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Advancing Health Equity for Sexual and Gender Minority Populations
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Advancing Health Equity for Sexual and Gender Minority Populations

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 11982

Special Issue Editor

Dr. Eileen Yuk-Ha Tsang

E-Mail Website
Guest Editor
Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong 852, China
Interests: gender and sexuality; HIV; work and labor; China; sociology of sex work

Special Issue Information

Dear Colleagues,

Sexual and gender minorities (SGM) face unique and challenging inequities across a breadth of experiences and issues. Sexual and Gender Minorities denote lesbian, gay, bisexual, transgender, intersex, and other populations whose sexual orientation and/or gender identity, sexual orientation, and reproductive development are considered outside cultural, societal, or physiological norms. They experience bias, discrimination, and job insecurity, which affects everything from professional occupational success to personal relationships. These inequities must be addressed through the provision of safe and inclusive environments, improved identification of disparities, and the creation of a pipeline of equity-focused strategies for changes in society. It is crucial to identify and define these disparities, as well as to investigate their underlying causes and mitigate their impact.

 Potential topics include (but are not limited to) the following:

  • Achieving health equity: terminology, demographics, stigmas, and disparities.
  • Creating a welcoming and inclusive environment.
  • Trauma-informed care.
  • Primary care and preventative healthcare of LGBTQI+ patients.
  • LGBTQI+ youth and adolescents.
  • LGBTQI+ older adults.
  • Intimate partner violence for LGBTQI+.
  • HIV/STI treatment and prevention for LGBTQI+ populations.
  • Collecting sexual orientation and gender identity data.

Dr. Eileen Yuk-Ha Tsang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (7 papers)

