Affirming and negotiating gender in family and social spaces: Stigma, mental health and resilience among transmasculine people in India

Scheim A., Kacholia V., Logie C., Chakrapani V., Ranade K., Gupta S.

IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.

Scheim A.I., Perez-Brumer A.G., Bauer G.R.

Transgender (trans) people experience profound mental health disparities compared with the general population, attributable in part to the psychological effects of gender non-affirmation. Despite the barriers to legal gender affirmation for trans people, little is known about its association with mental health. We therefore sought to determine whether having gender-concordant identity documents (IDs) is associated with mental health among trans adults in the USA. We hypothesised that having an ID that reflects one's preferred name and gender marker would be associated with reduced psychological distress and suicide risk.In this cross-sectional observational study, we obtained data from the 2015 US Transgender Survey, the largest cross-sectional survey of trans adults in the USA, with 27 715 participants. Eligible participants were adults (≥18 years), residing in a US state, territory, or overseas US military base; and considered themselves transgender, trans, genderqueer, non-binary, or similar. We excluded participants not living day-to-day in a different gender to the sex they were assigned at birth, participants who identified as crossdressers, and those missing data. The primary exposure of interest was whether all or some (vs none) of a respondent's IDs reflected their preferred name and gender marker. We examined associations with psychological distress (measured with the Kessler 6 scale) and suicide ideation, planning, and attempts in the past year, which we analysed using linear and modified Poisson regression models to examine associations with respondents' IDs.Of 22 286 respondents included in our analytic sample, 10 288 (weighted percentage 45·1%) had their preferred name and gender marker on none, 9666 (44·2%) on some, and 2332 (10·7%) on all of their IDs. Compared with those with no gender-concordant ID, respondents for whom all IDs were concordant had lower prevalence of serious psychological distress (adjusted prevalence ratio 0·68, 95% CI 0·61-0·76), suicidal ideation (0·78, 0·72-0·85), and suicide planning (0·75, 0·64-0·87), adjusting for potential confounders. Having some versus no concordant ID was generally associated with smaller reductions in distress and suicidality. Gender-concordant ID was not associated with suicide attempts (eg, adjusted prevalence ratio for all vs no IDs was 0·92, 95% CI 0·68-1·24).Possession of gender-concordant IDs might improve mental health among trans persons. Gender recognition policies should be considered structural determinants of transgender health.None.

Jain D., Rhoten K.M.

This article examines how efforts at legal legibility acquisition by gender diverse litigants result in problematic (e.g., narratives counter to self-identity) and, at times, erroneous discourses on sex and gender that homogenize the litigants themselves. When gender diverse persons approach the court with a rights claim, the narrative they present must necessarily limit itself to a normative discourse that the court may understand and, therefore, engage with. Consequently, the everyday lived experiences of gender diverse persons are often deliberately erased from the narrative as litigants mould themselves into the pre-existing normative legal categories of gender and sex. As a result of such mechanisms, the article finds that gender diverse litigants face epistemic injustice in the courts as their legal legibility is constructed within a constraining gender binary paradigm of judicial discourse.The article explores the trajectory of transgender rights in India, through an analysis of case law prior to and post the landmark NALSA decision, to understand how the approach to transgender rights and identities has been shaped by and shapes, in turn, normative conceptions of gender. The article argues for the incorporation of temporal pluralism into the law that would allow courts to hear gender diverse litigant accounts premised on contemporary gender diversity beyond the binary (rather than incontestable prior understandings based in past precedent), which would better account for such social injustices.

Bowling J., Blekfeld-Sztraky D., Simmons M., Dodge B., Sundarraman V., Lakshmi B., Dharuman S.D., Herbenick D.

Understandings of sex and intimacy carry important implications for individuals' behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India - Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others' characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here.

Alzahrani T., Nguyen T., Ryan A., Dwairy A., McCaffrey J., Yunus R., Forgione J., Krepp J., Nagy C., Mazhari R., Reiner J.

