Racial minority men who have sex with men (MSM) experience greater levels of discrimination and higher rates of HIV infection. However, little is known about the associations between racial and heterosexist discrimination and HIV risk behavior. Further, little is known about the mechanisms of the association between racial and heterosexist discrimination and HIV risk behavior. There is some evidence to suggest that depression may be a mechanism that mediates the relationship between racial and heterosexist discrimination and HIV risk behavior. Thus, one purpose of this study was to investigate the extent to which discrimination based on both race and sexual orientation, alone and in combination, are associated with HIV risk behavior. A secondary purpose of this study was to examine whether the relationship between discrimination and HIV risk behavior is mediated by depressive symptoms. Lastly this study sought to examine whether the relationships between discrimination, depressive symptoms, and HIV risk behavior were mediated by social support, LGBT and Native identity, and LGBT and Native community participation. This study analyzed data from the HONOR project, the first national study of two-spirit individuals, which included 221 American Indian and Alaska Native MSM. Logistic regression analyses were conducted to determine the extent to which experiences of racial and heterosexist discrimination were associated with HIV risk behavior. Results indicate that heterosexist discrimination was associated with HIV risk behaviors, whereas racial discrimination was not. Conversely, results indicate that racial discrimination was associated with depressive symptoms, whereas heterosexist discrimination was not. This study found no association between depressive symptoms and HIV risk behavior, even when accounting for alcohol and substance use. Results indicate that depressive symptoms are not a mechanism that explains the association between discrimination and HIV risk and perhaps the better mechanism to examine in future studies is substance use. Finally, LGBT community participation was shown to have protective effects against HIV risk behaviors. These findings have the potential to guide development of mental health and HIV prevention interventions for Native MSM, with special attention to LGBT community participation and social support. Future research should examine attributes such as types, sources, and frequency of heterosexist discrimination and LGBT community participation.

Anti-LGBTQ laws and policies are considered to be institutional forms of discrimination,or the provide legal pathways for people to actively discriminate against LGBTQ+ people, or they fail to provide protections from discrimination to LGBTQ+ communities. Given the rise of far-right government in the (United States) U.S. and its foundations on Christian Nationalism, there has been an alarming increase of anti-LGBTQ legislations across the United States as evidenced by the resurgence of “don’t say gay” bills and transgender health care bans across multiple states. While the detrimental effect of anti-LGBTQ legislation on LGBTQ+ people’s mental health has been documented, little research has been done to understand the ways in which these larger structural forms of discrimination are internalized and translate to individual mental health outcomes. Relevant to LGBTQ+ communities, suicide has been a prevalent public health concern that disproportionally impacts these communities. Building on Minority Stress Theory (MST) and the Psychological Mediation Framework (PMF) the present study sought to understand the direct and indirect associations of anti-LGBTQ legislations and anticipated discrimination with suicidal ideation. Perceived Burdensomeness, thwarted Belongingness, and entrapment were looked as mediators of these associations. Further the role of perceived social support as a potential protective factor was assessed. Results indicated that anti-LGBTQ policies were significantly associated with suicidal ideation. Anticipated discrimination was indirectly associated with suicidal ideation through perceived burdensomeness and entrapment. Finally perceived social support did not moderate any of these associations. Implications for practice, research and policy are discussed.

