The Supreme Court's 303 Creative Decision and the Threat to LGBTQ+ Health Care.

This Viewpoint examines the importance of the Supreme Court decision in 303 Creative and its possible effects on legislation safeguarding nondiscriminatory health care.

Legal Penalties for Physicians Providing Gender-Affirming Care.

This Viewpoint explains the "legal limbo" physicians may find themselves in, straddling state laws banning gender-affirming care and federal nondiscrimination law, both of which remain unclear due to ongoing legal challenges in the courts.

Association Between California's State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery.

Importance: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies. Objective: To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents. Design, Setting, and Participants: Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019. Exposures: California's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013. Main Outcomes and Measures: Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure. Results: A total of 25 252 patients (California: n = 17 934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001). Conclusions and Relevance: Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.

Antidiscrimination Laws as Essential Tools for Achieving LGBTQ+ Health Equity.

This Viewpoint discusses a pending US Supreme Court case to determine the extent to which people who identify as LGBTQ+ are protected under state antidiscrimination laws in the commercial marketplace.

Implications of Dobbs for the (Re)Criminalization of Intimacy Among LGBTQ Individuals.

This Viewpoint outlines how the revival of now defunct state-level antisodomy laws would harm the health care of LGBTQ individuals should the US Supreme Court reverse itself and urges medical professionals and their societies to advocate for the immediate abolition of antisodomy laws.

A psicologia e a questão da diversidade sexual no Brasil: a Resolução CFP nº 1/99 / Psychology and the issue of sexual diversity in Brazil: Resolution CFP nº 1/99

Nesta tese indagamos acerca do lugar da psicologia no debate público sobre diversidade sexual no Brasil da atualidade. Através da análise de publicações, fontes documentais públicas e entrevistas, exploramos diversos modos em que o saber e autoridade da profissão de psicólogo são invocados para sustentar posicionamentos públicos sobre a questão homossexual no país. Nesse âmbito, destacamos a Resolução nº 1/99 do Conselho Federal de Psicologia (CFP), que estabelece normas de atuação para os psicólogos em relação à questão da orientação sexual. Há mais de vinte anos essa normativa é um marco na conquista dos direitos LGBTQIA+ no país. Para essa discussão, reconstruímos os debates que precederam as condições institucionais e o contexto de elaboração da Resolução. Os efeitos da mesma extrapolam o âmbito da regulação profissional da psicologia. A seguir, abordamos as trajetórias de figuras com diferentes perfis de atuação que ganharam notoriedade por atacar publicamente a Resolução, suscitando, desta maneira, polêmicas em torno da mesma. Em seguida, exploramos as frequentes contestações à Resolução CFP nº 1/99 que se deram na arena legislativa e o deslocamento dessas ofensivas para a arena da justiça e para a disputa pela condução dos Conselhos de Psicologia em 2019. A compreensão destes processos como cenas de uma controvérsia pública busca jogar luz sobre a disputa entre diferentes visões da diversidade sexual e de gênero, que transitam pela ciência, religião e política. Acreditamos que esta investigação contribua para expandir a compreensão da evolução, dos efeitos e dos desafios que se colocam à expansão de abordagens afirmativas da diversidade sexual e de gênero no campo da Psicologia.

In this thesis, we inquire about the place of psychology in the public debate on sexual diversity in Brazil today. Through the analysis of publications, public documentary sources, and interviews, we explore different ways in which the knowledge and authority of Psychology as a profession are invoked to support public positions on homosexuality as an issue in the country. In this context, we highlight Resolution 1/99 of the Federal Council of Psychology (CFP), that establishes standards of action for psychologists in relation to the issue of sexual orientation. For over decades, this regulation has been a milestone in the achievement of LGBTQIA+ rights in the country. For this discussion, we reconstructed the debates that preceded the institutional conditions and the context in which the Resolution was drafted. Its effects go beyond the regulation of professional psychology. Next, we address the trajectories of figures with different profiles of action who gained notoriety for publicly attacking the Resolution, thus raising controversies around it. Then, we explore the frequent challenges to Resolution CFP 1/99, that took place in the legislative arena, and the migration of these offensives to the arena of justice, and to the dispute for the presidence of the Psychology Councils in 2019. An understanding of these processes as scenes of a public controversy sheds light on the dispute between different visions of sexual and gender diversity, which transit through science, religion and politics.. This investigation expand the understanding of the evolution, effects and challenges facing the expansion of affirmative approaches to sexual and gender diversity in the field of Psychology.