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Research

16 pages, 284 KiB  
Article
Resilience amid Adversity: A Qualitative Narrative Study of Childhood Sexual Abuse Among Bangladeshi Transgender Individuals
by Sanzida Yeasmin and Jennifer J. Infanti
Int. J. Environ. Res. Public Health 2025, 22(4), 615; https://doi.org/10.3390/ijerph22040615 - 15 Apr 2025
Viewed by 552
Abstract
Childhood sexual abuse (CSA) is a prevalent form of violence against children, associated with profound negative impacts on survivors’ health and well-being. In Bangladesh, sociocultural and economic barriers hinder CSA prevention and intervention, particularly for vulnerable populations such as transgender individuals. This study [...] Read more.
Childhood sexual abuse (CSA) is a prevalent form of violence against children, associated with profound negative impacts on survivors’ health and well-being. In Bangladesh, sociocultural and economic barriers hinder CSA prevention and intervention, particularly for vulnerable populations such as transgender individuals. This study explores the experiences of CSA among Bangladeshi transgender individuals, focusing on their coping mechanisms and resilience-building strategies. A qualitative narrative approach was employed, using life story-telling interviews with four transgender CSA survivors, and data were analyzed thematically. The findings reveal significant challenges, including social exclusion, humiliation, and lack of family support. Participants reported experiencing physical injuries, mental trauma, and loss of trust due to CSA, while the conservative nature of Bangladeshi society often prevented them from disclosing their abuse or seeking healthcare. These barriers exacerbate health inequalities among gender-minority children. Despite these adversities, participants described engaging in resilience-building strategies such as self-care, personal development, advocacy, and efforts to derive meaning from their experiences, while highlighting the perceived importance of family support. This study provides insights into the unique experiences of transgender CSA survivors in Bangladesh and calls for efforts towards gender-inclusive education, mental health support, and further research to address CSA-related adversity, encourage disclosure, and promote health equity for gender-minority groups. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
14 pages, 844 KiB  
Article
A Trans and Queer Discursive Approach to Gender Diversity and Misgendering in the Transgender and Gender Diverse Population: Queering a Study for ICD-11
by Anna Baleige and Frédéric Denis
Int. J. Environ. Res. Public Health 2025, 22(2), 178; https://doi.org/10.3390/ijerph22020178 - 28 Jan 2025
Viewed by 703
Abstract
Producing knowledge about transgender and gender-diverse (TGD) individuals is a core public health strategy challenge. Yet several systemic limitations arise, notably the exclusion or exploitation of TGD individuals by research systems reproducing systemic discrimination by embedding social norms as self-evident facts of nature. [...] Read more.
Producing knowledge about transgender and gender-diverse (TGD) individuals is a core public health strategy challenge. Yet several systemic limitations arise, notably the exclusion or exploitation of TGD individuals by research systems reproducing systemic discrimination by embedding social norms as self-evident facts of nature. This is particularly worrying in biomedical research, and contributes to the invisibilization of participants’ gender diversity. This trans research illustrates methodological challenges through queering an earlier study by focusing on misgendering as a discursive element. We based our work on discursive materials reported by TGD participants in an ICD-11 study on gender incongruence. We used network analyses to illustrate potential differences between declared gender identity and discourse practices. Our results highlight a gap between declared gender identity and discourse practices, bringing the number of non-binary participants in the sample from 15 (20.8%) to 36 (50.0%). Moreover, misgendering and the use of derogatory terms are more common toward gender-diverse individuals. Sexual orientation shows a similar trend. This study reveals the reproduction of social norms within research processes and medical knowledge, as well as how, from an individual perspective, their non-compliance seems to be a key factor in TGD individuals’ experience. By providing this simple methodological example, we hope to promote better integration of gender and its various dimensions into biomedical and public health research. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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14 pages, 494 KiB  
Article
Religious Affiliation, Internalized Homonegativity and Depressive Symptoms: Unveiling Mental Health Inequalities among Brazilian Gay Men
by Felipe Alckmin-Carvalho, António Oliveira, Patricia Silva, Madalena Cruz, Lúcia Nichiata and Henrique Pereira
Int. J. Environ. Res. Public Health 2024, 21(9), 1167; https://doi.org/10.3390/ijerph21091167 - 2 Sep 2024
Cited by 2 | Viewed by 1516
Abstract
Introduction: Different religious narratives associate same-sex sexuality, in its various manifestations, with moral deviation or sin. Gay men who are socialized in more religious communities appear to experience and internalize greater levels of homonegativity, as well as to present greater indicators of depressive [...] Read more.
Introduction: Different religious narratives associate same-sex sexuality, in its various manifestations, with moral deviation or sin. Gay men who are socialized in more religious communities appear to experience and internalize greater levels of homonegativity, as well as to present greater indicators of depressive symptoms. The purpose of this study was to evaluate indicators of perceived homonegativity in the community and internalized, and signs/symptoms of depression reported by Brazilian gay men with a nominal religion and compare them to those reported by Atheists or Agnostics. Method: Our sample comprised 194 Brazilian gay men, distributed into three groups: Christians (Protestants and Catholics, n = 71; 36.6%); Spiritualists (Kardecists or religions of African origin, n = 52; 26.8%) and Atheists or Agnostics (n = 71; 36.6%). The following measurement instruments were used: sociodemographic questionnaire, Internalized Homophobia Scale and Beck Depression Scale. Results: High mean scores of depression were verified in all groups, and 60% of the sample presented some level of depression. There was a higher level of self-reported homonegativity among Christians and Spiritualists compared to that reported by Atheists or Agnostics, with the differences between the groups being significant. The regression analysis indicated a significant effect of religion on homonegativity, but not on depression. Conclusion: Our results suggest that gay men’s chronic exposure to non-affirming religious affiliation contexts may harm the construction of a positive gay identity and should be taken into consideration when addressing mental health inequalities of sexual minorities. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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13 pages, 480 KiB  
Article
“Empowerment for Us by Us (E4UBU)”: Developing a Model of Empowerment Using Feminist Participatory Methods with LBQT+ Persons Assigned Female at Birth in Western Kenya
by Heather M. Tucker, Rebecca Odhiambo, Laura Jadwin-Cakmak, Anita Mbanda, Ashley Lacombe-Duncan, Caroline Rucah, Ini-Abasi Ubong, Cynthia Akoth Ouko, Wilson Odero and Gary W. Harper
Int. J. Environ. Res. Public Health 2024, 21(7), 948; https://doi.org/10.3390/ijerph21070948 - 19 Jul 2024
Viewed by 1691
Abstract
Lesbian, bisexual, queer, trans and other gender diverse persons assigned female at birth (heretofore referred to as “LBQT+ persons”) in Western Kenya experience intersectional oppression and stigma. This stigma can manifest in acts of sexual and gender-based violence (SGBV) and sexual and gender [...] Read more.
