Promoting the Health of Gender and Sexual Minorities _ ____________________________________________
could jeopardize the support that already exists [87]. Studies have demonstrated that disclosing sexual orientation to family members during the high school years may create some danger for LGBTQIA adolescents, including, as previously discussed, abuse and the threat of being made homeless [82]. Not all GSM youth are aware of their right to medical confi- dentiality. LGBTQIA youth who know their rights have been found to be more likely to discuss sexual orientation and con- cerns with their healthcare providers. Most who do not discuss sexual orientation have said that they would have done so had they known that their confidentiality was protected [46; 88]. Many resources are available to LGBTQIA youth and their families, particularly in metropolitan regions. For example, Parents, Families, and Friends of Lesbians and Gays (PFLAG), an organization that works to unite GSM individuals with family and friends, offers support, education, and advocacy through online information sharing and community chapter efforts. Additional resources, including hotlines for youth, are provided at the conclusion of this course. Before recom- mending a resource, healthcare professionals should assess it for absence of social bias and provision of a professionally neutral environment [2]. ADULTS LGBTQIA adults have also experienced increased incidents of violence. The Federal Bureau of Investigation (FBI) has con- sistently ranked antigay violence as the second most frequent form of bias-motivated crime. In 2022, the FBI reported that 17.2% of the total 11,288 reported single-bias incidents had been motivated by bias related to sexual orientation [67]. Addi- tionally, the National Coalition of Anti-Violence Programs reported a slight decrease (compared to the previous year) in the number of incidents of anti-LGBT violence (825 incidents) but a significant increase in incidents involving physical and sexual violence [68]. Health maintenance and promotion are important to the LGBTQIA community, but these issues have received little attention in the general public’s health-related media. Many Internet sites provide health information related to sensi- tive topics for the general population as well as the GSM population. However, a difference exists between the general population and the LGBTQIA population when the GSM individual cannot talk further with a healthcare professional about a sensitive topic because of fear of stigmatization or discrimination. Some Internet sites have been able to address, in part, the sensitive health information needs of the GSM community (see Resources ). Distress caused by the experiences of marginalization, stigma, prejudice, discrimination, and internalized homophobia is a consistent theme of the professional literature. Research has suggested that most gay men and lesbians adopt negative atti- tudes toward their sexuality early in their developmental his- tories. As previously discussed, because health problems often begin in youth, internalized homophobia may also affect health
indirectly, especially when operating below consciousness in adults [18]. The coming-out process has been identified as a source of chronic stress, resulting in psychogenic suppression of the immune response for the LGBTQIA individual. A direct correlation has been found between where in the coming-out process an individual is and an increased incidence of physical illness, such as malignancies and some infectious disease pro- cesses other than HIV/AIDS [89]. Internalized homophobia has also been associated with high-risk sexual behaviors, such as practicing unsafe sex. Research has explored the potential influence of these negative attitudes on health experiences and behaviors, particularly those of gay men as related to HIV and AIDS. Difficulties with intimacy and other aspects of relationships may manifest as well, including an inability to disclose HIV status to sex partners [90]. African American men who have sex with men have been found to be less likely to identify themselves as gay, more likely to report having sex with women, and less comfortable discussing their behavior with friends. They have also been found to exhibit higher levels of internalized homophobia [90]. Prejudice and fear of discrimination have resulted in dif- ficulty accessing or avoidance in seeking health care [35]. While some healthcare providers have acknowledged that LGBTQIA individuals are part of their patient populations, they have determined that sexual orientation does not need to be addressed [8]. Others have indicated that they believe gay men and lesbians deserve to be ill or that they are unworthy of treatment. Reports exist of a “rough” or “violent” digital rectal exam on a patient after the patient was discovered to be gay [8]. One study examined both implicit and explicit bias against lesbian women and gay men among first-year hetero- sexual medical students with an emphasis on two predictors of such bias—contact and empathy [91]. A total of 4,441 students participated in the study. Nearly one-half (45.8%) of respon- dents with complete data on both bias measures expressed at least some explicit bias, and most (81.5%) exhibited at least some implicit bias. Amount and favorability of contact with gay/lesbian patients predicted positive implicit and explicit attitudes. Cognitive and emotional empathy predicted positive explicit attitudes, but not implicit attitudes [91]. Another study found that implicit preferences for heterosexual people versus GSM people are pervasive among heterosexual healthcare providers. The study examined attitudes among 2,338 medical doctors, 5,379 nurses, 8,531 mental health providers, 2,735 other treatment providers, and 214,119 nonproviders in the United States and internationally between 2006 and 2012 [92]. Prejudice has also resulted in legal and legislative actions with potentially negative consequences for the LGBTQIA population. For example, in 2004, the Michigan House of Representatives proposed a piece of legislation known as the “Conscientious Objector Accommodation Act” (House Bill 4660). This bill would have allowed healthcare providers the right to refuse to provide services that conflict with their beliefs [93]. While the bill did not pass, opponents expressed concern about its potential to harm the health of LGBTQIA persons.
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MDDC1026
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