The transgender population is makes up about 0.3% of the U.S. population (Gates 2011). The term transgender is both an identity and an umbrella term used to describe people who do not adhere to traditional gender norms (Institute of Medicine 2011). Transgender people experience many barriers to services, negative health outcomes, and discrimination (Fredrikson-Goldsen et al. 2013; Institute of Medicine 2011; Eliason et al. 2009; Hendricks & Testa 2012). Mental health clinics are an important site for understanding transgender peoples' experiences due to being a gatekeeper for other medical services and their role in helping transpeople with issues surrounding coming out, victimization, and discrimination (Grant et al. 2011; Youth Suicide Prevention Program 2011). The mental health field has a contested relationship with the transgender population due to a history of pathologizing gender variance, barriers to accessing services, and insensitivity from mental health providers (American Psychiatric Association 2013; Eliason et al. 2009). I conducted secondary data analysis using the National Transgender Discrimination Survey (2008) in order to understand the relationships between gender non-conforming identities, others' perception of one's gender identity, and discrimination at mental health clinics. Results suggest that there is an association between gender identity, others' perception of one's gender identity, and discrimination. This association depends on which gender identity, the degree to which an individual identifies with each term, and the type of discrimination. Logistic regression results reveal that identity and others' perception are not significant predictors for experiencing discrimination. Rather, income and race are significant predictors for experiencing discrimination at metal health clinics.

An important need exists to build a baseline understanding of the phenomenon of formal mentoring relationships involving adults and youth from the gay community. During the formative years when gay adolescents navigate through the process of understanding, defining, accepting, and sharing their identity as a sexual minority, they are often faced with high levels of environmental risks, including victimization, stress, and negative social sanctions by others. Formal mentoring has been recommended as a potential strategy to offer unique one-to-one support to gay youth that can help to foster resilience and a range of positive outcomes, including strengthening processes involved in identity development; yet, no previous studies have captured insights about these relationships. Using Interpretative Phenomenological Analysis (IPA), this study investigated the following research questions: (a) What are the most important characteristics of long-term formal mentoring relationships between gay adults and gay youth from the perspectives of the participants? (b) How, if at all, do mentors and mentees perceive potential benefits and limitations for gay youth participating in long-term formal mentoring relationships with gay adults? (c) How, if at all, do mentors and mentees perceive their mentoring relationship uniquely contributing to sexual-minority identity development in gay youth? After a 2-year search for participants, a purposeful sample of one mentoring dyad was chosen. Semi-structured in-person interviews were conducted with the match at the 17-month and 22-month mark of their relationship. This study contained four assertions based on this study's findings: (a) This long-term mentoring relationship between an adult and a youth from the gay community shared numerous similarities with other high quality mentoring relationships; (b) This mentoring relationship offered insight into how to create individualized and long-term support for sexual-minority identity development in youth; (c) This mentoring relationship represented an important but unrealized type of support that can potentially be used to complement existing peers, internet, and community-based resources for gay youth; and (d) Complexity continues to exist in using language and self-labeling to define, inquire, and provide support to individuals from the gay community--especially youth. Recommendations for programming, policy, and future research are provided.

SAMMANFATTNING Bakgrund: Historiskt sett har homosexualitet setts som ett psykiatrisk eller medicinskt problem. Trots att dagsläget till viss mån förändrats, kan homosexualitet och könsöverskridande identitet till följd av heteronormen ses som tabubelagda ämnen. HBTQ-personer har en ökad risk att utveckla psykiska sjukdomar, men undviker att söka vård till följd av tidigare erfarenheter eller rädsla. Sjuksköterskans uppgift är att generera acceptans och trygghet. Syfte: Sammanställa kunskap om HBTQ-personers erfarenheter av bemötandet i vården. Metod: Litteraturöversikt över 12 originalartiklar. Ingående studier är utförda i olika vårdinstanser i Sverige, USA och Nya Zeeland. Resultat: Resultaten visar att det finns både styrkor och brister i bemötandet i vården. Vissa informanter upplevde att vårdpersonalen var heteronormativt inställd, opåläst om HBTQ och i enstaka fall homo- och/eller transfobisk. Fler av informanterna kände oro inför att avslöja sin sexuella läggning för vårdpersonal. Men resultaten visar också att det finns vårdpersonal som enligt informanterna uppvisar acceptans och neutralitet. Slutsats: HBTQ-personers erfarenheter av bemötandet i vården är att det präglas av heteronormativitet och okunskap, men att det också finns vårdpersonal som är påläst och accepterande. / ABSTRACT Background: Through history, homosexuality has been recognized as a psychological or medicational condition. Regardless of present amendments, homosexuality and gender-specific identity may to some extent be seen as tabu. LGBTQ persons generally has an increased risk for developing psychological illnesses, but refrain from seeking care due to previous experiences or fear of poor treatment. The nurse shall generate acceptance and a sense of safety. Aim: To compile knowledge of LGBTQ persons´experiences of treatment in health care. Method: An overview of 13 original articles. The studies viewed in this overview are performed in varied care units in Sweden, the USA and New Zealand. Results: The results point to both strengths and shortcomings of the treatment towards LGBTQ persons in health care. Some informants sensed a heteronormative attitude and ignorance among the healthcare professionals, and in some cases homo- and/or transphobia. Many informants felt uneasy about revealing their sexual orientation to the health care professionals. But the results also show that some healthcare professionals expressed acceptance and neutrality. Conclusion: LGBTQ persons experience a sense of heteronormativity and ignorance in regards to treatment in healthcare, but there are healthcare professionals that are educated and accepting.

