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Health Inequalities and Social Support among LGBT + Populations

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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 (30 November 2020) | Viewed by 81421

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Special Issue Editors

Prof. Julie Fish

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Guest Editor

School of Applied Social Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
Interests: LGBT health inequalities

Prof. Trish Hafford-Letchfield

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Assistant Guest Editor

School of Social Policy and Social Work, School of Humanities and Social Sciences, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, Scotland
Interests: ageing in marginalised populations; sexuality and sexual and gender identities in social work; arts-based pedagogies; leadership and management in social work and social care

Dr. Michael Toze

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Assistant Guest Editor

Public Health and Social Determinants of Health, Lincoln Medical School, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, England
Interests: the rights of LGBT+ communities

Prof. Dr. Kathryn Almack

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Assistant Guest Editor

School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9EU, England
Interests: LGBT+ lives across the life-course; LGBT+ parenting; LGBT+ ageing and end of life care; sociology of family lives and relationships of care; death, dying and bereavement

Special Issue Information

Dear Colleagues,

Health inequalities, that is the differences in health and healthcare experiences arising through social inequalities, is a key concern for global public health. Until recently, there has been very little attention to health inequalities on the grounds of sexual orientation and gender identity. Over the past five years, however, there is increasing recognition by governments and NGOs of the need to understand and address LGBT+ ¹ health inequalities (e.g. UK House of Commons, 2019; European Union, 2018). There is growing evidence to demonstrate that LGBT+ people experience health inequalities when compared with heterosexual and cisgendered people. Within and among LGBT+ people, those with intersectional identities by ‘race’ and ethnicity, disability, age, religion and belief, gender identity and gender may have different experiences of health and wellbeing. Such health inequalities are acute in mental, sexual and physical health, health risk behaviours including higher rates of substance misuse, smoking, alcohol consumption, and preventing loneliness, which affects both physical and mental health.

Access to social support may be key to strengthening communities. Equal partnerships, where relationships are formally recognised and building ‘families of choice’ may be health promoting. We are interested in sources of resilience and what they bring to healthier lives and in combatting inequalities.

This special issue is interested in papers on various aspects of LGBT+ health inequalities including, but not limited to, those discussed above. We encourage the submission of inter-disciplinary and collaborative work. In particular, we seek theoretically informed papers, intervention studies, practice-focussed reports, knowledge translation studies, papers of health equity models, policy development or systematic reviews. We welcome original studies using qualitative or quantitative approaches.

LGBT+ includes people who are lesbian, gay, bisexual and transgender, non-binary and intersex.

References

House of Commons (2019) https://www.parliament.uk/business/committees/committees-a-z/commons-select/women-and-equalities-committee/news-parliament-2017/lgbt-health-social-care-report-published-19-20/

EU (2018) https://www.ilga-europe.org/what-we-do/our-advocacy-work/health/health4lgbti

Prof. Julie Fish
Prof. Trish Hafford-Letchfield
Dr. Michael Toze
Prof. Kathryn Almack
Guest Editors

Manuscript Submission Information

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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.

Keywords

inequalities in health and health care
social determinants of health
LGBT+ health equity
intersectionality and health inequalities
minority stress theory
disclosure
salutogenesis

Published Papers (14 papers)

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Editorial

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5 pages, 280 KiB

Open AccessEditorial

What Are LGBT+ Inequalities in Health and Social Support—Why Should We Tackle Them?

by Julie Fish, Kathryn Almack, Trish Hafford-Letchfield and Michael Toze

Int. J. Environ. Res. Public Health 2021, 18(7), 3612; https://doi.org/10.3390/ijerph18073612 - 31 Mar 2021

Cited by 5 | Viewed by 3555

Abstract

Health inequalities are differences in health experiences and outcomes which arise through the everyday circumstances of people’s lives and the appropriateness of the systems put in place to support them [...] Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

