Promoting the Health of Gender and Sexual Minorities

Course #91792 - $20 • 5 Hours/Credits


Study Points

  1. Define multiple terms related to the concept of sexual identity.
  2. Define heterosexism and homophobia and identify how they may be barriers to increasing professional awareness of gender and sexual minorities (GSM).
  3. Summarize myths related to the GSM population.
  4. Describe research challenges related to the GSM population.
  5. Describe select theoretical models related to the development of one's sexual identity (the "coming-out" process).
  6. Cite unique health and safety concerns experienced by the GSM population and available resources that healthcare professionals can provide to these patients and their families.
  7. Identify culturally appropriate strategies useful for implementing skills, including the application of crosscultural communication.

    1 . "Bisexual" is defined as
    A) the successful resolution of questions about one's sexual orientation.
    B) an enduring emotional, romantic, sexual, and/or affectional attraction to another person.
    C) an adjective that refers to people who relate sexually and affectionately to both women and men.
    D) an institutional and societal reinforcement of heterosexuality as the privileged and powerful norm.

    DEFINITIONS

    Bisexual: An adjective that refers to people who relate sexually and affectionately to both women and men.

    Click to Review



    2 . The inner sense of oneself as a sexual being, including how one identifies in terms of gender and sexual orientation, is the definition of
    A) gay.
    B) bisexual.
    C) sexual identity.
    D) sexual orientation.

    DEFINITIONS

    Sexual identity: The inner sense of oneself as a sexual being, including how one identifies in terms of gender and sexual orientation.

    Click to Review



    3 . The term "homophobia" was coined in
    A) 1897.
    B) 1932.
    C) 1967.
    D) 1980.

    HOMOPHOBIA, HETEROSEXISM, AND INTERNALIZED HOMOPHOBIA

    Much professional literature has documented the negative social attitudes toward sexual minorities [23]. These negative attitudes have been frequently referred to as "homophobia." The term was coined in 1967 and defined very specifically as "the dread of being in close quarters with homosexuals...the revulsion toward homosexuals and often the desire to inflict punishment as retribution" [16]. Some in the general population believe that the word "homophobia" always includes a component of violence. The condition was classified as a phobia and operationalized as a prejudice. The phobia manifests as antagonism directed toward a particular group of people, leading to disdain and mistreatment of them [16].

    Click to Review



    4 . The stigmatization in thinking and actions found in our nation's cultural institutions is termed
    A) heterosexism.
    B) cultural heterosexism.
    C) psychologic heterosexism.
    D) None of the above

    HOMOPHOBIA, HETEROSEXISM, AND INTERNALIZED HOMOPHOBIA

    A more appropriate term for the phenomenon of negative social attitudes may be "heterosexism" because it focuses on the normalization and giving of privilege to heterosexuality [25]. The term encompasses the prejudice and social stigma from institutional and interpersonal sources encountered by sexual minorities, including a range of discriminatory experiences, not only those related to phobias and violence [26]. Implicit and explicit forms of discrimination have been included in the definition of heterosexism. For example, the use of noninclusive questions while conducting a patient's sexual history could be considered implicit discrimination because the questions reflect a possible lack of awareness and inclusivity. Mean-spirited, antigay statements or actions by an individual or an institution could be considered explicit discrimination because the action is undeniably direct. A hospital visitation policy that prevents GSM individuals from visiting their partners is another form of discrimination included in the definition of heterosexism.

    The subtle and pervasive ways that discomfort with GSM individuals may be manifested have been examined and, in some instances, categorized as "cultural heterosexism," which is characterized by the stigmatization in thinking and actions found in our nation's cultural institutions, such as our educational and legal systems [27]. "Cultural heterosexism fosters individual antigay attitudes by providing a ready-made system of values and stereotypical beliefs that justify such prejudice as natural" [28]. Perhaps the paucity of information about the GSM community in basic professional education textbooks has been a reflection of cultural heterosexism. Writers, funding sources, and publishers have been exposed to the same cultural institutions for many years.

