LGBTQ+ Individuals, Health Inequities, and Policy Implications

When the Office of Disease Prevention and Health Promotion (“ODPHP”) released its Healthy People 2020 goals and objectives, it recognized the public health needs of the lesbian, gay, bisexual, and transgender (“LGBT”) community for the first time. The stated goal of Healthy People 2020 is to “improve the health, safety, and wellbeing of [LGBT] individuals.” One barrier to obtaining the needed information for achieving this goal is a lack of necessary data collection, particularly as it regards the LGBTQ+ community. This paper will provide a basic overview of health inequities experienced by the LGBTQ+ community and introduce interventions of interest to the legal and public health communities

“An Institution Can Have Good Intentions and Still Be Atrocious : Transgender and Gender Expansive Experiences in Social Work Education

Educational settings have been found to be challenging arenas for transgender and gender expansive (TGE) youth and young adults due to misgendering, lack of affirming bathrooms, systemic exclusion (e.g., legal names and lack of inclusive gender identity demographic options), and frequent silence or avoidance related to TGE issues. Though studies of TGE adult experiences in higher education are emerging, most explore disaffirming experiences. Social work education focuses on diversity, equity, and inclusion, along with how to promote social justice, which suggests more affirming environments for TGE individuals. However, little is known about the experiences of TGE students and even less about faculty in social work education. To help fill this gap, the researchers interviewed 23 TGE social work students and faculty to explore their experiences of gender-related affirmation and challenges in social work educational programs. The findings from a thematic analysis identified examples of affirming and disaffirming experiences and recommendations for improving gender affirmation and inclusion in social work programs. Social work is in a strategic position to serve the needs and impact the social welfare of TGE individuals, starting with educational settings

Does it get better? LGBTQ social work students and experiences with harmful discourse

Although the field of social work is grounded in social justice, the social work educational experience, including classrooms, may not live up to this value, especially for lesbian, gay, bisexual, transgender, and queer (LGBTQ) students. Using a qualitative phenomenological approach, this study examined the experiences of harmful discourse in social work classrooms for LGBTQ students. Findings indicate that students experienced being misgendered, tokenized, and erased through cis-/heteronormative language and classroom teachings. Although social work is guided by frameworks of social justice, microaggressions and discrimination may be vaguely glossed over, if addressed at all. This study highlights the gap between the values social work teaches and how social work education is delivered

Does it get better? Exploring “it gets better” videos using visual sociology

In 2010, the It Gets Better (IGB) project website was launched to house videos containing messages of support for youth who identify as sexual and/or gender minorities (SGMs). Despite success as a virtual social movement, scholars have suggested that the imagery portrayed may unintentionally exclude those who are most marginalized and that the videos often implore individuals to endure suffering now to gain happiness later. Using visual sociology methodology, the visual messaging and demographics of IGB video producers were examined and compared against criticisms of the project. Imagery portrayed was consistent with common concerns about exclusions of minorities, those who do not fit social standards of physical attractiveness, and those who challenge heteronormativity and adherence to gender norms. Despite IGB videos’ intentions to promote hope, the tales of struggle and hardship relayed often resulted in the depiction of negative emotions. Expressions of confidence, defiance, and empathy were visible, but the most prevalent emotion was sadness. Negative visual presentations and exclusion of significant demographics within the SGM community suggest IGB videos project more complex visual signals and different messaging than would be expected from videos designed to be supportive. Professionals should be attuned to these concerns when working with SGM youth

Exploring Gender Identity with a Photo Diary

Gender identity is an abstract component of one’s identity, yet a person’s physical appearance can be a significant source of anxiety and dysphoria or acceptance and integration. Distinct from individuals’ sex assigned at birth, gender identities refer to the internal sense of self. The social construct of gender identity, however, has been predominantly understood as a continuum or dichotomy of masculinity and femininity. According to J. Butler, gender is a performative act with a basis that lies in socialization, whereas sex is a biological categorization of male, female, or intersex according to scientific indicators, including external genitalia, gonads, internal reproductive organs, and sex chromosomes. When working with transgender people of color, A. A. Singh and V. S. McKleroy note the importance of understanding their resilience and how it may have helped them navigate challenges related to race and ethnicity in addition to gender identity. For affirming care, practitioners need to integrate understanding of intersectionality into their practice