Research

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14 pages, 459 KiB

Open AccessArticle

Contesting Sexual Prejudice to Support Sexual Minorities: Views of Chinese Social Workers

by Diana K. Kwok

Int. J. Environ. Res. Public Health 2021, 18(6), 3208; https://doi.org/10.3390/ijerph18063208 - 19 Mar 2021

Cited by 7 | Viewed by 2889

Abstract

Professional development has been recognized as one of the strategies to effectively combat sexual prejudice and negative attitudes against lesbian, gay, bisexual, questioning/queer (LGBQ+) individuals and sexual minorities. Nevertheless, studies related to LGBQ+-inclusive training are rarely found in the Chinese Hong Kong context, where sexual prejudice still prevails without the establishment of antidiscrimination law. Sociocultural considerations, such as religious and parental influences, are obstacles to discussing the reduction of sexual prejudices, both within wider society and social work organizations, without institutional support. This paper aims to understand social workers’ perspectives on prejudice reduction training themes and perceived cultural barriers through qualitative in-depth interviews with 67 social workers. Qualitative thematic analysis yielded the following themes: (1) understanding sexuality; (2) initiating training legitimately; (3) contesting religious and cultural assumptions; (4) resolving value and ethical dilemma; (5) selecting relevant knowledge; (6) implementing diverse training strategies. The study suggests that social workers and service providers need to understand how sexual prejudice is manifested in Hong Kong through unique cultural forces. LGBQ+-inclusive content, addressing updated concepts and prejudice-free language, should be incorporated into the training curriculum. Intergroup contact, professional reflection, and experiential learning are suggested as training strategies (190). Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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14 pages, 323 KiB

Open AccessArticle

Experiences of LGBTIQA+ People with Disability in Healthcare and Community Services: Towards Embracing Multiple Identities

by Amie O'Shea, J. R. Latham, Ruth McNair, Nathan Despott, Mellem Rose, Ruby Mountford and Patsie Frawley

Int. J. Environ. Res. Public Health 2020, 17(21), 8080; https://doi.org/10.3390/ijerph17218080 - 2 Nov 2020

Cited by 13 | Viewed by 7234

Abstract

Healthcare and disability support services are increasing their efforts towards inclusion and recognising the needs of different groups. This research project was conducted by academic and peer researchers (LGBTIQA+ people with disability) in Victoria, Australia using four focus groups with LGBTIQA+ people with disability. We report on two overarching themes relating to participants’ experiences of accessing health services as LGBTIQA+ people with disability: difficulties in managing multiple identities and the impacts of community services and supports. Participants described having to repeatedly ‘come out’ in a range of ways and contexts as complex and layered processes in which it was difficult to present their full range of needs and experiences to services. We also found that the role of community in promoting a sense of belonging and resilience increased capacity to manage health service use and advocacy. Services and communities aiming to be inclusive to all have the opportunity to recognise and respond to the issues faced by LGBTIQA+ people with disability as a way to pay attention to how overt and subtle practices of discrimination continue to operate despite repeated attempts at or claims of being ‘inclusive.’ Our research suggests actual inclusive, accessible services can be achieved in part through policy and practice that actively responds to the specific needs of LGBTIQA+ people with disability, in addition to LGBTIQA+ education for disability services and disability and accessibility education for LGBTIQA+ focused services. As we do in this article, we argue that this work must be done by prioritising authentic participation of LGBTIQA+ people with disability in the services and research that is about them. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

18 pages, 331 KiB

Open AccessArticle

Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

by Michael Toze, Julie Fish, Trish Hafford-Letchfield and Kathryn Almack

Int. J. Environ. Res. Public Health 2020, 17(20), 7614; https://doi.org/10.3390/ijerph17207614 - 19 Oct 2020

Cited by 5 | Viewed by 2197

Abstract

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people’s capability to achieve good health. We draw upon 36 older LGBT people’s qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants’ accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

18 pages, 547 KiB

Open AccessArticle

A Framework for Enhancing Access to Equitable Home Care for 2SLGBTQ+ Communities

by Andrea Daley, Shari Brotman, Judith A. MacDonnell and Melissa St. Pierre

Int. J. Environ. Res. Public Health 2020, 17(20), 7533; https://doi.org/10.3390/ijerph17207533 - 16 Oct 2020