    Click to Review



    5 . What is one of the reasons that heterosexism stands in the way of the healthcare professional's ability to learn about the LGBTQIA population and its needs?
    A) Gay patients have feared open discussion about their health needs.
    B) Prejudice has impacted research efforts by limiting available funding.
    C) The healthcare system has failed to educate providers and researchers about the unique aspects of LGBTQIA health.
    D) All of the above

    HOMOPHOBIA, HETEROSEXISM, AND INTERNALIZED HOMOPHOBIA

    The manifestations of heterosexism and homophobia have inhibited our learning about the LGBTQIA population and its needs [9]. Gay patients have feared open discussion about their health needs because of potential negative reactions to their self-disclosure. Prejudice has impacted research efforts by limiting available funding [8]. All of these factors emphasize that the healthcare education system has failed to educate providers and researchers about the unique aspects of LGBTQIA health [29,34].

    Click to Review



    6 . Which of the following statements is TRUE about homosexuality?
    A) Gays are child molesters.
    B) Homosexuality is a choice.
    C) Many myths surround homosexuality.
    D) Gays and lesbians are easily identified because of distinctive characteristics.

    MYTHS AND FACTS

    Many myths surround homosexuality; a few are outlined below. The origin of these myths may be better understood after examining the history of homosexuality as well as the attitudes toward human sexuality in general. The history of the development of societal norms related to homosexuality includes misconceptions developed during times when research was not available on which to build a scientific knowledge base [1,35,36,37].

    Myth: Sexual orientation is a choice.

    Fact: No consensus exists among scientists about the reasons that an individual develops his/her sexual orientation. Some research has shown that the bodies and brains of homosexual men and women differ subtly in structure and function from their heterosexual counterparts; however, no findings have conclusively shown that sexual orientation is determined by any particular factor or set of factors. Many people confuse sexual orientation with sexual identity. The reader may consider reviewing the definitions of these terms when further considering this myth.

    Myth: Gays and lesbians can be easily identified because they have distinctive characteristics.

    Fact: Most gay and lesbian individuals conform to the majority of society in the way they dress and act. While some gay men and lesbian women may fit the stereotypes that society holds, homosexual individuals generally look and act like everyone else. Most people never suspect the sexual orientation of a GSM individual.

    Myth: Gays are child molesters.

    Fact: According to experts in the field of sexual abuse, the vast majority of those who molest children are heterosexual. The average offender is a white heterosexual man whom the child knows.

    Click to Review



    7 . Regarding sexual orientation, research has shown that
    A) sexual orientation is purely psychologic.
    B) sexual orientation is often confused with sexual identity.
    C) the brain structures of homosexuals and heterosexuals are the same.
    D) All of the above

    MYTHS AND FACTS

    Myth: Sexual orientation is a choice.

    Fact: No consensus exists among scientists about the reasons that an individual develops his/her sexual orientation. Some research has shown that the bodies and brains of homosexual men and women differ subtly in structure and function from their heterosexual counterparts; however, no findings have conclusively shown that sexual orientation is determined by any particular factor or set of factors. Many people confuse sexual orientation with sexual identity. The reader may consider reviewing the definitions of these terms when further considering this myth.

    Click to Review



    8 . Definitions have been identified as a challenge to studying the GSM population because
    A) classification of certain populations has not been uniform.
    B) there is no consensus on definitions used for this community.
    C) there has been less data collected on certain terms (e.g., transgender).
    D) All of the above

    RESEARCH CHALLENGES

    First, establish clear definitions of the populations. Because there is no consensus on the definitions, it is impossible to accurately estimate the percentage of the population that would be classified as gay or lesbian. For example, the 2010 U.S. Census counted same-sex couples but did not count single gays or lesbians. Estimates of these singles range from 1% to 20% of the U.S. population [8,38,39]. While different definitions and measures of sexual orientation have been used since the 1860s, the definition of sexual orientation should include self-identity, behavior, emotional attractions, cultural affiliation, and those aspects of sexual orientation that may change across developmental periods [16]. The term "transgender" is also difficult to define and measure, partly because it has been less examined than other terms, such as "heterosexual," "homosexual," "bisexual," "gay," or "lesbian." Generally, the term "transgender" includes several populations, including transsexuals and crossdressers. Further defining each of these populations creates additional challenges [8]. Consensus on the definitions of "youth" and "elderly" and other demographic terms is needed as well.

