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Journal ArticleDOI

Primary healthcare for the Indian LGBTQ community – A call for inclusion

22 Nov 2021-Journal of Gay and Lesbian Social Services (Informa UK Limited)-pp 1-19
TL;DR: For years now, the Indian healthcare system has been viewed through the lens of heteronormativity, sidelining sexual and gender minorities as discussed by the authors, and despite the lack of established data, an estimated 45.4 m...
Abstract: For years now, the Indian healthcare system has been viewed through the lens of heteronormativity, sidelining sexual and gender minorities. Despite the lack of established data, an estimated 45.4 m...
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TL;DR: The mental health issues relevant to gender-diverse individuals as well as gender identity is important and deserves its own separate detailed discussion in this paper , where the authors have made recommendations for clinicians, researchers and policymakers.
Abstract: Abstract Sexual orientation is a key determinant of the identity of human beings. It has also been seen as a social determinant of health. People whose sexual orientation is non-heterosexual or sexual minorities or sexually diverse are included in the broad umbrella term LGBT (Lesbian, Gay, Bisexual, and Transgender) which is a commonly used acronym in activism, social policy, and subsequently cultural literature. For this reason, this Commission focuses primarily on sexual orientation i.e. lesbian, gay and bisexual (LGB) groups. We have used terms non-heterosexual, sexual minorities or sexual variation interchangeably. We have not considered asexual individuals as research in the field is too limited. We are cognisant of the fact that topics relating to mental health and sexual orientation discussed in this Commission will intersect with other issues of personal, cultural and social identity, and will thus be relevant to individuals including many transgender individuals. The inclusion of mental health issues relevant to gender-diverse individuals as well as gender identity is important and deserves its own separate detailed discussion. The exact number of sexually diverse individuals in a population is often difficult to estimate but is likely to be somewhere around 5% of the population. Rates of various psychiatry disorders and suicidal ideation and acts of suicide in LGB populations are higher than general population and these have been attributed to minority stress hypothesis. Elimination of inequality in law can lead to reduction in psychiatric morbidity in these groups. However, these are all diverse groups but even within each group there is diversity and each individual has a distinct and unique experiences, upbringing, responses to their own sexual orientation, and generating varying responses from families, peers and friends as well as communities (including healthcare professionals). The mental healthcare needs of sexual minority individuals vary and these variations must be taken into account in design, development and delivery of healthcare and policies. Improving access to services will help engagement and outcomes and also reduce stigma. The commission recommends that there is no role for so-called conversion therapies and other recommendations are made for clinicians, researchers and policymakers.

5 citations

Journal ArticleDOI
TL;DR: In this article , the attitude of medical students towards same-gender attraction and how it has shaped and reshaped in an ever-changing social environment was explored, and more than 80% of the students believed homosexuality is a sexual orientation whereas only 15% believed it is an acquired behaviour and only 1.9% considered it an illness.
Abstract: Abstract The Supreme Court of India, decriminalized same-sex activities in 2018 but the Indian medical curriculum has not been updated and inclusive of the sexual minorities despite the change. This study explores the attitude of medical students towards same-gender attraction and how it has shaped and reshaped in an ever-changing social environment. Medical students of four reputed Indian medical colleges were asked to self-administer an 18-item questionnaire anonymously. Internal consistency of the questionnaire statements was high. Of 729 initial responses, 84 were omitted for giving incomplete responses and 3 were omitted for not being Indian. A total of 642 responses was included in the analysis. More than 80% of the students believed homosexuality is a sexual orientation whereas only 15% believed it is an acquired behaviour and only 1.9% considered it an illness. However, more than 95%of students agreed that homosexuality is not an illness. Although the overall attitude of Indian medical students has changed since decriminalization, urgent work on the medical curriculum is needed to change some negative attitudes so that patients receive appropriate care.