Cited by 3 | Viewed by 3391

Abstract

Canadian, US, and UK public health and clinical research has identified barriers to health service access for Two-Spirit, lesbian, gay, bisexual, transgender, queer, non-binary, and intersex (2SLGBTQ+) communities. While offering important insight into the health service experiences of 2SLGBTQ+ communities, this body of research only recently, and still only minimally, reports on home care access experiences. Drawing on key findings from the 2SLGBTQ+ Home Care Access Project, a mixed-methods, Ontario-wide study, this paper animates an Access and Equity Framework, using participant stories and perspectives to underscore the relevance and effectiveness of the Framework as a tool to support systematic organizational assessment, evaluation, and implementation of access and equity strategies. Home care organizations can use this tool to assess their programs and services along a continuum of intentionally inviting, unintentionally inviting, unintentionally disinviting, and intentionally disinviting care for 2SLGBTQ+ people. To support this process, the framework includes six indicators of access to care: community engagement, leadership, environment, policies and processes, education and training, and programs and services. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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20 pages, 1607 KiB

Open AccessArticle

Sexual and Mental Health Inequalities across Gender Identity and Sex-Assigned-at-Birth among Men-Who-Have-Sex-with-Men in Europe: Findings from EMIS-2017

by Ford Hickson, Max Appenroth, Uwe Koppe, Axel J. Schmidt, David Reid and Peter Weatherburn

Int. J. Environ. Res. Public Health 2020, 17(20), 7379; https://doi.org/10.3390/ijerph17207379 - 10 Oct 2020

Cited by 14 | Viewed by 4619

Abstract

Some men who have sex with men (MSM) were assigned female at birth (AFB) and/or identify as trans men. Little is known about how these men differ from other MSM. We compared sexual and mental health indicators from the European MSM Internet Survey (EMIS-2017), comparing men AFB and/or currently identifying as trans men with those assigned male at birth (AMB) who identified as men. EMIS-2017 was an opportunistic 33-language online sexual health survey for MSM recruiting throughout Europe. We used regression models adjusting for age, country of residence and employment status to examine differences across groups. An analytic sample of 125,720 men living in 45 countries was used, of which 674 (0.5%) were AFB and 871 (0.7%) identified as trans men. The two sub-groups were not coterminous, forming three minority groups: AFB men, AFB trans men and AMB trans men. Minority groups were younger and more likely unemployed. Anxiety, depression, alcohol dependence and sexual unhappiness were more prevalent in sex/gender minority men. Conversely HIV and STI diagnoses were less common. AMB trans men were most likely to have sexual risk behavior with steady partners and to have unmet health promotion needs, and were least likely to be reached by interventions. Sex assigned at birth and trans identification were associated with different sexual and mental health needs. To facilitate service planning and to foster inclusion, sex-assigned-at-birth and current gender identity should be routinely collected in health surveys. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

20 pages, 380 KiB

Open AccessArticle

“We Just Take Care of Each Other”: Navigating ‘Chosen Family’ in the Context of Health, Illness, and the Mutual Provision of Care amongst Queer and Transgender Young Adults

by Nina Jackson Levin, Shanna K. Kattari, Emily K. Piellusch and Erica Watson

Int. J. Environ. Res. Public Health 2020, 17(19), 7346; https://doi.org/10.3390/ijerph17197346 - 8 Oct 2020

