a need for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) education and had concerns about their general health, discrimination against them and vulnerability to violence including sexual assaults.

CONCLUSIONS

The well-being of the GLBs in Botswana was influenced by both positive internal acceptance of their sexual orientation and negative external acceptance by society. Health care professionals played insignificant roles in the promotion of GLBs' well-being, and could make greater inputs into health education efforts, and more significant contributions towards enhancing the GLBs' levels of well-being. Enhanced collaboration between health professionals and human rights activists are recommended to reduce violations of Botswana's GLBs' dignity and to improve their quality of life, including enhanced access to and utilization of health care services.

Lesbian, gay and bisexual experiences within critical care nursing, 1988-1998: a survey of the literature

The aim of this paper is to provide an analysis of the extent to which gay, lesbian and bisexual service user experiences are represented within the critical care literature. A survey of five well established critical care journals, covering the period 1988-1998, was conducted in order to reveal the range of themes addressed within them. The findings suggest that these groups are invisible in this field of practice and consequently their particular concerns have remained marginalised. The implications of this absence are far reaching, potentially inhibiting nurses from establishing effective caring relationships with either lesbians, gays or bisexuals and from identifying and developing appropriate interventions for the care of these patients and their families.

The expressed needs of a group of HIV-infected gay men subsequent to hospital care

A qualitative study was conducted to explore how a group of HIV-infected gay men experienced their encounters with the health care community and to develop a theoretical understanding of the care given from the patient's perspective. Ten HIV-infected gay men were recruited from an outpatient clinic in a city in the southeastern part of the United States. Collection and analysis of data was conducted with a qualitative approach using a constant comparative method. The themes summarizing the findings were integration, recognition, security, availability of facilities, and confirmation. These themes contain both negative and positive experiences and conceptualize different needs from a patient's perspective. The role of the nurses' attitudes to and perceptions of gay HIV-infected men was emphasized.

People with HIV/AIDS: who cares?

Studies have shown that some nurses, doctors and other carers have negative attitudes towards people with human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Some cope by avoiding working with such patients, while others just do the best they can. But does it matter? This paper describes a review of the literature on the impact of attitudes to care and the barriers affecting the quality of care for people with HIV/AIDS by professional health care workers and other carers. Most of the reports identified were based on attitude scales, mostly unique and often unvalidated. Attitudes of health care workers based in the community, and 'house keeping' staff such as porters, receptionists, etc., have been neglected areas of research. There is also little information about the culture of organizations and the attitudes of individuals with HIV/AIDS to care. Only three references were found in which both patients' and carers' attitudes to each other were considered and none of these looked at negative feelings and their impact. There is scope therefore to investigate the attitudes of patients and carers towards each other and how this can effect the quality of care. It is anticipated that the benefits of such investigations could lead to the development of educational strategies designed to improve the quality of patient care.

The work of clinical nurse specialists (HIV/AIDS) in areas with a low prevalence of HIV infection

The role of the clinical nurse specialists (HIV/AIDS) who work in areas with a low known prevalence of HIV is considered and their contribution to patient care, either directly or indirectly through the education and support of other health care workers, is discussed. Attention is given to the implications for nursing practice and the role of the clinical nurse specialist associated with the relative infrequency of contact with patients who have HIV disease; and some of the issues for people living with HIV/AIDS in rural areas are alluded to. Finally, some of the limitations of the clinical nurse specialist role are delineated and some consideration is given to the future role of clinical nurse specialists for HIV and AIDS.

Combating heterosexism: implications for nursing

Gays and lesbians are becoming increasingly visible to the healthcare professional as a result of the AIDS epidemic and the growing number of lesbian mothers. Ethical practice requires that nurses have an understanding of diverse cultures but focus has historically been on racial and ethnic minorities; little research exists on those with minority sexual or affectional preferences. Heterosexism, the promotion of a heterosexual orientation as the only viable option, has much the same effect as racism. Individuals experience feelings of shame, self-hatred, and lowered self-esteem. The purpose of this article is (1) to present the current state of knowledge regarding individual identity formation and couple development in the gay and lesbian community and (2) to describe the impact of heterosexism. Implications for nursing practice and research will be explored.

Prevalence and health implications of anti-gay discrimination: a study of black and white women and men in the CARDIA cohort. Coronary Artery Risk Development in Young Adults

This study investigates the prevalence of self-reported experiences of discrimination based on sexual orientation among black and white women and men (25 to 37 years old) who are members of CARDIA, a multisite longitudinal study of cardiovascular risk factors. Among the 1,724 participants who responded to a 1989 questionnaire obtaining data on lifetime number of sexual partners and who participated in the Year 7 exam (1992-1993), which included questions about discrimination, 204 (12 percent) reported having at least one same-sex sexual partner: 27 (7 percent) of the 412 black women, 13 (6 percent) of the 221 black men, 87 (14 percent) of the 619 white women, and 77 (16 percent) of the 472 white men. Among these four groups, 33, 39, 52, and 56 percent, respectively, reported having experience discrimination based on sexual orientation. Additionally, 85 percent of black women and 77 percent of the black men reported having experienced racial discrimination, and 89 percent of the black women and 88 percent of the white women reported having experience gender discrimination. In the light of research associating negative stressors with poor health outcomes, including elevated blood pressure, future studies should assess public health implications of discrimination based on sexual orientation, in conjunction with racial and gender discrimination.

Attitudes of practitioners to lesbian, gay and bisexual clients

Many health-care workers have a negative attitude towards their lesbian, gay and bisexual clients. Negative attitudes regarding same-sex attractions appear to be deeply ingrained in the majority of nurses' minds as a result of the socialization process. It is vital that nursing embraces issues related to sexual orientation so that quality health care can be provided for all. Doctors also have a responsibility to address the issue of homophobia both within their profession and in relation to their clients. To facilitate this, a framework using a sexual health model should be employed as this would encourage the clinician to contemplate these sensitive issues. This article will explore the attitudes of nurses and will outline the implications for care and education.

Caring for the 'new' family in palliative care

A knowledge of societal changes within the family and bereavement theories increases the nurse's understanding of the loved ones' needs in palliative care. The encouragement of self-awareness and reflective practice facilitates staff to support the new family or patient's partner effectively.

The continent colonic conduit in the management of severe constipation

The continent colonic conduit is an innovative surgical technique which has great potential for improving the quality of life of certain patients with severe evacuatory problems for whom other treatment methods have failed.

Homosexuality: a neglected issue in stoma care

Problems of living with an altered body image following stoma surgery have long been recognised, but the specific needs of homosexual patients undergoing such surgery have been largely disregarded. This article examines the ways in which nurses can support their homosexual stoma clients.