The impact of marriage equality campaigns on stress: Did a Swiss public vote get under the skin?

Lesbian, gay, bisexual, trans, intersex, and queer (LGBTIQ+) individuals encounter persistent structural inequalities and discrimination that can lead to detrimental psychological and physiological health outcomes. Amid evolving legal landscapes, little attention has been directed toward understanding the physiological health effects of societal shifts on these communities. This study aims to explore the impact of a national marriage equality vote and associated debates on psychological and biological stress among LGBTIQ+ individuals and cisgender, heterosexual, endosex individuals (termed cis-heterosexual) in Switzerland. We gathered longitudinal survey and biological data collected in hair samples among LGBTIQ+ and cis-heterosexual individuals before, during, and after the 2021 national vote (survey data: NT1T2 = 954; NT2T3 = 880; biological data: NT1T2 = 393; NT2T3 = 354). Preregistered analyses reveal a notable increase in biological stress levels (i.e., cortisol and cortisone levels), but not perceived stress, among both LGBTIQ+ as well as cis-heterosexual individuals who were close to them during the campaign. Results further point out the negative impacts of the campaign against marriage equality (i.e., no-campaign) on LGBTIQ+ individuals' biological stress levels as well as on those of their allies. These effects were, however, moderated by exposure to the campaign for marriage equality (i.e., yes-campaign), indicating the powerful buffering effects of the yes-campaign on the impact of discrimination on individuals' health. However, these positive effects appear to come at a cost, potentially impacting the well-being of individuals engaged in advocating for the yes-campaign. This research underscores the lasting impact of political campaigns on individuals' health.

Protective and Risk Factors for Suicidal Behaviour in Self-Declared LGBTIQ+ Adolescents.

BACKGROUND: Adolescents who identify as sexual minorities often face social stigmatisation, which can lead to increased adversity and a higher risk of suicidal behaviours. However, there are also protective factors that may promote resilience to these risk behaviours. This study aims to identify factors that predict resilience in sexual minority adolescents with high suicidal vulnerability. METHODS: The study sample comprised 78 self-reported LGBTIQ+ adolescents aged between 13 and 18 years old (M = 16.11, SD = 1.56) who had previously attempted suicide. They completed several psychosocial instruments to measure risk and protective variables related to suicidal vulnerability. RESULTS: Entrapment was found to be the most predictive risk variable for suicide attempts. However, protective variables promoting resilience were also found, such as adequate parental communication, life satisfaction, and cognitive reframing. DISCUSSION: The findings related to prevention of suicide attempts are discussed and we highlight the urgent need to enhance certain internal and contextual protective factors to promote resilience in the face of suicidal vulnerability in certain clinical subpopulations exposed to highly adverse situations.

Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.

BACKGROUND: Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. METHODS: We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. RESULTS: Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. DISCUSSION: To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.

A Pilot Study of Metacognitive Training in U.S. Republican Leaners: Reducing Polarization Toward LGBTIQ+ Persons.

Negative attitudes and stigmatization toward sexual minorities is a cause of minority stress of non-heterosexual persons on an individual level and has a negative impact on democratic coexistence in postmodern, plural society on a societal level. Derived from clinical research, we developed a short metacognitive training (MCT) intended to induce doubt toward inaccurate beliefs about LGBTIQ+ persons. We expected this MCT to reduce homonegativity, threat perceptions of LGBTIQ+ persons, and to foster extended outgroup tolerance compared to an education and a no-treatment control condition. We tested this hypothesis in U.S. Republican leaners who represent a social group that is likely to hold homonegative attitudes. We randomly assigned 490 U.S. Republican leaners to an MCT condition comprising 16 questions and respective answers (n = 166) vs. an education control condition (n = 164) vs. a no-treatment control condition (n = 160). We found that Republican leaners after receiving MCT (1) had a significant reduction of homonegativity (ds ≥ 0.28), (2) significantly perceived LGBTIQ+ persons as less threatening (ds ≥ 0.30), and (3) were significantly more tolerant of various outgroups such as LGBTIQ+ persons, feminists, liberals, and climate activists (ds ≥ 0.23) relative to both control conditions. The small effects of this short intervention and the possibility of systematically applying MCT in social discourse to reduce homonegativity with its potential significance for LGBTIQ+ individuals' mental health are discussed. Furthermore, we highlight this pilot study's significance toward intervention possibilities regarding political division and polarization in postmodern, democratic societies.

Characterization of content associated with lesbian, gay, bisexual, transgender, intersex, and queer individuals in Chilean medical schools: a cross-sectional survey.