Erasing violence: lesbian women asylum applicants in the United States.

Despite growing recognition of sexual orientation- and gender identity-based violence, scholars continue to identify barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals seeking asylum protection. Lesbian women asylum applicants, in particular, encounter a system that is unsure how to classify their cases and that generally questions the credibility of women's experiences. In this way, lesbian women applicants are among the most vulnerable populations of asylum claimants, particularly in the U.S. context. In this research note, I examine U.S. appellate level Circuit Court cases initiated by lesbian women asylum applicants. I expand existing literature to include an examination of how the violence faced by lesbian women is interpreted and ultimately erased as Circuit Courts grapple with legal interpretations of persecution. Specifically, I find three mechanisms of erasure: ruling that the violence experienced was unextreme, finding that the applicants' accounts of violence were unsubstantiated, or arguing that the violence experienced was unrelated to the applicants' sexual orientation. When placed in historical context, these patterns are troubling. Unlike previous decades that have witnessed overt homophobia, racism, and ethnocentrism in the immigration system, these cases indicate a more subtle form of exclusion-finding technicalities in case law and formal legal definitions as grounds for denial.

LGBTQ state policies: A lever for reducing SGM youth substance use and bullying.

PURPOSE: Sexual and gender minority youth (SGMY) are more likely than their cisgender and heterosexual peers to use substances and to be bullied, yet it is unknown whether the absence/presence of youth- and LGBTQ-specific equity laws drive these disparities. The purpose of this study was to extend previous research focused on adult- and LGBTQ-specific structural factors (e.g., same-sex marriage laws) to determine whether the youths' structural environment (i.e., state-level LGBTQ youth-focused equity laws) was associated with bullying and recent alcohol use, binge drinking, and cigarette use among SGMY. PROCEDURES: We utilized data from the LGBTQ National Teen Survey, collected in 2017 (N = 8,841 sexual and gender minority youth). Linear regression analyses examined the association between bullying and substance use and between state-level LGBTQ youth-focused equity laws (individually and as a composite variable) and bullying and substance use. FINDINGS: SGMY living in states with LGBTQ equity laws were less likely to experience bullying. Findings regarding the relation between LGBTQ equity laws and substance use were mixed, such that LGBTQ equity laws were associated with a higher likelihood of binge drinking and alcohol use, and a lower likelihood of cigarette use. CONCLUSIONS: Findings highlight the role of state-level equity laws in reducing bullying and substance use disparities for SGMY. Yet, given the finding that equity laws were associated with a higher likelihood of binge drinking, it is important to continue to explore how the structural environment shapes SGMY health.

Fertility-a human right worthy of mandated insurance coverage: the evolution, limitations, and future of access to care.

We review the history, current status, and potential future of state infertility mandates and focus on the business implications of mandates and on the inadequacies and reproductive injustice resulting from gaps between legislative intent and practical implementation. Nineteen states have passed laws that require insurers to either cover or offer coverage for infertility diagnoses and treatment. The qualifications for coverage, extent of coverage, and exemptions vary drastically from one state to another, resulting in deficiencies in access to care even within mandated states for certain groups, such as single individuals, patients in same-sex relationships, and patients pursuing fertility preservation. Although insurance coverage of fertility services in the United States has expanded as an increasing number of states have enacted infertility mandates, significant gaps in implementation and access remain even among states with existing mandates. Provider, patient, and legislative advocacy is warranted in the name of reproductive justice to expand insurance coverage and, in turn, maximize reproductive outcomes, which have been shown to improve as financial barriers are lifted.

The "Real" Chechen Man: Conceptions of Religion, Nature, and Gender and the Persecution of Sexual Minorities in Postwar Chechnya.