Lesbian, bisexual, queer, trans and other gender diverse persons assigned female at birth (heretofore referred to as “LBQT+ persons”) in Western Kenya experience intersectional oppression and stigma. This stigma can manifest in acts of sexual and gender-based violence (SGBV) and sexual and gender minority (SGM)-based violence, as well as various forms of discrimination—all of which have been linked to disproportionately higher levels of negative health outcomes for this group. Despite these challenges, many LBQT+ persons have been able to gain personal and collective power and thrive in this oppressive environment. The Empowerment for Us by Us (E4UBU) project is a mixed methods feminist participatory research study focused on exploring how LBQT+ persons conceptualize and define empowerment for themselves, and to understand their perspectives on how feelings of power and powerlessness influence their physical and mental health. This paper focuses on data from the first phase of the study, in which qualitative in-depth interviews were conducted with 40 LBQT+ persons (ages 19 to 50) from Kisumu and Homa Bay in Western Kenya. A participatory interpretive phenomenological analysis was conducted to understand the lived experiences of LBQT+ persons as they navigate intersectional oppression and its influence on their experiences of empowerment and subsequent health outcomes. Findings from this analysis were presented to two different focus groups composed of participants who had participated in the in-depth interviews to gather their insights on the interpretations of the interviews as a form of member checking. Findings revealed that “empowerment” was not experienced and viewed by LBQT+ persons as a monolithic construct, but rather a process through which LBQT+ persons are able to transform negative forces of intersectional oppression and powerlessness into experiences of power and subsequent individual and collective action and impact—all leading to improved mental health and well-being. This process is facilitated at several junctures by participatory seeking and attainment of community-appropriate resources at multiple socio-ecological levels that, when accessed with sufficient intensity, frequency, and duration, enhance one’s journey through the process of empowerment. These facilitation junctures are viewed as likely points of focus for public health intervention. Analysis also revealed that the process of empowerment is dependent on the context within which the process is occurring, the specific issues being faced, and the population of focus. Recommendations for how this model can be used for future research and practice to improve the lives of LBQT+ persons in Kenya are discussed. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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13 pages, 539 KiB  
Article
Distress as a Function of Social Exclusion and Assertiveness among Homosexual/Bisexual People
by Chau-kiu Cheung and Eileen Yuk-ha Tsang
Int. J. Environ. Res. Public Health 2024, 21(5), 633; https://doi.org/10.3390/ijerph21050633 - 16 May 2024
Viewed by 1450
Abstract
Homosexual (lesbian or gay) and bisexual (i.e., LGB) people tend to suffer from social exclusion and thus distress. To prevent or relieve distress, the people’s assertiveness about justice and rights is an advocated means, but its effectiveness is uncertain, considering possible conflict with [...] Read more.
Homosexual (lesbian or gay) and bisexual (i.e., LGB) people tend to suffer from social exclusion and thus distress. To prevent or relieve distress, the people’s assertiveness about justice and rights is an advocated means, but its effectiveness is uncertain, considering possible conflict with social exclusion. To clarify the effectiveness, this study analyzed data collected from 189 Chinese LGB adults in Hong Kong, which is a special administrative region of China generally Westernized and liberal to sexual orientation. Controlling for prior distress reported, the analysis showed that distress was lower when assertiveness was higher or social exclusion experienced was lower. However, distress was higher when both assertiveness and social exclusion experienced were higher. The higher distress implies a conflict between assertiveness and social exclusion to raise distress. It also implies the need to avoid conflict when promoting assertiveness and eliminating social exclusion to prevent distress in LGB people. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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13 pages, 472 KiB  
Article
Internalized Sexual Stigma and Mental Health Outcomes for Gay, Lesbian, and Bisexual Asian Americans: The Moderating Role of Guilt and Shame
by Kian Jin Tan and Joel R. Anderson
Int. J. Environ. Res. Public Health 2024, 21(4), 384; https://doi.org/10.3390/ijerph21040384 - 22 Mar 2024
Cited by 3 | Viewed by 3045
Abstract
The literature unequivocally demonstrates that lesbian, gay, and bisexual (LGB) individuals experience disproportionate mental health and social wellbeing impacts. Here, we respond to recent calls for research in the field of sexual minority health to better understand why various overlapping and intersecting identities [...] Read more.
The literature unequivocally demonstrates that lesbian, gay, and bisexual (LGB) individuals experience disproportionate mental health and social wellbeing impacts. Here, we respond to recent calls for research in the field of sexual minority health to better understand why various overlapping and intersecting identities can further drive health disparities. In this paper, we focus on the specific intersections of ethnicity and sexuality for Asian LGB individuals and the role of internalized stigma in driving poorer mental health outcomes for this group. We recruited 148 LGB Asian participants residing in the United States (Mage = 22.82 years, SD = 4.88) to participate in our online cross-sectional survey in which we collected data on their internalized stigma, levels of guilt and shame about their sexuality, and measures of depression, anxiety, and distress. Contrary to our predictions, there were no bivariate relationships between internalized sexual stigma and any of the mental health outcomes. However, a parallel mediation analysis revealed that guilt, but not shame, mediates the relationship between internalized sexual stigma and all mental health outcomes (depression, anxiety, and stress) for LGB Asian American individuals. This research highlights the important of exploring additional variables that may exacerbate of protect against poor mental health for individuals with multiple intersecting identities. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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15 pages, 381 KiB  
Article
Correlates of Attitudes toward Sexual Minorities among Vietnamese Social Work Practitioners
by Trang Mai Le, Nilan Yu and Stephanie Webb
Int. J. Environ. Res. Public Health 2023, 20(5), 4241; https://doi.org/10.3390/ijerph20054241 - 27 Feb 2023
Cited by 1 | Viewed by 1743
Abstract
This article examines the correlates of Vietnamese social work practitioners’ attitudes toward individuals who identify as lesbian or gay. This study, among the very few studies on the general topic in non-Western contexts and the first of its kind in Vietnam, investigates correlates [...] Read more.
This article examines the correlates of Vietnamese social work practitioners’ attitudes toward individuals who identify as lesbian or gay. This study, among the very few studies on the general topic in non-Western contexts and the first of its kind in Vietnam, investigates correlates of attitudes toward sexual minorities that are known in the literature. The data are drawn from a survey of 292 Vietnamese social work practitioners. The findings suggest that the attitudes of Vietnamese social work practitioners are associated with gender, educational attainment, level of social work education, practice experience, practice sector, professional contact with sexual minority clients, personal contact with sexual minorities, exposure to content on sexual minorities in social work courses and professional development activities, and independent learning activities about sexual minorities but not with age, religious affiliation, and marital status. Implications for social work education and practice are considered. Full article
(This article belongs to the Special Issue Advancing Health Equity for Sexual and Gender Minority Populations)
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