A Structural Analysis of Gender-Based Violence and Depression in the Lives of Sexual Minority Women and Trans People.

This article explores structural mechanisms that are the context for violence and depression in the lives of sexual minority women and trans people in Ontario, Canada. The article draws on interviews with 14 people who reported experiences of depression in the previous year, foregrounding three representative narratives. Narrative and case study analysis reveal that violence is a repeated and cumulative experience over lifetimes, occurring across different interpersonal contexts and institutional encounters. A common theme across the narratives is that experiences of violence are connected to a broader context in which structural arrangements, cultural norms, and institutional processes create conditions where marginalized people are put in harm's way, perpetrators are empowered, and justice and access to help are elusive. As the violence experienced by these sexual minority women and trans people is rooted in structural and cultural oppression represented in poverty, racism, misogyny, homophobia, and transphobia, the prevention of violence and its consequences for these and other marginalized populations requires systemic transformation of the structures and systems that currently allow and perpetuate harm.

Culturally Competent Gender, Sex, and Sexual Orientation Information Practices and Electronic Health Records: Rapid Review.

BACKGROUND: Outdated gender, sex, and sexual orientation (GSSO) information practices in health care contribute to health inequities for sexual and gender minorities (SGMs). Governments, statistics agencies, and health care organizations are developing and implementing modernized practices that support health equity for SGMs. Extending our work, we conducted a rapid review of grey literature to explore information practices that support quality health care for SGMs. OBJECTIVE: The aim of this rapid review of grey literature was to elucidate modern GSSO information practices from leading agencies for adaptation, adoption, and application by health care providers and organizations seeking to modernize outdated GSSO information practices that contribute to health inequities among SGMs. METHODS: We searched MEDLINE and Google from 2015 to 2020 with terms related to gender, sex, sexual orientation, and electronic health/medical records for English-language grey literature resources including government and nongovernment organization publications, whitepapers, data standards, toolkits, health care organization and health quality practice and policy guides, conference proceedings, unpublished academic work, and statistical papers. Peer-reviewed journal articles were excluded, as were resources irrelevant to information practices. We also screened the reference sections of included articles for additional resources, and canvassed a working group of international topic experts for additional relevant resources. Duplicates were eliminated. ATLAS.ti was used to support analysis. Themes and codes were developed through an iterative process of writing and discussion with the research team. RESULTS: Twenty-six grey literature resources met the inclusion criteria. The overarching themes that emerged from the literature were the interrelated behaviors, attitudes, and policies that constitute SGM cultural competence as follows: shared language with unambiguous definitions of GSSO concepts; welcoming and inclusive care environments and affirming practices to reduce barriers to access; health care policy that supports competent health care; and adoption of modernized GSSO information practices and electronic health record design requirements that address invisibility in health data. CONCLUSIONS: Health equity for SGMs requires systemic change. Binary representation of sex and gender in electronic health records (EHRs) obfuscates natural and cultural diversity and, in the context of health care, places SGM patients at risk of clinical harm because it leads to clinical assumptions. Agencies and agents in health care need to be equipped with the knowledge and tools needed to cultivate modern attitudes, policies, and practices that enable health equity for SGMs. Adopting small but important changes in the language and terminology used in technical and social health care systems is essential for institutionalizing SGM competency. Modern GSSO information practices depend on and reinforce SGM competency in health care.

Student Journal Club to Improve Cultural Humility with LGBTQ Patients.

Health degree programs provide opportunities to reduce disparities in care for LGBTQ patients by exposing students to LGBTQ communities and current health issues. However, LGBTQ content is mostly absent from medical school curricula. This mixed method assessment study, conducted during the 2018 to 2019 academic year, examined the feasibility of implementing a medical student journal club focused specifically on LGBTQ health issues as a complementary training tool to support efforts to create an inclusive educational environment. Compared to the pre-test, mean response scores increased for most of the parameters including familiarity with LGBTQ healthcare issues, confidence in the ability to identify harmful medical provider practices, and reading and assessing scientific literature. Qualitative data showed increased confidence, comfort and knowledge about LGBTQ health barriers. This study offers a framework for using a journal club to provide an effective platform for enhancing students' LGBTQ cultural humility and research literacy.