This dissertation examines the political economy of HIV biomedical prevention research—largely designed in the global North but conducted in the global South—and its implications for people of diverse genders and sexualities. As a recognized global leader in HIV biomedical prevention research among people categorized as men who have sex with men (MSM) and transgender women, Peru offers a key site in which to explore the increasing focus on gender and sexual identity as a strategic area for extractive research practices. This phenomenon has become particularly visible in the epidemic’s 4th decade, which has emphasized the pursuit of biomedical prevention strategies. Building on nine years of previous experience working inside HIV biomedical prevention studies, this project involved 24 months of ethnographic research, including participant observation; 110 interviews with scientists, study staff, and research subjects; 10 focus groups; and analyses of relevant scientific publications. This study presents four key findings. First, US and Peruvian researchers’ historical and continued entanglement primed Peru to become a hotbed of HIV biomedical prevention research. In this context, population categories imported from the global North have served as powerful tools to sustain a booming local research market, which produces data that aligns with the global demands of the HIV industry. Second, on the ground, research begets more research rather than institutionalized HIV prevention technologies, creating a sustained enterprise in which issues of compensation, value, and labor shape the science. The commodification of gender and sexually diverse identities operates here in two ways: as a mechanism to access particular kinds of bodies and associated HIV risk data, and as a mechanism by which to claim expertise in the HIV prevention research industry for both researchers and community members. Third, Peruvians classified as MSM and transgender women are afforded only temporary access to cutting-edge strategies to prevent HIV, limited to study participation. The result is a sustained pool of people in need of HIV care primed to support the HIV biomedical research economy. Finally, this project illuminates a key paradox within the industry’s contemporary focus on gender and sexual diversity in HIV prevention science. This focus creates the impression that progressive health politics marked the field, while obscuring and absolving ongoing forms of exploitation and unequal gains embedded within it.

Adolescence is a challenging life period in which young people have to deal with both physical and mental changes. For gay, bisexual and questioning (BGQ) youth, the challenges in their adolescents could be tougher. Previous research has demonstrated the unique psychosocial and sexual health needs of this vulnerable sub-group of the youth population. However, most of these studies were conducted in the West. Local data has been far from enough for us to understand the lives and health needs of Hong Kong GBQ youth, who have been affected by a different set of cultural values and social situations. This study adopted a qualitative approach to explore the lives of and the factors affecting the health of GBQ youth in Hong Kong. Both focus groups and individual interviews were used. Data analysis was guided by the principle of grounded theory. Twenty sexual minority male youth aged between 15 and 21 were recruited in the study. It appeared that the discovery of sexual identities for Hong Kong GBQ youth usually began in the early adolescence and was usually followed by a stage of struggle and denial of same-sex attraction. Traditional Chinese family values and mainstream Christianity doctrine heavily influenced on the informants’ and others’ acceptance towards homosexuality. GBQ youth also encountered different forms of prejudicial events in practically all social situations which in turn affected their psychosocial wellbeing and sexual health. Furthermore, parents, school professionals and healthcare workers seemed to lack appropriate skills and attitudes to promote GBQ youth’s health. / published_or_final_version / Public Health / Master / Master of Public Health