Background: As of 2016, ≈1.4 million people in the United States identify as transgender. Despite their growing number and increasing specific medical needs, there has been a lack of research on cardiovascular disease (CVD) and CVD risk factors in this population. Recent studies have reported that the transgender population had a significantly higher rate of CVD risk factors without a significant increase in overall CVD morbidity and mortality. These studies are limited by their small sample sizes and their predominant focus on younger transgender populations. With a larger sample size and inclusion of broader age range, our study aims to provide insight into the association between being transgender and cardiovascular risk factors, as well as myocardial infarction. Methods and Results: The Behavioral Risk Factor Surveillance System data from 2014 to 2017 were used to evaluate the cross-sectional association between being transgender and the reported history of myocardial infarction and CVD risk factors. A logistic regression model was constructed to study the association between being transgender and myocardial infarction after adjusting for CVD risk factors including age, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, smoking, and exercise. Multivariable analysis revealed that transgender men had a >2-fold and 4-fold increase in the rate of myocardial infarction compared with cisgender men (odds ratio, 2.53; 95% CI, 1.14–5.63; P=0.02) and cisgender women (odds ratio, 4.90; 95% CI, 2.21–10.90; P2-fold increase in the rate of myocardial infarction compared with cisgender women (odds ratio, 2.56; 95% CI, 1.78–3.68; P

Russell S.T., Pollitt A.M., Li G., Grossman A.H.

This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth.Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior.After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts.For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.

Parker C.M., Hirsch J.S., Philbin M.M., Parker R.G.

This scoping study sought to provide an overview of existing interventions, programs and policies that address family-based stigma and discrimination against LGBTQ youth.A keyword search in three online databases identified relevant scientific publications. Because it located a relatively small number of peer-reviewed publications, additional grey literature references were included, identified through consultation with specialists and through anonymous peer-review. Research, policies and interventions were categorized using an adapted ecological framework.There is very little peer-reviewed research on interventions to reduce family stigma and discrimination against LGBTQ youth. Most on-going work to improve family environments for LGBTQ youth appears to be currently conducted by city governments and non-governmental organizations. Very few interventions or programs provide any outcome data. Theoretical frameworks and approaches vary widely.Given the widely recognized importance of a supportive family environment for a healthy transition to adulthood for LGBTQ youth, there is an urgent need for scientific research on policies and interventions to address stigma and discrimination and create supportive environments within families. Tackling family-based stigma and discrimination will require interventions and policies at each level of the ecological framework, including individual- and interpersonal-level interventions as well as community-level programs and structural-level policymaking.

Downing J.M., Przedworski J.M.

Transgender people experience significant interpersonal and structural discrimination and stigma. However, little is known about the health of transgender people, and even less about the health of specific groups-including male-to-female, female-to-male, and gender-nonconforming transgender populations-despite the variation in social and biological characteristics across groups.Data are from the 2014-2016 Behavioral Risk Factor Surveillance System, analyzed in 2017. The study population included 2,221 transgender and 523,080 cisgender respondents from 31 states and one territory. The authors estimated the prevalence and adjusted odds of chronic health conditions, health-related quality of life, disabilities, health behaviors, and health utilization among three transgender groups, when compared separately with cisgender males and cisgender females.An estimated 0.24% (95% CI=0.21, 0.27) identified as male-to-female; 0.14% (95% CI=0.12, 0.17) identified as female-to-male; and 0.10% (95% CI=0.08, 0.12) identified as gender-nonconforming. All transgender groups experience worse mental health and disabilities; few differences in healthcare access and utilization were observed. Gender-nonconforming people had higher odds of multiple chronic conditions, poor quality of life, and disabilities than both cisgender males and females. Female-to-male people had a higher odds of no exercise and cardiovascular disease compared with cisgender females.Given the high burden of disabilities; poor mental health; and multiple chronic conditions among transgender (particularly gender-nonconforming) populations, supportive services and care coordination may be consequential levers for improving transgender health.

Gilbert P.A., Pass L.E., Keuroghlian A.S., Greenfield T.K., Reisner S.L.

There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research.We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990-2017, and extracted key details (e.g., sample composition, alcohol measures, results).Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods.Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.

Jhang J.

Niranjan Hebbar Y., Singh B.

Rood B.A., Maroney M.R., Puckett J.A., Berman A.K., Reisner S.L., Pantalone D.W.

Minority individuals might conceal their identity in social contexts in an effort to avoid stigma and victimization. Unfortunately, identity concealment is thought to impact psychological distress in transgender and gender nonconforming (TGNC) individuals. Thus, through 30 in-depth interviews, we sought to understand if and how identity concealment was experienced by TGNC individuals. Findings indicated that (a) TGNC identity concealment is a source of stress, (b) individuals might conceal their TGNC identity based on social context, (c) concealment of assigned sex and gender history can function to affirm one's true gender identity, and (d) concealment of gender history is a rejection of one's assigned sex. In addition, (a) passing/blending is an important interpersonal and intrapersonal process, (b) the importance of passing/blending can change over time, and (c) not passing/blending may result in worrying about personal safety. The authors discuss how concealment can both inhibit and promote psychological health for TGNC individuals, and they offer clinical applications for health providers. (PsycINFO Database Record

Bry L.J., Mustanski B., Garofalo R., Burns M.N.