    Second, construct valid and reliable measures of sexual orientation and transgender identity that accurately represent their definitions. Without clear conceptual definitions, development of valid and reliable measures is difficult to achieve. Different measures exist, but there is no consensus. In addition, there is limited literature discussing when and where the measures should be used [8].

    Third, sample rare and hidden populations [8]. Large-scale random surveys are expensive, and researchers often must conduct smaller studies and use samples of convenience [9]. This sampling method may result in biased and uninformative data. For example, studies examining the prevalence of suicide among lesbian and gay youths and adults have yielded inconsistent results, in part because of the absence of good data. Additionally, researchers have had to rely on retrospective data from individuals after they self-label, disclose, and volunteer to participate in research projects [40]. Other factors may also impact sampling. For example, while studying GSM elderly, qualitative research sampling has been affected by deaths and memory changes, resulting in incomplete interviews [41].

    Click to Review



    9 . Which of the following is a challenge when sampling rare and hidden populations, such as the LGBTQIA population?
    A) Resources are freely allocated without follow-up plans.
    B) Researchers have to rely on retrospective data from individuals.
    C) It is inexpensive, but time consuming because the studies are so large.
    D) There are no effective sampling methods for surveying rare populations.

    RESEARCH CHALLENGES

    Third, sample rare and hidden populations [8]. Large-scale random surveys are expensive, and researchers often must conduct smaller studies and use samples of convenience [9]. This sampling method may result in biased and uninformative data. For example, studies examining the prevalence of suicide among lesbian and gay youths and adults have yielded inconsistent results, in part because of the absence of good data. Additionally, researchers have had to rely on retrospective data from individuals after they self-label, disclose, and volunteer to participate in research projects [40]. Other factors may also impact sampling. For example, while studying GSM elderly, qualitative research sampling has been affected by deaths and memory changes, resulting in incomplete interviews [41].

    Homophobia and heterosexism place LGBTQIA studies outside the mainstream in terms of importance as well as allocation of resources [9]. While difficulties with sampling have been used as a rationale for denying funding for research into LGBTQIA matters, effective sampling methods have been developed for surveying other rare populations, for example, ethnic minority groups or age groups [8]. These same methods can be used with the LGBTQIA community [9].

    Click to Review



    10 . What is one of the disadvantages of using sexual identity theoretical models?
    A) The models are too broad, applying to all individuals.
    B) The models describe the arrival of same-sex identity through a series of steps or stages.
    C) Bisexuality is commonly addressed in the models, detracting from issues in the GSM population.
    D) The models were developed from exclusively female samples and do not include other backgrounds and genders.

    SEXUAL IDENTITY MODELS

    Coming-out models have generated much interest in developmental concerns related to sexual identity, thus bringing attention to gay and lesbian youth. However, the models may not be applicable to all individuals. The models, which have been developed from exclusively male samples, have not fully considered the diversity that exists among individuals of different backgrounds, ethnicities, and genders. Using theoretical models with female sexual minority samples has not always been helpful. Using data from young men also has been problematic because not all young men use sex to help them determine their identity; rather, they often know who they are prior to engaging in gay sex [40].

    Initially proposed more than 30 years ago, coming-out models describe the arrival of same-sex identity by means of a series of steps or stages. These stages delineate when, in the development of same-sex identity, recognition of, making sense of, naming, and publicizing oneself as lesbian or gay occurs. The models are nearly universal in their stage sequence regarding the ways that LGBTQIA youth move from a private, at times unknown, same-sex sexuality to a public, integrated sexuality. Development has been generally perceived as linear and universal among individuals who share some real or hypothesized commonalities. Bisexuality has been seldom addressed in the models [40].

    Click to Review



    11 . According to the model of homosexuality developed by Cass,
    A) individuals go through six age-specific stages.
    B) individuals can be in only one stage at a time but can return to the previous stage.
    C) identity awareness occurs when an individual realizes that he or she is a homosexual.
    D) identity synthesis occurs when an individual accepts himself or herself and other homosexual individuals.

    SEXUAL IDENTITY MODELS

    Cass was the first to articulate a model of homosexual identity [47]. Believing that individuals have an active role in the acquisition of a homosexual identity, Cass suggested that individuals pass through six non-age-specific stages [47]:

    • Identity confusion: The individual is conscious of being different.

    • Identity comparison: The individual believes that he or she may be homosexual but attempts to act heterosexual.