Learning to Thrive in a Binary World: Understanding the Gendered Experiences of Nonbinary Individuals and Ways to Bolster Wellbeing

Indiana University-Purdue University Indianapolis (IUPUI)Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people identify as nonbinary – or not exclusively a man or woman. Despite a growing literature on the experiences of binary transgender individuals, little has been explored regarding experiences unique to nonbinary individuals. The research that does include nonbinary individuals focuses primarily on adverse risks and outcomes. As such, a dearth of empirical research exists to understand the unique experiences of nonbinary people and how they relate to wellbeing. A qualitative participatory action study using PhotoVoice was conducted virtually to address the identified gaps in the literature on nonbinary individuals concerning gendered experiences and wellbeing. Prevailing theories of wellbeing informed the study along with minority stress theory and the resilience literature to account for environmental factors of oppression and individual and community resilience. A sample of 17 nonbinary adults in the Midwestern United States was recruited using convenience sampling and participated in online group discussions and individual interviews. The findings were reported in sections corresponding with the three study aims: 1) Explore core dimensions of wellbeing as defined by nonbinary individuals, 2) Identify promotive and corrosive factors of that wellbeing, and 3) Provide recommendations to bolster nonbinary wellbeing. The findings provided a thorough description of how nonbinary individuals perceive their wellbeing concerning their gender and as part of a marginalized population. Thematic analysis identified nine wellbeing themes for how participants conceptualized their wellbeing (e.g., Exploring gender identity and expression, Being connected to community, etc.), seven themes of promotive and corrosive factors of wellbeing (e.g., Positive, accurate, and nuanced representation, Coping skills to manage minority stressors, etc.), and three themes of recommendations (e.g., personal, interpersonal, and professional) with eighteen strategies to bolster wellbeing among nonbinary individuals and communities. The significance of the findings to social work was discussed, including practice application and advocacy. This study contributes to PhotoVoice methodology, wellbeing literature, and trans literature

An Argument for Explicit Public Health Rationale in LGBTQ Antidiscrimination Law as a Tool for Stigma Reduction

The lesbian, gay, bisexual, transgender (inclusive of nonbinary), and queer (collectively, LGBTQ) community is experiencing health inequities at alarming rates. From behavioral health issues, to violence issues, to increased rates of homelessness, structural stigma impacts LGBTQ communities at a disproportionate rate. Suicide numbers are particularly concerning. The LGB community rate of suicide is two to three times that of the general population. For the transgender and nonbinary community, that number soars to nearly nine times that of the general population. In this article, we examine the social determinates of health impacting the LGBTQ community and the ways structural stigma supports health inequity. Given the health data, the article analyzes how policymakers could include an explicit rationale in antidiscrimination laws to shift social norms and lower stigma in pursuit of improving population health. Even when a policy is anti-discriminatory on its face, naming the intent of shifting norms and lowering stigma matter. When the explicit rationale is named, it can serve two purposes: 1) articulating a clear public health purpose of the antidiscrimination law and 2) educating the public on the need for norm change and its public health impact. Making it clear that the goal of social norm change is to protect and improve the population’s health may make the state’s compelling state interest case stronger, particularly in the face of Religious Freedom Restoration Acts, in challenges to antidiscrimination laws

Adopting e-Social Work Practice: Pedagogical Strategies for Student Decision Making to Address Technology Uncertainty

Student technology uncertainty was investigated in an introductory e-Social Work (e-SW) practice course. e-SW practice includes technology-mediated advocacy, research, and services delivery. A convergent parallel mixed methods design included pre- and post-test e-SW self-efficacy surveys and student reflections. There were significant measurable changes in the practice self efficacy scale and sub-scales. Thematic analysis demonstrated the course addressed student needs for increasing their knowledge and confidence prior to engaging in e-SW practice. Privacy and security regulation compliance showed the least increase in self-efficacy and should be an area for further development in future e-SW courses. The findings contribute to a growing literature supporting the need for investment in harnessing technology for future growth in the field of social work