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semistructured interviews were conducted with 10 sexual minority males and transgender females aged 18-22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.

Tamagawa M.

Bowling J., Dodge B., Banik S., Bartelt E., Mengle S., Guerra-Reyes L., Hensel D., Herbenick D., Anand V.

Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India's oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants' photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants' extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.

Johnson R., Beach D., Al-Janabi H.

Mukherjee S., Ray S.

Hijras, a non-normative sexual minority, routinely experience an array of risks, stigmas, and exclusions in their everyday lives and livelihoods which intensified during COVID-19. The present study explores perceptions and lived-in experiences of hijras during the pandemic in two Indian Smart cities – Bhubaneswar and New Delhi. Data was collected through in-depth interviews, FGDs, and non-participant observation from a sample of 84 hijra respondents via snowball sampling. Using thematic analysis, study findings have been conceptualized into economic challenges, healthcare challenges, and discrimination, that reflects how hijras in New Delhi were relegated to the urban margins, as compared to those in Bhubaneswar.

Babu D., Blount-Hill K.

Valenzuela-Contreras C., Méndez-Bustos P., Arellano-Faúndez O.

Arora M., Sansfaçon A.P.

Background: Adolescence, the transitional phase between childhood and adulthood, involves significant biological, social, cognitive and emotional changes. In India, adolescents (10–18 years) form 21% of the population, increasing to 33% when including those aged 10–24 years, making India home to the world’s largest adolescent population. The concept of adolescence, unlike the biological process of puberty, is culturally determined and influenced by globalisation and changing societal values. Objectives: This article aims to (a) elucidate the barriers hindering transgender and gender diverse (TGD) youth in India from accessing gender affirmation, including familial rejection, constraining legal provisions and inadequate public health infrastructure; (b) underscore the impact of socio-cultural and political attitudes on health disparities faced by TGD youth, emphasising the need for comprehensive and individualised healthcare and socio-cultural support; (c) advocate for a socio-medical approach to address the unique challenges of Indian TGD youth, focusing on collaborative efforts among healthcare professionals, social institutions and policymakers; (d) propose strategies for improving access to early gender-affirmative care, including training healthcare providers, promoting comprehensive medical support and advocating for the rights of TGD youth. Methods: A blind review of literature was conducted using PUBMED/MEDLINE, Google Scholar, Web of Science, PsycINFO and SCOPUS with keywords such as ‘transgender youth’, ‘nonbinary and gender diverse youth’, ‘gender-affirming medical care in India’ and ‘youth mental health’. The search eventually included peer-reviewed publications, books, reviews, editorials, opinion pieces, feature stories and individual case reports. Articles were screened and thematically analysed to synthesise findings. Results: The review highlights significant barriers to gender-affirming care for TGD youth in India, including familial rejection, restrictive legal frameworks and inadequate public health infrastructure. Socio-cultural and political attitudes contribute to health disparities, necessitating comprehensive healthcare and socio-cultural support. Conclusions: Addressing the challenges faced by TGD youth in India requires a socio-medical approach, emphasising collaborative efforts among healthcare providers, social institutions and policymakers. Strategies for improvement include training healthcare providers, promoting comprehensive medical support and advocating for the rights of TGD youth to ensure early and effective gender-affirmative care.

Osmetti L.A., Allen K.R., Kozlowski D.

Caballero R., Radusky P.D., Zalazar V., Cardozo N., Romero M., Dumas Pelletti C.M., Aristegui I.

Raj P., Dubey A.

Objective: In India research on health issues of transgender populations are very recent and limited though transgenders are an important sub-group of the population. Hence, this study attempts to understand the state of transgender health research in India through a systematic review of literature.Methods: A systematic literature review was conducted using bibliometric analysis. Initially, 132 studies were identified, and only 37 articles meeting selection criteria were subsequently selected for review using PRISMA 2020 guidelines. The research landscape was examined with tools such as Biblioshiny, Arc-GIS (10.1), and Vos-Viewer.Results: The review highlights that existing literature on transgender health in India mainly focuses on sexual health while neglecting their overall health status. It also emphasises the skewed geographical coverage of these studies. Based on the analysis, the interdisciplinary nature of the subject is illustrated in a three-field plot and through term co-occurrence. These indicate the need for culture-specific gender-affirmative services promoting a holistic approach to comprehend the health of transgender populations in India.Conclusion: In India research on transgender health is lopsided and at an initial stage. There is a need to develop diverse research focus on various health issues of transgenders that should also be geographically representative. Future in-depth research on this subject will enable optimizing resource allocation, developing effective gender-inclusive policies, and support holistic planning for better health status of transgender people in India, and other countries with similar socio-cultural background.