BACKGROUND: Lesbian, gay, bisexual, transgender, intersex, queer, and other sexual and gender identities (LGBTIQ+) individuals face health inequities. Additionally, medical students report a lack of confidence in providing specific health care to LGBTIQ + individuals, and medical schools do not offer the breadth and depth of coverage needed to fully prepare and make them comfortable in caring for these individuals. This study aims to characterize the teaching of curricular content related to LGBTIQ + health issues in medical schools in Chile. METHODS: This was a cross-sectional descriptive mixed-methods study based on a 15-question survey sent to school directors of the 24 medical schools in Chile, conducted between October 2020 and July 2021. The questions included in the study were mostly based on two pre-existing questionnaires covering content, assessment methods, and identification of barriers to teaching this content. RESULTS: The validated questionnaire was answered by 14 of 24 Chilean medical schools, with 11 schools (78.9%) declaring that they included some training in their curriculum. The predominant range of time allocated to LGBTIQ + training in medical programs was between 1 and 5 h. The most addressed topics were HIV (92.85%), sexual orientation (78.57%), and chronic disease risk in LGBTIQ + populations (78.57%). Most schools, accounting for 71.5%, considered the content they delivered to be "moderately insufficient" or "insufficient". Regarding the teaching methodologies, the most used were lectures (92.8%), clinical cases (42.9%), and clinical simulation (28.6%). CONCLUSION: Most surveyed medical schools reported curricular spaces dedicated to teaching health issues of LGBTIQ + individuals, primarily during the pre-internship training period. However, the time allocated is insufficient, and there is little approach to topics beyond the patient's sexual history or sexual orientation. Given the crucial role of medical schools, they must adopt both local and national strategies to enrich training focused on the care of LGBTIQ + patients.

Impacts of sociodemographic factors, identities and neighbourhood safety on the relationship between urban green space and adolescent mental well-being: Findings from Tamaki Makaurau Auckland, Aotearoa New Zealand.

This study explored the relationship between green space accessibility (GSA) in residential area and adolescents' mental well-being, and whether the relationship was moderated by sociodemographic factors (sex, ethnicity, neighbourhood deprivation), identities (gender and sexuality minority, disability) and perceived neighbourhood safety simultaneously. Data from 3813 adolescents who lived in Tamaki Makaurau Auckland, Aotearoa New Zealand were obtained from the Youth19 Rangatahi Smart Survey. A Gaussian-based two-step floating catchment area method was employed to measure the spatial accessibility to green space at the neighbourhood level. The World Health Organization-5 Well-being Index was used to assess emotional well-being (EW), and the Reynolds Adolescent Depression Scale-short form was employed to measure depressive symptoms (DS). Through moderation analyses, results showed that perceived neighbourhood safety plays a vital role in the GSA - mental well-being association, with a negative trend in adolescents who reported being less safe in neighbourhoods. Adverse associations of GSA were found in gender and sexuality minority, disabled, Asian and Pacific adolescents, under the condition of not feeling safe in neighbourhoods all the time. The results showed marginalised adolescents tended to feel less safe in neighbourhoods, have lower EW and a higher level of DS. Additionally, the results from bivariate correlations showed there were inequalities in GSA for adolescents who lived in most deprived neighbourhoods and adolescents of Maori ethnicity. This study provides novel evidence of the importance of safe and inclusive green space for effectively promoting mental health and mitigating health inequalities of adolescents in urban areas.

Microaggression toward LGBTIQ people and implications for mental health: A systematic review.

BACKGROUND: Research suggests that microaggressions detrimentally impact the mental health of members of marginalized social groups. AIMS: The aim of this systematic review was to assess the exposure to microaggressions and related implications on mental health of Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) people. METHOD: Medline, Scopus, PsycINFO, CINAHL, and EMBASE were searched until January 2023. Studies reporting data on the exposure to microaggressions toward LGBTIQ people were identified. Meta-analyses of rates of exposure to microaggression and of the association between microaggressions and mental health outcomes were based on odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI), estimated through inverse variance models with random effects. RESULTS: The review process led to the selection of 17 studies, involving a total of 9036 LGBTIQ people, of which 6827 identifying as cisgenders, and 492 as heterosexuals, were included in the quantitative synthesis. Overall, LGBTIQ people showed an increased risk of microaggression (SMD: 0.89; 95% CI [0.28, 1.50]), with Transgender people having the highest risk (OR: 10.0; 95% CI [3.08, 32.4]). Microaggression resulted associated with risk of depression (SMD: 0.21; 95% CI [0.05, 0.37]), anxiety (SMD: 0.29; 95% CI [0.17, 0.40]), suicide attempts (OR: 1.13; 95% CI [1.08, 1.18]), alcohol abuse (OR: 1.32; 95% CI [1.13, 1.54]), but not to suicidal ideation (OR: 1.56; 95% CI [0.64, 3.81]) and cannabis abuse (OR: 1.44; 95% CI [0.82, 2.55]). The quality of the evidence was limited by the small number of studies. CONCLUSIONS: LGBTIQ people are at higher risk of microaggressions compared with their cisgender/heterosexual peers, which may lead to mental health consequences. This evidence may contribute to public awareness of LGBTIQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs and destigmatizing efforts) as parts of tailored health-care planning aimed to reduce psychiatric morbidity in this population.