Cited by 47 | Viewed by 10672

Abstract

“Chosen family”—families formed outside of biological or legal (bio-legal) bonds—is a signature of the queer experience. Therefore, we address the stakes of “chosen family” for queer and transgender (Q/T) young adults in terms of health, illness and the mutual provision of care. “Chosen family” is a refuge specifically generated by and for the queer experience, so we draw upon anthropological theory to explore questions of queer kinship in terms of care. We employ a phenomenological approach to semi-structured interviews (n = 11), open coding, and thematic analysis of transcriptions to meet our aims: (1) Develop an understanding of the beliefs and values that form the definition of “chosen family” for Q/T young adults; and (2) Understand the ways in which “chosen family” functions in terms of care for health and illness. Several themes emerged, allowing us to better understand the experiences of this population in navigating the concept of “chosen family” within and beyond health care settings. Emergent themes include: (1) navigating medical systems; (2) leaning on each other; and (3) mutual aid. These findings are explored, as are the implications of findings for how health care professionals can better engage Q/T individuals and their support networks. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

12 pages, 324 KiB

Open AccessArticle

State Involvement in LGBT+ Health and Social Support Issues in Canada

by Nick J. Mulé

Int. J. Environ. Res. Public Health 2020, 17(19), 7314; https://doi.org/10.3390/ijerph17197314 - 7 Oct 2020

Cited by 4 | Viewed by 2833

Abstract

For the first time, the broad health issues, needs and concerns of LGBT+ people in Canada were taken up by the federal government’s Standing Committee on Health in 2019. The findings of their consultations with LGBT+ Canadians produced a report that at once captures the breadth of input received, and provides an opportunity for accountable state response to LGBT+ health needs in the form of research, education, policy, funding and programming, yet questions arise as to the socio-political approach that will ultimately be taken. This focus on the health of LGBT+ Canadians follows decades of grassroots and sometimes state-funded research on this very issue. This study undertook a critical content analysis, premised on the queer liberation theory of The Health of LGBTQIA2 Communities in Canada report issued by the Standing Committee on Health. Although the report, for the most part, covers a breadth of broad LGBT+ health issues (a noted shift from the predominance of HIV/AIDS), the depth to which the Standing Committee took up and absorbed such issues is far less apparent. The heavy emphasis on entry-level recommendations by which to take up important LGBT+ health issues undermines a more progressive, liberationist approach that would more effectively address these concerns. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

16 pages, 337 KiB

Open AccessArticle

Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan

by Shanna K. Kattari, Leonardo Kattari, Ian Johnson, Ashley Lacombe-Duncan and Brayden A. Misiolek

Int. J. Environ. Res. Public Health 2020, 17(18), 6805; https://doi.org/10.3390/ijerph17186805 - 18 Sep 2020

Cited by 12 | Viewed by 4502

Abstract

Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

11 pages, 996 KiB

Open AccessArticle

The Impact of Emotional Symptoms and Family Support on the Association Between Homophobic Bullying and Sedative/Hypnotic Use among Gay and Bisexual Men in Taiwan: A Moderated Mediation Model

by Dian-Jeng Li, Yu-Ping Chang, Yi-Lung Chen and Cheng-Fang Yen

Int. J. Environ. Res. Public Health 2020, 17(11), 3870; https://doi.org/10.3390/ijerph17113870 - 29 May 2020

Cited by 3 | Viewed by 2687

Abstract

Sedative/hypnotic use and homophobic bullying have become a big mental health concern for gay and bisexual men. However, few studies have investigated the mediators and moderators of the association between them. The current study aimed to build a conceptual model to estimate the mediating effect of emotional symptoms and the moderating effect of family support on this association among gay and bisexual men in Taiwan. A total of 500 gay or bisexual men were recruited for the study. Their history of homophobic bullying, their experience of sedative/hypnotic use, their perceived family support, and their current emotional symptoms were evaluated using self-reporting questionnaires. A moderated mediation model was developed to test the mediating effect of emotional symptoms and the moderating effect of family support. A higher level of homophobic bullying was significantly associated with sedative/hypnotic use among gay and bisexual men and this was mediated by a higher severity of emotional symptoms. A moderating effect of family support was identified, wherein the mediating effect of emotional symptoms was weaker when there was a higher level of perceived family support, thus revealing the protective effect of family support. The significant impact of emotional symptoms and family support on the association between homophobic bullying and sedative/hypnotic use was identified. Timely interventions for emotional symptoms and the enhancement of family support are crucial for gay and bisexual men. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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14 pages, 1354 KiB