A Psychosocial Risk Model of Potentially Traumatic Events And Sexual Risk Behavior Among LGBTQ Individuals.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face heightened risk of potentially traumatic events (PTEs) exposure, including hate crimes and childhood abuse. Past research demonstrates associations between PTEs exposure and sexual risk behavior; however, examining the indirect effect of PTEs on sexual risk behavior remains understudied among LGBTQ individuals. This study tested a path analysis model to inform interventions targeted to reduce sexual risk behavior, as conceptualized by condomless sex with casual partners without knowing the person's HIV or sexually transmitted infection (STI) status, among LGBTQ individuals with PTEs exposure. Participants completed an online one-time survey and included 207 LGBTQ adults who experienced at least one PTE during the past year. Indirect effect results indicated that PTEs exposure was related to sexual risk behavior through serial associations between shame, loneliness, and substance use. Direct effect estimates indicated that greater PTEs exposure was associated with greater shame, loneliness, substance use, and sexual risk behavior. Greater shame was associated with greater loneliness, which was associated with greater substance use. Also, greater substance use was associated with greater sexual risk behavior. This study adds to the burgeoning body of literature on the relationship between PTEs exposure and sexual risk behavior among LGBTQ individuals. Clinical and counseling interventions for LGBTQ individuals with PTEs exposure should work to address modifiable psychosocial risk factors associated with sexual risk behavior.

"No Pumps Allowed": The "Problem" With Gender Expression and the Morehouse College "Appropriate Attire Policy".

Within higher education literature, historically Black colleges and universities (HBCUs) have been lauded for their exceptional ability to provide African American students with culturally engaging academic and social environments. While the aforementioned may be true, much of this literature has presented HBCU students and these institutions as monolithic entities, with little regard to the ways social identities (e.g., gender, gender identity, sexual identities) shape students' undergraduate experiences. This investigation uses critical discourse analysis to explore the media's coverage and reactions to the Morehouse College appropriate attire policy in order to examine how their campus stakeholders problematized gender expression within this HBCU context. Implications for this research provides insights into how HBCU communities can both recognize and respond to the needs of their diverse queer student populations. This study concludes with highlighting new advancements being made on HBCU campuses that illustrate how they are making their campuses more inclusive of queer students.

More Natural Does Not Equal More Normal: Lesbian, Gay, and Bisexual People's Views About Different Pathways to Parenthood.

Heterosexual reproduction is often seen as normal and natural, with the two descriptors commonly understood as mutually reinforcing. I argue that, despite their apparent similarity, the meanings of "normal" and "natural" are distinct in important ways-a distinction that questions the positioning of lesbian motherhood and gay fatherhood as inferior. Through an analysis of lesbian, gay, and bisexual people's ethical judgments about different ways of creating families, I show that pathways to parenthood that make a family appear "more normal" rely on means of reproduction that seem, in fact, "less natural." Conversely, reproductive possibilities seen as "more organic" create families that depart more substantially from the cultural norm of the nuclear family. As a result of this tension, different pathways to parenthood can be justified as being "in children's best interests." However, while this children-centered justification can be flexibly applied, it also has contradictory meanings.

"I've Redeemed Myself by Being a 1950s 'Housewife' ": Parent-Grandparent Relationships in the Context of Lesbian Childbirth.

This article investigates the relationship between grandparents and lesbian daughters in the context of childbirth, looking specifically at the role that pregnancy plays in shaping kinship affinities. Gender, sex, and heterosexuality are fundamental to Euro-American kinship discourse and practice; lesbian couples' parenthood through donor conception represents a significant departure from prevailing tropes of kinship. Thus, questions arise about how lesbians experience becoming and being parents, and about how their own parents may respond to becoming a genetic or nongenetic grandparent. This article draws on original data from interviews conducted in the United Kingdom with lesbians who became parents by donor conception, and grandparents with lesbian daughters in those situations where the older generation was not originally supportive of their daughters. It explores the negotiated meaning of pregnancy and how relationships with grandparents may be shaped by whether or not it is the daughter of the family who gave birth.