    • Identity tolerance: The individual realizes that he or she is homosexual.

    • Identity acceptance: The individual begins to explore the GSM community.

    • Identity pride: The individual becomes active in the GSM community.

    • Identity synthesis: The individual fully accepts himself or herself and other homosexual individuals.

    Cass believed that individuals could be in more than one stage at a time and that they could return to a stage already passed through without it being considered regression.

    Click to Review



    12 . According to Troiden's sexual identity model,
    A) the first stage is "identity awareness."
    B) in the commitment stage, the individual comes out as a GSM person.
    C) coming out usually occurs first in the heterosexual community, then to the homosexual community.
    D) before puberty, an individual experiences homosexual feelings without understanding the implications for self-identity.

    SEXUAL IDENTITY MODELS

    In 1989, Troiden posited four age-specific stages in the homosexual identity process, which contrasted with Cass's non-age-specific stages [48]. Troiden's four stages are: sensitization, identity confusion, identity assumption, and commitment. The sensitization stage, which begins before puberty, finds the individual experiencing homosexual feelings without understanding the implications for self-identity. The identity confusion stage, which occurs during adolescence, is when the individual realizes that he or she may be homosexual. During the identity assumption stage, the individual comes out as a GSM person, usually first to the homosexual community and later to the heterosexual community. During the commitment stage, the individual lives as a GSM individual.

    Click to Review



    13 . The "homosexual adolescent" was not discussed in professional literature until
    A) 1944.
    B) 1972.
    C) 1984.
    D) 1999.

    UNIQUE HEALTH AND SAFETY CONCERNS

    The "homosexual adolescent" was first acknowledged by empirical social science in 1972 [66,67]. Additional empirical research reports were not available until the late 1980s, and sexual minority youth continued to remain largely invisible, even within the lesbian and gay community, until the 1990s [68]. Fortunately, the body of professional literature related to GSM youth has been evolving quickly.

    Click to Review



    14 . What coping strategy might LGBTQIA youth use while going through early phases of the coming-out process and meeting school and societal demands?
    A) Engaging in promiscuous behavior
    B) Physical and emotional withdrawal from others
    C) Becoming overly involved in extracurricular activities
    D) All of the above

    UNIQUE HEALTH AND SAFETY CONCERNS

    LGBTQIA youth may employ many coping strategies in an attempt to understand themselves and their place in society. Some may withdraw physically and emotionally, perhaps in an effort to avoid discovery. Others may turn to substance use or develop eating disorders. Among LGBTQIA youth, the rates of suicide ideation and attempts have been reported to be alarmingly high [77]. Some LGBTQIA youth strive for academic or athletic achievement, perfectionism, or become overly involved in extracurricular activities in an effort to avoid their feelings [10]. Still others, as a reaction against unacceptable thoughts and attractions, may exaggerate their heterosexuality and engage in promiscuous behavior [78]. Many become homeless. According to a report published by the National LGBTQ Task Force (NLGBTQTF), an estimated 20% to 40% of the 1.6 million homeless American youth are LGBT [79]. Some of these youth, when they came out to their parents or guardians, were told to leave home. Some left home to escape physical, sexual, or emotional abuse. Youth who end up at homeless shelters have also reported being threatened, belittled, and abused by shelter staff [79].

    Click to Review



    15 . Bisexual adults
    A) experience fewer health disparities than the general population.
    B) are more likely to experience depression than the general population.
    C) should be grouped with heterosexuals when determining healthcare needs.
    D) None of the above

    UNIQUE HEALTH AND SAFETY CONCERNS

    Existing research about bisexual health is scarce in large measure because the health issues that directly affect the bisexual population have either been ignored or treated as identical to the issues that affect heterosexuals or gay men and lesbians. Bisexuals have been found to experience greater health disparities and a greater likelihood of experiencing depression than the broader population [95].

    Click to Review



    16 . During substance abuse withdrawal, LGBTQIA adults may experience
    A) euphoria.
    B) relief of negative feelings.
    C) a return of internalized homophobia.
    D) a freedom to act on homosexual feelings.

