_____________________________________________ Promoting the Health of Gender and Sexual Minorities
als. Gay and lesbian victims may experience more maladaptive outcomes as a result of the unique components of same-sex IPV, their sexual minority status in American society, and the lack of appropriate services tailored to victims of this type of domestic violence [139]. Results from the National Longitudinal Study of Adolescent to Adult Health indicate that IPV within the context of same-sex relationships led to more depressive symptoms and greater involvement in violent delinquency, with the impact of IPV on violent delinquency being greater for victims of same-sex IPV compared with opposite-sex IPV [139]. Violence Violence toward an LGBTQIA individual affects the entire GSM community and the general population. Each year, thousands of incidents of violence against gays and lesbians are reported. These incidents range from verbal abuse to homicide [140]. While statistics demonstrating the incidences of antigay violence are frightening, they do not adequately convey the fear and anguish experienced not only by survivors but also by their communities [141]. Violence has occurred in a variety of settings and in all ages of LGBTQIA individuals. Settings range from elementary schools to nursing homes. Violent crimes based on one’s sexual orientation were not recorded until after 1990, when the federal Hate Crime Statis- tics Act went into effect. This law requires the Department of Justice to collect and publish annual statistics on crimes that manifest prejudice based on race, religion, sexual orientation, and ethnic origin [142; 143]. Education for law enforcement personnel about evaluating a crime scene for evidence of a bias crime has taken place across the nation. However, determining the accurate incidence of antigay bias crimes remains difficult. Interviews with LGBTQIA victims have revealed their fear of disclosure and other anxieties. This has resulted in victim failure to report assaults or pursue investigations and has contributed to difficulties with data collection [141]. LGBTQIA individuals experience many of the same physical and emotional effects following violence as the general pub- lic. However, LGBTQIA individuals “are often the objects of hate-based violence because of their sexual orientation and may show signs of exacerbated internalized homophobia after victimization” [140]. Healthcare professionals working with these individuals should be informed about the physical and mental health consequences of violence associated with stigmatization based on sexual orientation [140]. OLDER ADULTS Research challenges have made determining the size and other demographic and sociologic characteristics of the older GSM population very difficult. The LGBT Aging Center has esti- mated that approximately 1.5 million LGBT adults 65 years of age or older reside in the United States, with the number expected to double by 2030 [144]. Literature discussing the health and health needs of GSM elderly has also been limited. As a result, identifying problems and advocating for solutions
for this population has been challenging [144; 145]. Clearly, older GSM individuals experience the same marginal- ization due to age and ethnic or racial heritage as the nation’s general population. Older gay adults experience additional marginalization related to sexual orientation. While federal and state governments offer a wide variety of social programs and services that aim to support the lives of older people, rarely do these programs recognize or support the families that LGBTQIA people build [145]. For example, in the past, same-gender partners have not received Social Security ben- efits, no matter how long partners had been together. As of June 2015, this has changed. A spouse, divorced spouse, or surviving spouse of a same-sex marriage or non-marital legal same-sex relationship may not only qualify to receive Social Security benefits (including death benefits) but is required to disclose their relationship, as their partner’s income will affect their benefits [146]. Although limited, research findings have shed some light on LGBTQIA elderly. For example, older gay men are more likely to be angry after years of oppression than are non-gays. While some of these men have directed the anger constructively into their occupations or political activism or toward developing strong networks of friends, others have turned the anger inward and consequently experience anxiety, depression, and self-esteem problems related to internalized homophobia [147]. Older gays may also receive less sympathy and attention in general when dealing with the loss of a long-term lover or close friend. Because of problems from family members and reactions from healthcare providers and others, the GSM individual may also experience complications with the griev- ing process [147]. Another area of need for older GSM individuals is that for HIV/AIDS education. The stereotype that older people are not sexually active has contributed to making this an unno- ticed population for AIDS educators and others [148; 149]. As recently as the late 1990s, primary care physicians were less likely to discuss HIV or HIV risk reduction with patients older than 50 years of age than with those 30 years of age and younger [150]. Only within the GSM community itself have prevention campaigns targeted all age groups [149]. Researchers have reported striking differences between older and younger GSM people related to their attitudes toward public disclosure of their gay sexual orientation [41; 151]. One of the most trying issues related to caring for older LGBTQIA individuals is the issue of patient self-disclosure [152]. In a study involving more than 2,500 LGBT persons 65 years of age or older, more than 20% did not disclose their sexual identity to their physician [153]. In general, elderly LGBTQIA individu- als come from a highly stigmatized background in which they had been considered most of their lives to be ill and deviant. Consequently, they have learned to conceal their sexual ori- entation as a means of survival [154].
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MDDC1026
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