Normalising intolerance: the efforts of Christian Right groups to block LGBTIQ+ inclusion in South African schools.

Post-apartheid, South Africa has come a long way in making the inclusion of gender and sexuality equality explicit in its Constitution. To make schools more inclusive for lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) identifying learners, the Department of Basic Education has developed what it claims are South Africa's first guidelines regarding sexual orientation, gender identity and sex characteristics (SOGIESC). Despite the emphasis on equality in South Africa's post-apartheid policies, which set out to protect the rights of LGBTIQ+ individuals, there has been a backlash from conservative advocacy groups, many with links to the US Christian Right. This paper argues that contrary to the disinformation being propagated by anti-LGBTIQ + groups, it is queer and transgender individuals who experience extreme levels of violence and marginalisation in schools. The empirical research makes explicit the bullying and exclusion that transgender and gender-diverse youth experience in school; however, this evidence is neglected in conservative claims that SOGIESC (SOGIESC) guidelines and Comprehensive Sexuality Education (CSE) endanger other learners. Notably, and in stark contrast to those advocating for measures to make schools safer for LGBTIQ + learners, far-right advocacy groups have no empirical basis to support their claims.

Psychometric Validation of the "LGBTIQ+ Themes in Literature Education" Scale (LTiLE).

The aim of this research is to describe the adaptation process and psychometric properties of the "LGBTIQ+ Themes in Literature Education" (LTiLE) scale, the first instrument aimed at measuring attitudes toward the inclusion of LGBTIQ+ content in the teaching interventions of future literature educators. The study seeks to identify empirical evidence of content, construct, convergent, and discriminant validity, as well as internal consistency reliability, and the absence of bias in assessments based on participants' gender identity. Following the attainment of a high level of significant agreement on the quality of its content, an Exploratory Factor Analysis and Confirmatory Factor Analysis were conducted using a random sample of 592 Spanish recent graduates from programs related to Primary and Secondary Education teacher training. Both discriminant and convergent validity estimates yielded optimal results. Nomological validity was established through gender-based score comparisons, revealing significantly more favorable scores for cisgender women and other gender identities. A similar differential item behavior based on gender and measurement invariance according to the teaching stage were observed. Internal consistency was evaluated using ordinal α, McDonald's ω, composite reliability, and complementarily, Cronbach's. Psychometric evidence confirms LTiLE's validity, reliability for prospective literature educators in non-university education.

Teaching social business to Thai students: A case of LGBTIQ+ social business.

This paper examined the learning experiences of a group of undergraduate business students from a Thai business school in a social business course. The key point to examine in this study is learning and teaching approaches for social business education that can promote understanding of gender diversity. To understand the experiences of stakeholders in social business education, a qualitative approach was adopted wherein students, teaching staff and social entrepreneurs engaged with the researcher in a real-time, hands-on social business environment. We collected secondary data from assignments, feedback, and presentations from students and their social business coaches. We also collected primary data in the form of personal interviews with two social entrepreneurs who coached students in this course. The results suggest that the development of pedagogy for social business requires multidisciplinary collaboration and codesign among course coordinators, teachers, social business, and students. We also summarized four appropriate learning approaches, LGBTIQ + social business, in the Thai higher education context: advocacy, problem-based, research-based and practical-operational approaches. We suggest that social business should also be taught by academic staff and industry representatives to help students in the learning process. This study also suggests that a student-centered approach can help students synergize social impacts with the financial returns of social business by adopting inquiry-based activities, role plays, and talking with LGBTIQ + social entrepreneurs.

Indigenous LGBTIQSB + People's Experiences of Family Violence in Australia.