    UNIQUE HEALTH AND SAFETY CONCERNS

    The pressure of coming of age in a society that says that LGBTQIA individuals should not exist or act on their feelings contributes to the use of alcohol and drugs [132]. Internalized homophobia develops and creates feelings of denial, fear, anxiety, and even revulsion about being gay, socializing in the GSM community, and having gay sex. Substance use temporarily relieves these negative feelings, allowing homosexual feelings to be acted upon. The homophobic feelings return during drug withdrawal. Substance use occurs again, contributing to the self-hatred. Depression leading to a worsening self-esteem may result from the use of alcohol and many other drugs [132].

    Click to Review



    17 . Which of the following statements about domestic violence in gay relationships is TRUE?
    A) It is much more common in same-gender couples than in opposite-gender couples.
    B) Homophobia makes accessing helpful services problematic for GSM individuals involved in domestic violence.
    C) There is abundant information available about the emotional or physical health of individuals in relationships experiencing violence.
    D) Both A and B

    UNIQUE HEALTH AND SAFETY CONCERNS

    Because of under-reporting, it is difficult to accurately gauge the incidence rate of domestic violence in same-gender couples. However, it has been estimated at 25%, roughly the same as the rate for opposite-gender couples [134]. There is a dearth of research information available about the emotional and physical health of individuals in violent relationships. Despite fear about the consequences of revealing their sexual orientation, community denial, and not wanting to further stigmatize the LGBTQIA community, more LGBTQIA individuals have been speaking out about violence and abuse in their relationships [134]. Domestic violence is in many ways the same as domestic violence in heterosexual relationships. That is, it is cyclical; the abusing partner's purpose is to wield and maintain control and power; the abused partner suffers fear and isolation; and the abuse may be physical, sexual, emotional, economical, or psychologic and may include threats and coercion [134]. Homophobia makes accessing information and support services problematic for LGBTQIA individuals [134].

    Click to Review



    18 . Which of the following is NOT one of the four crosscultural communication skill areas for culturally competent interactions with LGBTQIA patients?
    A) Take actions to increase defensiveness and resistance.
    B) Know what causes others to become defensive and resistant.
    C) Know recovery skills to use when communication errors occur.
    D) Be able to explain a problem or issue from another person's perspective.

    CROSSCULTURAL COMMUNICATION

    The healthcare professional can utilize a variety of strategies to promote personal sensitivity, awareness, and knowledge of the LGBTQIA population. Borrowing from the discipline of crosscultural counseling, four communication skill areas may provide a framework for strategies that the healthcare professional can use to be more culturally competent when interacting with the LGBTQIA subculture. The skill areas are [151]:

    • Be able to explain a problem or issue from another person's perspective.

    • Know what causes the other person to become defensive and resistant.

    • Take actions to reduce defensiveness and resistance.

    • Know recovery skills to use when communication errors occur.

    Click to Review



    19 . When working with youth, use of anticipatory guidance is very important. Which of the following strategies will assist the healthcare provider to assess where in the sexual identity process a GSM individual might be?
    A) Promoting isolation and withdrawal
    B) Being familiar with one of the sexual identity models
    C) Providing GSM-friendly literature in patient waiting areas
    D) None of the above

    CROSSCULTURAL COMMUNICATION

    Being familiar with at least one of the sexual identity models discussed would assist the healthcare professional to assess at what point in the coming-out process an individual may be. For LGBTQIA youth, having this awareness could strengthen the planning related to their overwhelming need for anticipatory guidance [84].

    Click to Review



    20 . Which of the following strategies is helpful during a patient interview of an elderly LGBTQIA individual?
    A) Be ready to make appropriate referrals to LGBTQIA community support services.
    B) Understand that all elderly LGBTQIA individuals view disclosure of sexual orientation the same way.
    C) Demonstrate awareness that the elderly LGBTQIA individual has more support systems available than younger LGBTQIA individuals.
    D) None of the above

    CROSSCULTURAL COMMUNICATION

    Demonstrating awareness that elderly LGBTQIA individuals may have fewer support systems is important. The American Association of Retired People provides Internet resources designed for elderly GSM persons. Individuals unable to use Internet services will need assistance with referral sources. Becoming familiar with appropriate LGBTQIA community referral sites is important as well. Contact local LGBTQIA support agencies for information about their services. Referring GSM individuals to a GSM-related referral site is like referring a diabetic to the American Diabetes Association [154].

    Click to Review