2 citations

Journal ArticleDOI
TL;DR: Kumar et al. as discussed by the authors assessed the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community, especially medical students and doctors who are a critical link for the integration of the transgender community into society.
Abstract: Being one of the first Indian states to come out with a transgender bill in 2015, Kerala's Social Justice Department also implemented various health-based provisions for transgender individuals catering to their physical, mental, and gender-based health. Many of these are still in the process of being set up and transgender individuals will have to wait for smoother access to healthcare. This study aims to assess the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community- especially medical students and doctors who are a critical link for the integration of the transgender community into society. Responses were collected from 452 medical doctors and students from Kerala through scales that measured awareness level and attitude, including transphobia. The relation of gender, age, years of experience, and specialty of medical personnel to the level of transphobia and awareness about transgender issues was also analyzed using statistical methods. Transphobia levels were moderate in the sample. Women and medical students had lower levels of transphobia than men and practicing doctors respectively. Awareness levels were average for general information about the transgender community, such as its core features and difference from other similar categories but were low on health-related aspects of transgender persons (such as their physical and mental health issues, healthcare provisions, and knowledge on gender affirmation surgery). More inclusive actions are needed in medical education, legislative actions, advocacy groups, and the formation of multidisciplinary surgical teams to further the cause of the transgender community.
Journal ArticleDOI
TL;DR: The authors explored the duality of law with regard to the LGBTQ+ community, examining both its historical regulation of non-heteronormative genders and sexualities and its contradictory potential to transcend such regulations over time.
Abstract: ABSTRACT This article explores the duality of law with regard to the LGBTQ+ community, examining both its historical regulation of non-heteronormative genders and sexualities and its contradictory potential to transcend such regulations over time. Situated within a postcolonial analytical framework, it undertakes a thematic overview and narrative appraisal of research materials, drawn from a diverse array of social science disciplinary intersections, spanning the timeline from 1990 to 2022, that expounds on the intricate and overlapping imbrications between law and the LGBTQ+ community in India. It was observed that the extant academic deliberations on the subject are dispersed across disciplinary boundaries within the larger scope of humanities and social sciences, necessitating an integrative approach. By delving into the historical antecedents of the subject matter, the current findings are situated within four domains, namely: i) the colonial nexus; ii) the postcolonial public redress; and iii) other domains of sustained legal contestation, such as healthcare, workplace, media censorship, and the fraught terrain of identity and legal lexicon.
Journal ArticleDOI
TL;DR: In this article , the authors examined the mental health effects of cyberbullying on sexual minorities in India and found that cyber bullying led to aversive emotional outcomes (anger, sadness, shame), behavioural outcomes (reluctance to socialization, displacing anger to family members, self-injury), and psychopathologies (Depression, Sleep Disorders, Anxiety).
Abstract: This exploratory sequential mixed-method study examines the mental health effects of cyberbullying on sexual minorities in India. In the first phase, 13 sexual minorities who encountered cyberbullying in the past month were interviewed. The second phase was a survey-based quantitative study (N = 103) developed based on the qualitative findings. The qualitative result suggests that cyberbullying experienced by LGBTQIA+ persons takes three forms: Verbal-aggressive (abusive commenting, threatening), Sexual (asking for sexual favor, sending pictures of genitalia), and Attack on identity (calling one's identity immoral, unnatural). The participants coped with the cyberbullying through three strategies: Active responding to the bully (retaliation, exposing the bully, attempting to explain), Psychological blocking (adopting an `I don't care' attitude, stop replying), and Technological blocking (blocking, deactivation, increasing filters). Cyberbullying led to aversive emotional outcomes (anger, sadness, shame), behavioural outcomes (reluctance to socialization, displacing anger to family members, self-injury), and psychopathologies (Depression, Sleep Disorders, Anxiety). The quantitative study shows a significant negative relationship between cyberbullying and mental health. Also, a positive correlation is observed between acceptance received from social media and the mental health status. However, the acceptance from social media does not significantly moderate the relationship between cyberbullying and mental health status. Also, there was no significant difference in mental health status, severity and frequency of cyberbullying, and acceptance from family and social media, based on education, employment status, and life-stage of the participants.
References
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Journal ArticleDOI
TL;DR: The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures and odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high level of distress.
Abstract: This study describes stress as derived from minority status and explores its effect on psychological distress in gay men. The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence. The mental health effects of the three minority stressors were tested in a community sample of 741 New York City gay men. The results supported minority stress hypotheses: each of the stressors had a significant independent association with a variety of mental health measures. Odds ratios suggested that men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress.

3,209 citations

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TL;DR: The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between1990 and 2000.

623 citations

Journal ArticleDOI
TL;DR: The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them.
Abstract: Purpose of reviewTransgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research prioriti

457 citations

Journal ArticleDOI
TL;DR: Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family and helps inform assessment of impairment and determination of appropriate interventions.
Abstract: The effects of a substance use disorder (SUD) are felt by the whole family. The family context holds information about how SUDs develop, are maintained, and what can positively or negatively influence the treatment of the disorder. Family systems theory and attachment theory are theoretical models that provide a framework for understanding how SUDs affect the family. In addition, understanding the current developmental stage a family is in helps inform assessment of impairment and determination of appropriate interventions. SUDs negatively affect emotional and behavioral patterns from the inception of the family, resulting in poor outcomes for the children and adults with SUDs. Social workers can help address SUDs in multiple ways, which are summarized in this article.

310 citations

Journal ArticleDOI
TL;DR: Implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers, and future research should investigate how implicit sexual prejudice affects care.
Abstract: Objectives. We examined providers’ implicit and explicit attitudes toward lesbian and gay people by provider gender, sexual identity, and race/ethnicity.Methods. We examined attitudes toward heterosexual people versus lesbian and gay people in Implicit Association Test takers: 2338 medical doctors, 5379 nurses, 8531 mental health providers, 2735 other treatment providers, and 214 110 nonproviders in the United States and internationally between May 2006 and December 2012. We characterized the sample with descriptive statistics and calculated Cohen d, a standardized effect size measure, with 95% confidence intervals.Results. Among heterosexual providers, implicit preferences always favored heterosexual people over lesbian and gay people. Implicit preferences for heterosexual women were weaker than implicit preferences for heterosexual men. Heterosexual nurses held the strongest implicit preference for heterosexual men over gay men (Cohen d = 1.30; 95% confidence interval = 1.28, 1.32 among female nurses; C...

306 citations