In March of 2017, the Russian LGBT Network received their first reports of police violence against individuals in Chechnya because of their perceived sexual orientation. In the following months, news spread of a campaign of forced disappearances and torture specifically targeting suspected homosexual men. Between December, 2018 and February, 2019, police carried out another wave of unlawful detentions of men on the basis of their sexual orientation. The reports of unlawful detentions and extrajudicial killings of queer men may seem surreal in a world that has slowly grown more progressive with regard to LGBT rights issues. And yet, this violence is the reality faced by gay and bisexual men in Chechnya under Ramzan Kadyrov, the hypermasculine Chechen leader. This paper explores the ways in which religious practice, imaginations of nature, and conceptions of gender have influenced Chechnya's current anti-LGBT climate.

Fish in a Barrel: Police Targeting of Brisbane's Ephemeral Gay Spaces in the Pre-Decriminalization Era.

Across history, and particularly in periods of criminalization, the gay community have often been forced to resort to public spaces-"beats"-to clandestinely seek out anonymized sex with partners who share their sexual preference. This article reframes the construction of gay beats as ephemeral spaces that prevails in existing sexuality literature. Instead, it shows that Brisbane's beats were semi-permanent spaces with subcultural meaning to the local gay community-a fact that was used by police to target gay men during law enforcement's attempts to reestablish a moral order in the postwar era. Using a combination of archival material, personal narratives and secondary sources, this article effectively reframes the concept of gay beats as transitory spaces, and instead argues that it was their permanence and resilience in Brisbane's gay subculture that made them a perfect hunting ground for police looking to target a vulnerable homosexual community.

Variables Which Influence the Early State Adoption of Pro-LGBT Legislation.

State-level legislation was instrumental in achieving marriage equality and is similarly crucial in establishing protection from discrimination for LGBT employees. States that were early legalizers of same-gender marriage shared geographic, political, and demographic variables. An analysis of the characteristics of states that are early adopters of legislation prohibiting LGBT employment discrimination lacks in the literature. This study analyzed variables significant to the early state adoption of legislation prohibiting discrimination against LGBT employees using multinomial logistic regression. A state's region, the size of its urban population, college graduates, and the percentage of same-gender families were among nine variables significant to state adoption of anti-discrimination statutes protecting LGBT employees. Efforts to secure protection from discrimination for LGBT employees should focus on fair working conditions for all as opposed to specific rights based on sexual orientation and gender identity. Further, different LGBT rights issues may warrant different strategies for public support.

State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012-2014.

BACKGROUND: Exposure to structural stigma (i.e., societal norms and policies that constrain access to resources) may help explain poor health outcomes among sexual minority (SM) individuals in the USA. PURPOSE: We examined the relationship between structural stigma and smoking prevalence among U.S. SM and heterosexual adults. METHODS: We adapted an index to capture multiple state-level structural stigma indicators, including attitudes toward same-sex marriage; the geographical density of same-sex couples; and state-level policies toward SMs. The outcome variable was current smoking, derived from the National Adult Tobacco Survey (2012-2014). Poisson regression models stratified by SM status were used to assess the relationship between structural stigma and the prevalence ratio (PR) of current smoking. We included a squared term for stigma to explore nonlinear relationships between stigma and smoking. Interaction terms were used to examine effect modification by sex. RESULTS: Adjusted models suggested a curvilinear PR relationship between stigma and smoking for both SM (linear PR = 1.03 [0.97-1.08]; quadratic PR = 0.98 [0.97-1.00]) and heterosexual (linear PR = 1.00 [0.99-1.02]; quadratic PR = 0.99 [0.988-0.995]) adults. The quadratic term was significant (p < .05) for both SM and heterosexual respondents, however, the change in probability of smoking associated with structural stigma was more pronounced among SM individuals. Specifically, the highest and lowest exposures to stigma were associated with the lowest probabilities of smoking. There was no apparent effect modification by sex. CONCLUSIONS: Findings lend support to addressing SM structural stigma as a driver of smoking, particularly among SM adults.