Open AccessArticle

Mental Health Inequities among Transgender People in Aotearoa New Zealand: Findings from the Counting Ourselves Survey

by Kyle K.H. Tan, Sonja J. Ellis, Johanna M. Schmidt, Jack L. Byrne and Jaimie F. Veale

Int. J. Environ. Res. Public Health 2020, 17(8), 2862; https://doi.org/10.3390/ijerph17082862 - 21 Apr 2020

Cited by 37 | Viewed by 7661

Abstract

There has been little international research looking at differences in mental health across different age groups. This study examines mental health inequities between transgender people and the Aotearoa/New Zealand general population from youth to older adulthood. The 2018 Counting Ourselves survey (N = 1178) assessed participants’ mental health using the Kessler Psychological Distress Scale (K10) and diagnoses of depression and anxiety disorders, questions that were the same as those used in the New Zealand Health Survey. Our results showed significant mean score differences for transgender people on K10, and these differences were almost two standard deviations higher than the general population (Cohen’s d = 1.87). The effect size differences, however, decreased from youth to older adults. Regression analyses indicated trans women were less likely to report psychological distress than trans men and non-binary participants. There was an interaction effect for age and gender, with lower psychological distress scores found for younger trans women but higher scores for older trans women. The stark mental health inequities faced by transgender people, especially youth, demonstrate an urgent need to improve the mental health and wellbeing of this population by implementing inclusive institutional practices to protect them from gender minority stress. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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Review

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35 pages, 615 KiB

Open AccessReview

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review

by Elizabeth McDermott, Rosie Nelson and Harri Weeks

Int. J. Environ. Res. Public Health 2021, 18(2), 826; https://doi.org/10.3390/ijerph18020826 - 19 Jan 2021

Cited by 25 | Viewed by 8341

Abstract

This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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13 pages, 375 KiB

Open AccessReview

Research Ethics with Gender and Sexually Diverse Persons

by Mark Henrickson, Sulaimon Giwa, Trish Hafford-Letchfield, Christine Cocker, Nick J. Mulé, Jason Schaub and Alexandre Baril

Int. J. Environ. Res. Public Health 2020, 17(18), 6615; https://doi.org/10.3390/ijerph17186615 - 11 Sep 2020

Cited by 25 | Viewed by 11480

Abstract

Identifying and developing inclusive policy and practice responses to health and social inequities in gender and sexually diverse persons require inclusive research ethics and methods in order to develop sound data. This article articulates 12 ethical principles for researchers undertaking gender and sexually diverse social, health, and related research. We have called these the ‘Montréal Ethical Principles for Inclusive Research.’ While writing from an international social work perspective, our aim is to promote ethical research that benefits people being researched by all disciplines. This paper targets four groups of interest: 1. Cisgender and heterosexual researchers; 2. Researchers who research ‘general’ populations; 3. and sexually diverse researchers; 4. Human ethics committees. This article was stimulated by the 2018 Global Social Work Statement of Ethical Principles, which positions human dignity at its core. It is critically important to understand and account for the intersectionality of gender and sexuality with discourses of race, ethnicity, colonialism, dis/ability, age, etc. Taking this intersectionality into consideration, this article draws on scholarship that underpins ethical principles developed for other minoritized communities, to ensure that research addresses the autonomy of these participants at every stage. Research that positions inclusive research ethics at its foundation can provide a solid basis for policy and practice responses to health and social inequities in gender and sexually diverse persons. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

18 pages, 1107 KiB

Open AccessReview

A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance

by Laetitia Zeeman and Kay Aranda

Int. J. Environ. Res. Public Health 2020, 17(18), 6533; https://doi.org/10.3390/ijerph17186533 - 8 Sep 2020

Cited by 26 | Viewed by 6804

Abstract

Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsycInfo and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability. Full article

(This article belongs to the Special Issue Health Inequalities and Social Support among LGBT + Populations)

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