Purpose: This article uses an Indigenous concept of family violence as a frame to interrogate interviews held with Indigenous LGBTIQSB + people in Australia. The article reorients family violence away from Western heteronormative framings and aims to contribute towards a new conversation about family violence. Methods: A qualitative thematic analysis was used to analyse 16 interviews with Indigenous LGBTIQSB + people in the state of New South Wales, Australia. This is one of a series of articles that provide preliminary findings from a research project into the social and emotional wellbeing of Indigenous LGBTIQSB + young people living in New South Wales. Results: The interviews highlight the complex impact family violence on Indigenous LGBTIQSB + youth. The article shows differences in reactions between family and community in urban settings with those experienced in rural settings highlighting intergenerational differences, with older family members such as grandparents, more likely to exhibit negative reactions and behaviours. These experiences are interconnected as many young people were living in urban areas while extended family often lived in rural or remote communities. Conclusions: The findings of this study demonstrate the intersectional nature of family violence highlighting the fact that Indigenous LGBTIQSB + young people are integral parts of extended kinship networks, families and communities and are deeply impacted by any acts of family violence. The study's findings also support current research into family and community violence for LGBTIQ + people that shows the differential behaviours and actions of rural and urban families as well as the different reactions between generations within families.

Anxiety, depression and social support of LGBTIQ during COVID-19 in Kerala, India.

BACKGROUND: It is reported that the marginalised and underprivileged sections suffer bitter consequences in the event of calamities and pandemics. The present study aims at assessing the level of anxiety, depression and social support of the LGBTIQ communities during the COVID-19. Since the 'LGBTIQ' community is an integral part of society, it is necessary to study these psychological dimensions in the face of multiple waves of the pandemic in the country. AIM: The study aims to measure the anxiety, depression and social support of LGBTIQ during COVID-19 in Kerala. METHOD: The study followed descriptive research design and using snowball sampling, total of 106 respondents were interviewed from the urban and rural areas of Kerala. The researchers used the 'DASS21' to assess anxiety and depression and the Multidimensional Scale of Perceived Social Support to assess social support. RESULTS: Approximately half (44.3%) of the participants were experiencing severe or extremely severe levels of depression. At the same time, many of them had episodes of anxiety disorder at much higher levels (41.5%) than the other members of society. Perceived social support was negatively correlated with depression, anxiety and stress, while depression, anxiety and stress showed a positive correlation with each other. CONCLUSION: Common mental health problems such as anxiety, depression and stress were largely prevalent in the LGBTIQ community during COVID-19, who found the social support inadequate and suffered from other social and economic problems. There is a need to address these issues among this population.

Mistrust: Community engagement in global health research in coastal Kenya.

This article explores a case of mistrust in global health research and community engagement. It uses ethnographic material collected in 2014 and 2016 in Kenya, concerning community engagement by a HIV vaccine research group working with men who have sex with men and transgender women. In 2010, the research group was attacked by members of the wider community. Following the attack, the research group set up an engagement program to reduce mistrust and re-build relationships. Analysis focusing on mistrust shows the dynamics underlying the conflict: Norms around gender and sexuality, political support for LGBTIQ+ rights, and resources disparities were all at stake for those embroiled in the conflict, including researchers, study participants, religious leaders, and LGBTIQ+ activists in the region. Rather than a normative good with liberatory potential, community engagement in this paper is discussed as a relational tool with which mistrust was managed, highlighting the fragility of participation.

Development and Psychometric Evaluation of the IPV Internalized Stigma Scale.

Self-stigma is the internalization of widespread and negative attitudes around a devalued attribute. Being a victim of intimate partner violence (IPV) is a stigmatized identity, with IPV self-stigma is a potential barrier to help seeking. The lack of an IPV self-stigma scale limits current measurement of this latent trait; this study sought to fill this gap. We developed the IPV Internalized Self-stigma Scale (IPVIS) by revising existing self-stigma and devaluation/discrimination measures and adding new items to fill perceived gaps. Using an online survey, a diverse sample (N = 455, M = 39.51, SD = 12.03) with various relationship types (e.g., heterosexual, same-sex), IPV circumstances (e.g., male or female perpetrators/victims) and different gender and sexual identities was recruited. Participants first completed the item pool (44-items), followed by measures of IPV, anxiety, depression, social health, and self-efficacy with data analyzed using a multi-model approach (e.g., factor analysis, item response theory [IRT]). Factor analyses revealed one dominant factor; IRT analyses further refined the unidimensional item set. The final 11 items had high internal consistency, ω = .90, 95% CI [0.89, 0.91], and were highly informative with moderate to high discrimination levels. The IPVIS demonstrated measurement invariance by demographics, showing no differential item functioning by age groups, sex, residence (urban/suburban/rural), ethnicity (European/Caucasian vs. others), or relationship status (partnered/unpartnered). Initial validity examination revealed significant correlations between the IPVIS and related measures (e.g., depression, anxiety, social health). The IPVIS is suitable for research and has widespread clinical applicability. To the best of our knowledge, the IPVIS is the first scale developed that assesses IPV self-stigma inclusive of a diverse range of clients/participants, relationship types, and IPV circumstances.

