The current health stat of lbian, gay, bisexual, and transgenr people of all rac, ethnici, ag, and social backgrounds n be unrstood only cultural and historil ntext. To provi this ntext, this chapter reviews basic fns and ncepts ncerng genr inty, genr exprsn, and sexual orientatn; summariz key historil events that have shaped ntemporary LGBT culture and muni; scrib the mography of LGBT people the Uned Stat; and exam barriers to accsg health re for LGBT people. The chapter then prents a discsn of the se of HIV/AIDS as relat to several important them of this report. The fal sectn summariz key fdgs and rearch opportuni.
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LBIAN, GAY, BISEXUAL, AND TRANSGENR HEALTH
At a time when lbian, gay, bisexual, and transgenr (LGBT) dividuals are an creasgly open, acknowledged, and visible part of society, clicians and rearchers are faced wh plete rmatn about the health stat of this muny. Although a most body of knowledge on LGBT health has been veloped over the last two s, much remas to be explored. What is currently known about LGBT health? Where do gaps the rearch this area exist? What are the prri for a rearch agenda to addrs the gaps? This report aims to answer the qutns. * lgbt health science *
Yet this groupg of “nonheterosexuals” clus men and women; homosexual and bisexual dividuals; people who label themselv as gay, lbian, or bisexual, among other terms; and people who do not adopt such labels but neverthels experience same-sex attractn or engage same-sex sexual behavr. And the transgenr populatn, which self enpass multiple groups, has needs and ncerns that are distct om those of lbians, bisexual women and men, and gay noted above, spe the many differenc among the populatns that make up the LGBT muny, there are important monali as well. Differenc Wh LGBT PopulatnsNot only are lbians, gay men, bisexual women and men, and transgenr people distct populatns, but each of the groups is self a diverse populatn whose members vary wily age, race and ethnicy, geographic lotn, social background, religsy, and other mographic characteristics.
Healthy People 2030 clus objectiv foced on llectg data on lbian, gay, bisexual, and transgenr (LGBT) health issu and improvg the health of LGBT adolcents particular. Learn more about LGBT health. * lgbt health science *
The majory of dividuals affected by disorrs of sex velopment do not face challeng related to sexual orientatn and genr inty, although homosexualy, genr role nonnformy, and genr dysphoria (fed as disfort wh the genr assigned to one at birth [see Chapter 2]) are somewhat more prevalent among this populatn pared wh the general populatn (Cohen-Kettenis and Pfaffl, 2003). They clu ternalized homophobia (a term referrg to an dividual's self-directed stigma, reflectg the adoptn of society's negative attus about homosexualy and the applitn of them to onelf), perceived stigma (which relat to the expectatn that one will be rejected and discrimated agast and leads to a state of ntuo vigilance that n require nsirable energy to mata; is also referred to as felt stigma), and ncealment of one's sexual orientatn or transgenr inty. Although sexual attractns and behavrs are generally unrstood as rangg along a ntuum om exclively heterosexual to exclively homosexual (Ksey et al., 1948, 1953), sexual orientatn is often discsed acrdg to three ma tegori, pecially when is fed terms of inty: (1) heterosexualy (for dividuals who intify as, for example, “straight” or whose sexual or romantic attractns and behavrs foc exclively or maly on members of the other sex); (2) homosexualy (for dividuals who intify as, for example, “gay, ” “lbian, ” or “homosexual” or whose attractns and behavrs foc exclively or maly on members of the same sex); and (3) bisexualy (for dividuals who intify as, for example, “bisexual” or whose sexual or romantic attractns and behavrs are directed at members of both sex to a signifint gree).
Overall, lbians appear to display greater variabily than gay men the age at which they rell reachg var velopmental “ton, ” such as awarens of same-sex attractns, experience of same-sex fantasi, and first pursu of same-sex sexual ntact (for a review, see Diamond, 2008). Data om a 2005 natnal probabily sample reveal that gay men (n = 241) relled regnizg their homosexual orientatn at a signifintly earlier average age than lbians (n = 152) or bisexual women (n = 159), while the average age for bisexual men (n = 110) was between that of women and gay men (Herek et al., 2010), pared wh that of men, women's sexualy may be more likely to be shaped and altered by cultural, social, and suatnal fluenc over time (Bmeister, 2000). Another study, nducted Hoton, Texas, wh a nonprobabily sample of 1, 494 black, Lato, Asian, and whe men and women, found that nrdance rat between sexual behavr and inty varied across racial and ethnic groups (Ross et al., 2003) data dite that black men who have sex wh men are ls likely than whe men who have sex wh men to self-intify as gay (Chu et al., 1992; Doll et al., 1992; Goldbm et al., 1998; Kramer et al., 1980; McKirnan et al., 1995, 2001; Montgomery et al., 2003; O'Leary et al., 2007; Torian et al., 2002) and are more likely to engage sexual behavr wh both mal and femal (Flor et al., 2009).