Jadav S., Chakrapani V.

Adolescent children and youth with diverse sexual orientation and gender identity (SOGI), have a right to a safe and nurturing learning environment in schools and colleges. However, available literature shows that such children and youth face bullying in schools and are excluded by their teachers and peers because they are or are perceived to be lesbian, gay, bisexual, and transgender (LGBT) or questioning their sexual orientation or gender identity (SOGI). Schools that are not safe or inclusive for learners violate the right to education as enshrined in the United Nations Convention on the Rights of the Child and act as barriers to SDG 4 (ensure inclusive and equitable quality education and promote lifelong learning opportunities for all) and SDG 5 (gender equality). Research on bullying and violence in schools is critical for making institutions safe and welcoming for all students. Using empirical data from sexual and gender minority adolescents/youth, the authors highlight the various forms and the magnitude of SOGI-related bullying in educational settings and the availability and use of current redressal mechanisms. The authors also suggest mechanisms to be put in place to prevent and mitigate bullying, including the implementation of anti-bullying policies, awareness generation among students and teachers on diversity in gender and sexuality, establishing support systems for reporting bullying, and providing supportive counseling services for victims of bullying. They emphasize that educational institutions should be inclusive of people with diverse sexual orientations and gender identities—a key to achieving SDG 5—gender equality.

Banik S., Khan M.S., Jami H., Sivasubramanian M., Dhakal M., Wilson E.

Sexual and gender diverse people (SGDP) bear a disproportionate burden of and vulnerability to human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and risks of mental health problems worldwide including countries in South Asia such as Bangladesh, India, Nepal, and Pakistan. Despite recent advances in LGBTQ rights in several South Asian countries, the expression of sexual and gender identity and behavior different from local hetero- and cis-normative expectations remains taboo in South Asian culture. This is reinforced by structural and societal values and norms. As a result, SGD people continue to face multiple oppression-related stressors that are a source of distress. SGD people's experiences and health outcomes across their lifespans can be understood through an intersectional lens. Stigma, discrimination, marginalization, and trauma experienced being in disadvantaged and marginalized status add to minority stress which drives poor health outcomes among SGDP across South Asia (SA). Both the intersectionality and minority stress models may further explain the role of individual-level coping and community-level responses in reaction to oppressive experiences. Based on the authors’ work, in collaboration with the community-based partners in India, Bangladesh, Pakistan, and Nepal, this chapter describes culturally relevant social determinants which affect sexual health among SGDP in South Asia. We elaborate on the socio-cultural and structural factors that act as catalysts in reinforcing historical stigma and discrimination and its health sequelae for SGDP in Bangladesh, India, Pakistan, and Nepal.

Frances C., Garnsey C., DeMulder J.

Abstract Background There is a lack of reliable data on the size, characteristics, and experiences of sexual and gender minority (SGM) young people (ages 10–24) in low- and lower-middle- income countries (LMICs). This review examines the research conducted in the last thirteen years with and about SGM young people living in low-income settings and seeks to answer the question: What is known about the mental and physical health needs, safety, and wellbeing of SGM young people living in LMICs? Methods We conducted a scoping review informed by the methodological frameworks put forth by Arksey and O’Malley and the Joanna Briggs Institute. We systematically searched two general social science databases and one topic-specific database for peer-reviewed papers, of any research design, that included SGM young people or explored attitudes toward SGM young people in LMICs. We included papers that reported on factors influencing the health and wellbeing of SGM populations, including physical and mental health, healthcare-seeking behaviors, substance use, experiences of discrimination and/or stigma, experiences of violence and abuse (emotional, physical, and/or sexual), economically motivated paid sex practices, housing or economic security, and attitudes of others toward SGM populations. Results Of the 5,409 unique records identified, 79 papers drawing from data collected from 74 unique studies met the inclusion criteria. Only 50 of the 79 papers included SGM young people as participants, with just 13 focusing exclusively on SGM young people ages 10–24. The included papers were classified into three thematic groupings: attitudes toward SGM populations (n = 26), risks to health (n = 40), and experiences of stigma and discrimination (n = 13). Conclusion The findings indicate that the health and wellbeing of SGM young people in LMICs has been historically under-researched. While SGM young people have received more attention from researchers in recent years, the body of literature as a whole is disjointed and sparse, and often studies are about SGM young people, rather than with and for them. Our review highlights the need for more and better research, more accurate and disaggregated demographic data, and leadership and participation of SGM-led community-based organizations in the co-design of studies that focus on SGM young people.