The inclusion and representation of LGBTIQ+ content in undergraduate nurse education: A scoping review.

OBJECTIVES: The aim of this review was to gain an overview of existing empirical literature examining LGBTIQ+ content in undergraduate nursing curricula. DESIGN: An international scoping review was conducted using librarian assisted search strategies. DATA SOURCES: The databases CINAHL, SCOPUS and ERIC were searched. A total of 30 studies meeting the eligibility criteria were included in this review. REVIEW METHODS: Following a quality appraisal, thematic analysis was conducted to identify six key themes. RESULTS: 30 studies spanning 8 countries, across 5 continents were included in this review. 6 themes emerged 1) Level of Knowledge Regarding LGBTIQ+ People and Their Specific Health Needs, 2) Comfort and Preparedness in the Provision of Care to LGBTIQ+ People, 3) Attitudes Toward LGBTIQ+ People, 4) Inclusion of LGBTIQ+ Educational Content, 5) Framing of LGBTIQ+ Educational Content, 6) Pedagogical Strategies to Incorporate LGBTIQ+ Content. CONCLUSIONS: Nurse education is dominated by heteronormativity, deficit discourses, stereotypes, binary ideologies and western cultural perspectives. The body of literature surrounding LGBTIQ+ content in nurse education is largely quantitative, insular and contributes to the erasure of unique identities under the LGBTIQ+ umbrella.

Queervertising: An empowerment tool for the gay men and lesbian community.

Background: Today's society clams to be more inclusive, but there has been a lack of practical examination of this area. This study analyses how advertising and society interact and evolve in parallel, with advertising seeking to balance more traditional representations - in accordance with the Mirror Theory - with mainstreaming, which can influence social change. In this case, analysis is focused on the homosexual community. Methods: A content analysis of audiovisual advertising in Spain from the 1960s to 2021 is carried out in addition to a review of historical milestones and legislation. Results: The results evidence the transformation of advertising. The main findings show a shift from the total invisibility of the gay men and lesbian community in the 1960s to effective and respectful integration today. Conclusions: Queervertising is proposed as a new theoretical concept as the result of gender and sexual diversity being identified in advertising over time. The inclusion of gay men and lesbians in advertising is a current trend that, moreover, offers a challenge for brands. Although this turnaround in advertising creativity should be highlighted and recognized as being to some extent responsible for changes and social evolution, the commercial messages which are found today are still not always disruptive or excessively explicit, in order to avoid some rejection by audiences.

Teaching vulval anatomy in the twenty-first century: The Australian experience.

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

Violence Against LGBTIQ+ People at Universities: The Need to Uncover a Silent Reality.

Violence against LGBT community can manifest in different forms and exists in all spheres of society, including education. The main purpose of this article is to deepen the understanding of the state of the art about violence grounded in sexual orientation or gender identity in higher education in order to identify gaps for further research. The topic of this state-of-the-art literature review is the presence and magnitude of these forms of violence in the Spanish higher education system. For this reason, the inclusion criteria were empirical studies about the prevalence of violence against LGBTIQ+ individuals in the Spanish educational system. After analyzing the 25 articles that met the inclusion criteria, the main findings point that despite the existence of numerous international studies of the presence of violence against LGBTIQ+ people at colleges, little is known about this reality in Spain. The Spanish university system continues to remain hermetic, and violence against LGBTIQ+ people is silenced and hidden. Practice, policy and research implications of the findings are discussed in this article, highlighting the need of further research in this field. In this context, the research project Uni4Freedom, addresses this social and educational problem to contribute to the creation of safer universities for the LGBTIQ+ community and people who support them.

Lateral Violence and Microaggressions in the LGBTQ+ Community: A Scoping Review.

Violence and microaggressions against the LGBTQ+ community from those outside of the community is commonly known and understood within academic literature. However, there is limited comprehensive knowledge about violence and microaggressions that occur within LGBTQ+ communities. This scoping review helps to fill this gap in knowledge, analyzing and synthesizing 18 research articles published in English language scholarly journals all of which have been published between 2010 and 2020. Online databases ProQuest, SAGE Journals, Google Scholar, Taylor and Francis Journals, Scopus, Informit, Project MUSE, PubMed, and EBSCOhost were utilized to search for existing literature on ingroup LGBTQ+ microaggression. The found literature focused on power dynamics within the LGBTQ+ community and how that power has enabled subgroups within the community to enact microaggression on one another. We found that ingroup microaggressions experienced by members of the LGBTQ+ community are a result of dominant norms that give certain groups power over another.