This study examines the experiences of public library staff who works in an LGBTQ-profiled children’s library. The aim of the study is further to find out whether the library as an institution can challenge heteronormativity or if traditional gender identities are reproduced. I have conducted five qualitative interviews with librarians who all work in the same library, and who all work with children to some extent. The interview material is analyzed with queer theory and norm critical theories of pedagogy. These perspectives wish to critically examine heteronormativity and change what is defined as normal. The result of the study shows that the way the library works with separate rainbow shelves, where LGBTQ-themed material is gathered, is pointing out LGBTQ as something different. And although it may also shed a light on a group formerly made invisible, it is reproducing traditional gender identities and leaves heteronormativity unquestioned. By contrast, the way the librarians are working with always including LGBTQ-materials in programming as storytimes and book presentations, is challenging the dominant position of heterosexuality. It is also shown that the way the library staff has developed their written and oral communication with the patrons, including using the gender neutral pronomina ”hen” and alternatives to ”mom and dad”, is increasing the possibilities of an inclusive reception in the library. The oral communication is for various reasons not always used though. In conclusion the interviews show that the librarians are positive to working with LGBTQ-issues although they sometimes tend to forget. The study further concludes that the library’s way of working with LGBTQ-issues is both reproducing traditional gender identities, and challenging heteronormative structures. This is a two years master’s thesis in Library and Information Science.

Background: Research suggests sexual minority women have higher rates of substance use and mental health problems than straight women. Specifically, past studies have shown alcohol consumption and dependence rates are higher among sexual minority women, in addition to use of some drugs. Similarly, research shows mental health problems such as anxiety, depression and suicide rates are elevated among sexual minority women. These differences in mental health and substance use characteristics by sexual orientation may be explained by the negative health effects of social marginalization and the common use of drinking establishments for sexual minorities. Objective: The objective of this thesis is to compare substance use and mental health characteristics between lesbian/bisexual women and straight women, including: a) demographic variables; b) alcohol and drug consumption and dependence; c) the social context of substance use (i.e., use with others, motivations to use and locations of use); and, d) mental health characteristics. Methods: Data were obtained from a sample of residential treatment clients in treatment for primarily alcohol and/or cocaine problems. Respondents were asked to fill out self-administered questionnaires, which included details on demographics, substance use, mental health and the social context of use, as well as information on sexual orientation and gender identity. Bivariate and logistic regression analyses were performed to examine differences by sexual orientation. Results: Some sexual orientation differences were found regarding alcohol consumption and dependence during bivariate analysis. In logistic regression results, methamphetamine use was significantly (p<.01) elevated among bisexual women and tranquilizers use was elevated among lesbian and bisexual women when compared to straight women. Bivariate analysis revealed lesbian and bisexual women reported higher levels on motivations to use, but this difference was not significant in multivariate regression results. After regression adjustments, lesbian and bisexual women had higher levels of anxiety and higher rates of suicide attempts. Lastly, lesbian and bisexual women reported substance use with sex workers and sex clients more often than straight women, but no other differences in location and motivations to use were seen in the regression results. Conclusion: Among this sample of residential treatment clients, some mental health and substance use characteristic differences were found. These finding can assist in determining the best treatment practices for sexual minority women. / Graduate / 0347

Thesis (Ph. D.)--Michigan State University. Dept. of Rhetoric and Writing, 2008. / Title page also has title printed in Cherokee syllabics. Title from PDF t.p. (viewed on July 10, 2009) Includes bibliographical references (p. 281-290). Also issued in print.