Kharwar S., Singh P.

Evidence of experienced discrimination by the lesbian, gay, bisexual and transgender (LGBT) individuals makes it necessary to investigate antecedents of prejudice towards them. Desired social contact (DSC) and social distancing practices towards LGBT community may be related to the knowledge about and attitudes towards the LGBT community. However, the inter-construct mechanism underlying such practices needs to be investigated. Considering this need, the present study explored the relationship between knowledge, attitude, DSC and social distance practices towards the LGBT community. A total of 315 heterosexual participants (male—184, female—131; Mage = 24.66, SDage = 3.38) were contacted through emails and social media between November 2021 and February 2022 and requested to fill the questionnaires. The findings indicate that the relationships between knowledge, DSC and social distancing practices are significantly mediated by attitudes towards the LGBT community. The standardized indirect effect of knowledge (via attitude) on DSC was statistically significant (β = 0.47; 95% CI, 0.54, 0.40; p = 0.005). Also, knowledge’s standard indirect effect (via attitude) on social distancing was statistically significant (β =  − 0.25; 95% CI, − 0.32, − 0.16; p = 0.005). The findings assert that knowledge about and attitude towards LGBT community play a crucial role in shaping social contact and social distancing practices towards them. Increased knowledge about alternative sexualities may effectively reduce negative attitudes and social distancing practices and create a more inclusive and accepting society for sexual minority groups. Policymakers should strive to enhance the knowledge of general populations concerning sexuality and homosexual attractions through awareness programs and formal teaching.

Szwarcwald C.L., Pascom A.R., de Souza Júnior P.R., Damacena G.N., Castilho E.A.

Abstract Background Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). Methods Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18–64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott’s correction, was applied. Results Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1–4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9–2.5), and between the WSW proportions (4.6%; 95% CI 4.0–5.4%) and (2.1%; 95% CI 1.8–2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18–24 and 25–34 years, and individuals not living with a partner. Conclusions The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.

Ho L.L., Cheung A.T., Chan C.C., Wong E.L., Tam W.W., Chien W.T.

AbstractIntroductionLesbian, gay, bisexual, and transgender (LGBT) employees have increasingly reported experiencing different forms of workplace discrimination/harassment. Workplace allyship may be positively associated with psychological health through creating inclusive organizational cultures or reducing discrimination/harassment. However, comprehensive literature reviews or evidence syntheses on the effects of workplace allyship in mental health protection/promotion for LGBT employees are limited.MethodsThis scoping review aimed to summarize available evidence regarding the effectiveness of workplace allies for LGBT employees in preventing/minimizing psychological distress and clarify the therapeutic components. This review included published research articles and grey literature identified through 11 electronic databases, a secondary search, and other sources.ResultsWe identified 27 relevant articles. Most included studies used cross‐sectional or qualitative research designs, and evidence from countries beyond the United States was limited. Three essential/effective components of workplace allies/allyship were identified that could create supportive/safe workplace relationships/climates: (a) knowledge, (b) empathy, and (c) action.ConclusionsFurther longitudinal studies and controlled trials are needed to increase the quality of evidence on the effects and change processes induced by workplace allyship. Qualitative studies are also recommended to understand the health needs and mechanism of actions of workplace allyships in different LGBT communities.

Lyndon S., Rawat P.S., Bhardwaj K., Navare A.

PurposeThe purpose of this paper is to extend the theoretical understanding of the disclosure dilemma experienced by lesbian, gay and bisexual (LGB) employees. The study focuses on examining the factors related to self-disclosure such as co-worker support and fear of disclosure. Further, the study also aims at testing the impact of coworker support on the psychological well-being of LGB employees.Design/methodology/approachThe study adopts a concurrent triangulation research design, which involves a simultaneous collection of quantitative and qualitative data. Using a survey questionnaire, data from 200 LGB employees were collected. Semi-structured interviews were carried out with 10 LGB employees. The qualitative findings were treated as complementary to the relationship tested through the quantitative method.FindingsQuantitative results reveal that co-worker support positively impacts self-disclosure by LGB employees. And the fear of disclosure mediates the relationship between coworker support and self-disclosure. Further, self-disclosure is positively related to psychological well-being. The qualitative study brings insights from the lived experiences around these factors. This research expands knowledge about the factors associated with the disclosure of LGB employees.Originality/valueThe study examines the factors related to the disclosure of sexual identity and the experiences of the dilemma of LGB employees in the workplace. Most of the studies in the context of LGB have adopted a quantitative research design. The current study adopts a mixed methods approach with a concurrent triangulation research design.