Social inclusion of LGBTQ and gender diverse adults with intellectual disability in disability services: A systematic review of the literature

Theorizing the Role of Sex Educators in the Resistance and Reification of Epistemic Injustices Related to the Sexual Expression of People with Intellectual Disability

People with intellectual disability face a variety of epistemic injustices-systems of knowledge and educational inequality-related to their access to sex education and perceptions of their sexuality. Sex educators are in a position to address these injustices; however, they may not be fully aware of their own epistemic ethics. Furthermore, there is little theoretical understanding of how sex educators provide instruction within an environment that exhibits hostility toward the sexual expression of those with intellectual disability. This grounded theory study of interviews with 58 people who taught sex education to people with intellectual disability sought to understand the role of educators in perpetuating and resisting epistemic injustice by utilizing sex education to either facilitate or restrict the sexual expression of people with disabilities. We identified four micro-contexts: centralizing capacity to consent, emphasizing risk, desexualizing (through) sex education, and acknowledging gender identity. In each micro-context, we explore mechanisms of how educators were either allied in support of autonomy (person-centered values, expertise, access to curricular resources, self-advocates as teachers and partners, subversiveness, and de-problematizing normative sexual behavior) or reified sexual stigmas (fear of sexual abuse and sexual perpetration, conscripting to asexuality, the paternalistic service system, and complex ethical dilemmas) in the context of hostility to sex education and sexual expression. These findings have implications for promoting prosocial sexual expression and access to sex education for people with intellectual disability.

The Experiences of 2SLGBTQ+ Adults Labeled with Intellectual and/or Developmental Disabilities When Navigating Mainstream Queer Social Spaces

Drawing on interviews with 31 2SLGBTQ+ people labeled with developmental and/or intellectual disabilities, this exploratory study focuses on participants' experiences navigating mainstream queer social spaces. The current study is an explorative qualitative view at the intersection of the 2SLGBTQ+ and disability community. There is a call for more inclusive spaces for people with disabilities within queer social areas. Although queer spaces attempt to be free and inclusive, many have inaccessible activities and locations. The findings depict that individuals with lived experiences are not often represented in the 2SLGBTQ+ community due to a lack of inclusion. Participants highlighted feelings of rejection as people with disabilities were not represented in many 2SLGBTQ+ focused groups or organizations. The current paper calls attention to creating more inclusive intersectional spaces to promote inclusivity and ensure people with disabilities have the opportunity to contribute through an active role in the 2SLGBTQ+ community.

Navigating Unique Intersectional Experiences: LGBTQ+ Community Organisations Addressing Individuals With Intellectual Disabilities' Needs

BACKGROUND

This exploratory study aimed to enhance the understanding of practitioners' experiences within LGBTQ+ community organisations when providing interventions for LGBTQ+ individuals with intellectual disabilities. Three specific objectives were outlined: to document the situations and challenges encountered by practitioners; to identify perceived needs among LGBTQ+ individuals with intellectual disabilities and to elicit their suggestions for recommendations to improve services.

METHOD

A qualitative approach, involving in-depth interviews with 12 Québec-based LGBTQ+ community practitioners, underwent content analysis.

RESULTS

Findings were organised around three themes: perceived support needs of LGBTQ+ people with intellectual disabilities; challenges experienced in intervention and recommendations to improve services. Findings reveal that practitioners frequently face significant challenges when supporting LGBTQ+ individuals with intellectual disabilities, who often struggle with multiple daily challenges and insufficient support.

CONCLUSIONS

The study highlights the need to empower LGBTQ+ organisations with essential skills and foster partnerships with public service staff to ensure a more inclusive, intersectional approach.

Factors Associated With Experiences of Harassment or Abuse Among Lesbian, Gay, Bisexual, Trans, Queer, and Asexual Young People With Disability in Australia