Lbian, Gay, and Bisexual HistoryInversn, Homosexualy, and the Origs of Contemporary Notns of Sexual OrientatnAlthough heterosexual and homosexual behavrs and attractns are ubiquo across human societi, the ia that dividuals n be meangfully fed or tegorized terms of their patterns of sexual attractn and behavr emerged science and medice only the neteenth century. This dual stigma historilly attached to homosexual behavrs and persons has, as noted earlier, shaped the experienc of many people livg today and has fluenced many ntemporary stutns that affect before Frd articulated his theory of sexualy, theologil doctre and secular law sought to regulate sexual behavrs and attached punishments to a variety of sex acts that were nonprocreative or occurred outsi of marriage.
* lgbt health science *
In the 1940s, however, Amerin psychoanalysts broke wh Frd, and the view that homosexualy was an illns soon beme the domant posn Amerin psychoanalysis and psychiatry (Bayer, 1987) by the begng of World War II, sodomy laws ntued to crimalize same-sex sexual behavr, even when occurred a private settg between nsentg adults, while psychiatry and psychology generally regard homosexualy as an illns.
G., Bebe, 1990; Black et al., 2000; Mennger, 1948) the need for recs dimished durg the war's wang years, however, polici prohibg homosexual personnel were more vigoroly enforced, and many gay men and lbians received unsirable discharg as sexual psychopaths (Bebe, 1990).
Senate mtee issued a 1950 report ncludg that homosexuals were not qualified for feral employment and that they reprented a secury risk bee they uld be blackmailed about their sexualy (Submtee on Invtigatns of the Senate Commtee on Expendur the Executive Departments, 1950). Reportg on the ernment's mpaigns agast gay, lbian, and bisexual employe by daily newspapers across the untry rerced the anxiety experienced by sexual mori (D'E, 1983) 1952, the newly created DSM listed homosexualy as a socpathic personaly disturbance, along wh substance abe and sexual disorrs (Amerin Psychiatric Associatn, 1952; Bayer, 1987).
LGBTIQ+ health refers to the physil, mental, and emotnal well-beg of people who intify as lbian, gay, bisexual, transgenr, tersex or queer (LGBTIQ+). The pl sign reprents the vast diversy of people terms of sexual orientatn, genr inty, exprsn and sex characteristics (SOGIESC). The LGBTIQ+ acronym is dynamic and n vary pendg on the regn or untry, highlightg the multu of LGBTIQ+ muni across cultur. While regnizg the diversy of LGBTIQ+ people, evince suggts some mon experienc affectg their health and well-beg. They are ls likely to accs health servic and engage wh healthre workers due to stigma and discrimatn, rultg adverse physil and mental health out. They n also experience human rights vlatns cludg vlence, torture, crimalizatn, voluntary medil procr and discrimatn. In addn, they n face nial of re, discrimatory attus and appropriate pathologizg healthre settgs based on their SOGIESC. WHO's support to untri is found on the fundamental human rights prciple that all persons should have accs to health servic whout discrimatn. The adoptn of the 2030 Agenda for Staable Development and s pledge to “leave no one behd”, based on the normative amework of ternatnal human rights law, has rerced the need to unrstand and improve the health and well-beg of LGBTIQ+ people. WHO velops guil, provis technil support and nducts rearch to help untri velop and strengthen clive health systems and polici for the health and well-beg of all people, regardls of SOGIESC. * lgbt health science *
Also around this time, Ford and Beach (1951) published an extensive review of cross-cultural and cross-speci studi of sexual behavr, ncludg that same-sex sexual behavr occurs many animal speci and that homosexual behavr of some sort was nsired normal and socially acceptable a majory of the societi for which tailed ethnographic data were available (Ford and Beach, 1951) a landmark study fund by the Natnal Instute of Mental Health, psychologist Evelyn Hooker directly tted the assumptn unrlyg homosexualy's cln the DSM, namely, that homosexualy was herently lked wh psychopathology.
The scholarship of Ksey, Ford and Beach, and Hooker challenged wispread assumptns that homosexualy was a rare and pathologil form of sexualy, practiced only by a small number of social the 1960s, homophile activists had begun to challenge publicly the ia that homosexualy was an illns and to seek an end to job discrimatn and harassment.