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) young people with disability are known to experience higher rates of harassment or abuse than LGBTQA+ young people without disability. This study focused on participants in Australia and identified factors associated with harassment or abuse among LGBTQA+ adolescents and young adults who reported a disability as well as associations with mental health outcomes. Analyses were conducted from a national survey that included 2,500 LGBTQA+ people who reported a disability and were aged 14 to 21 years. Measures included experiences in the past 12 months of verbal and physical harassment or abuse due to one's sexual orientation or gender identity, sexual harassment or abuse, mental health, suicidality, and sociodemographic traits. Overall, 48.4% of participants with disability reported experiencing verbal harassment or abuse, 12.4% physical harassment or abuse, and 29.7% sexual assault or harassment. In multivariable regression analyses, verbal harassment or abuse was significantly more likely among trans men, participants with an intellectual disability, and those who were "out" to most or all of their family. Physical harassment or abuse was significantly more likely among participants with a physical or sensory disability. Sexual harassment or abuse was significantly more likely among trans women and participants with a physical or sensory disability. Participants who experienced harassment or abuse were also significantly more likely to have attempted suicide in the past 12 months. These findings will assist policymakers and practitioners in identifying contexts linked to a heightened risk of abuse among LGBTQA+ young people with disability and further underscore an immediate need to address and prevent harm in this population.

A tool for assessing sexual knowledge of people with Intellectual disabilities in Norway

Background

Previous research has shown that people with intellectual disabilities have limited sexual knowledge, which can be essential for developing positive sexuality. This study aimed to check the validity and reliability of an assessment tool (SexKunn) for measuring the sexual knowledge of people with intellectual disabilities in Norway. Further, we aimed to identify potential knowledge gaps among the participants and highlight their potential impact.

Methods

37 people with intellectual disabilities completed one assessment. 20 participants then completed a retest. Clinicians' (n=23) views on the assessment tool were measured to obtain face validity. Positive and negative agreement analysis was used to identify potential dimensions in the data.

Results

A weighted Cohen's kappa for the test and retest of the overall scores was considered to be substantial. The clinicians described an acceptable face validity regarding high positive value scores and low negative burden scores. They also suggested improvements. The study identified that the participants lacked knowledge about female genitals, hygiene, appropriate touching/sexual acts with friends/intimate partners, and contraception.

Conclusions

The SexKunn is a feasible assessment tool to measure sexual knowledge in people with intellectual disabilities. A lack of sexual knowledge of people with intellectual disabilities may violate their sexual rights.

Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets

To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.

Factors associated with experiences of abuse among lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) adults with disability in Australia

BACKGROUND

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) people with disability report greater levels of abuse than those without disability.

OBJECTIVE

This study sought to further understand these experiences by examining factors associated with experiences of abuse among LGBTQA+ adults who reported a disability in Australia.

METHODS

A national survey was conducted that included 2629 LGBTQA+ people who reported a disability aged 18 years and older, with data collected on experiences of verbal abuse, sexual assault, and social exclusion in the past 12 months as well as demographic characteristics.

RESULTS

Of participants with disability, 42.5% reported experiencing verbal abuse, 17.4% sexual assault, and 50.3% social exclusion based on their sexuality or gender identity in the past 12 months. From multivariable analyses, verbal abuse was significantly more likely among trans women and non-binary participants and among those classified with more severe disability. Sexual assault was significantly more likely among those who lived in a rural area or had a higher income. Social exclusion was significantly more likely among those who were trans woman or non-binary, identified as bisexual, aged 18-24 years, or born in an English-speaking country other than Australia.

CONCLUSIONS

These findings illustrate contexts for heightened risks of specific forms of abuse and highlight an urgent need to understand and address experiences of abuse and their consequences among LGBTQA+ people with disability.

Sexual Self-Determination of Individuals with Intellectual Disabilities-A Possible Philosophical Conceptualization and Resulting Practical Challenges

(1) Background: Self-determination is one of the central values of many societies. Self-determination concerns many areas of life, including sexuality. Unfortunately, the sexuality of individuals with intellectual disabilities (IID) is often discriminated against, and even in their everyday care, sexuality is often given too little space, not least because of knowledge deficits of parents and staff. A practicable conceptualization of sexual self-determination is a prerequisite for helping IID to achieve self-determined sexuality. The aim of this paper is to formulate such an applicable conceptualization and to discuss related challenges. (2) Method: This paper uses Harry Frankfurt's hierarchical conception of desires and the WHO definition of sexuality to develop a suitable understanding of sexual self-determination. (3) Results: The mentioned concepts offer promising tools to develop a conceptualization of sexual self-determination with high practical applicability. (4) Discussion: Sexual self-determination involves decision-making processes in relation to the different dimensions of sexuality. IID do need support to come to these decisions. Challenges that might be involved with such decision processes will be discussed.